MEDICATION COMPLIANCE IN OUTPATIENT PSYCHIATRY

Evidence continues to accumulate supporting the efficacy of psychotropic medication in treatment and prophylaxis of psychotic disorders. Simultaneously, we are learning that psychotropic drugs are not innocuous substances that can be indiscriminately dispensed for indefinite periods at arbitrary dosages. For each patient, the lowest dose necessary to maintain remission must be ascertained. As practitioners must monitor patients with increased rigor, the issue of compliance with medication becomes vital. No amount of technical expertise in psychodiagnostics or psychopharmacology is significant if the patient is unable or unwilling to comply fully with the doctor's recommendation. It is generally accepted that significant deviation in following physicians' orders occurs among 30%-50% of patients in general medical practice. Rates of noncompliance among psychiatric patients are likely to be at least as high as 50%.1 Our experience is exclusively with psychiatric aftercare patients at Northwestern Memorial Hospital Institute of Psychiatry's Sustaining Care Program and at The Thresholds rehabilitation agency, Chicago. From our experience, and reviews of compliance in general medical practice,2,3 especially that of Blackwell,4 an outline of factors relating to compliance among psychiatric outpatients is presented. These factors are organized into three areas: features of the therapeutic regimen, features of the patient, and features of the physician. © 1979.