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Ask the Mental Health Expert Archives 2001-2004

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Noncompliance Issues

Q. I feel that noncompliance with treatment regimes is a major issue in health care. What resources could you recommend for me to research the impact of noncompliance?

A. Yes, indeed--noncompliance with treatment is a big problem in both mental health and general medical settings. (By the way, many in the health field do not like the authoritarian connotation of compliance-as in, "You will comply!"-but the term is strewn throughout the literature). Just to give you a brief overview of the literature: Colom et al (J Clin Psychiatry 2000 Aug;61(8):549-55) found that rates of poor compliance with treatment may reach 64% for patients with bipolar disorder, and noncompliance is the most frequent cause of recurrence of bipolar illness.

Comorbidity with personality disorders was strongly associated with poor compliance. DiMatteo et al (Arch Intern Med 2000 Jul 24;160(14):2101-7) found that, compared with nondepressed patients, the odds are 3 times greater that depressed patients will be noncompliant with medical treatment recommendations. In another study of family medicine outpatients, Keeley et al (Arch Fam Med 2000 Jan;9(1):46-54) found that somatoform symptoms of conversion and hypochondriasis, but not somatization, were risk factors for treatment nonadherence.

Noncompliance with antipsychotic medication is a big problem for many patients with schizophrenia. One cause for this is the side effect profile of some medications; e.g., ones that cause substantial weight gain, sexual dysfunction, or movement disorders. Fortunately, we are now able to use agents that minimize such effects. But patients may not comply for a variety of more subtle reasons, such as denial of illness, fears of being labeled crazy, irrational fears about the nature of the treatment ("I will be turned into a zombie"), or the belief that they can cure themselves through non-professional means.

Clearly, addressing these factors is critical if we are to be of help to our patients. For more information, you might try contacting the National Alliance for the Mentally Ill at 800-950-NAMI.

March 2001

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