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Why don’t patients take their medicine? Reasons and solutions in psychiatry

Alex Mitchell is Consultant and Honorary Senior Lecturer in Liaison Psychiatry at University Hospitals Leicester (Department of Liaison Psychiatry, Brandon Unit, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK. Email: alex.mitchell{at}leicspart.nhs.uk) and author of the prize-winning book Neuropsychiatry and Behavioural Neurology Explained: : Diseases, Diagnosis, and Management (2003). Thomas Selmes is a senior house officer on the York psychiatry scheme and was previously a medical student at Leicester University.

Over the course of a year, about three-quarters of patients prescribed psychotropic medication will discontinue, often coming to the decision themselves and without informing a health professional. Costs associated with unplanned discontinuation may be substantial if left uncorrected. Partial non-adherence (much more common than full discontinuation) can also be detrimental, although some patients rationally adjust their medication regimen without ill-effect. This article reviews the literature on non-adherence, whether intentional or not, and discusses patients’ reasons for failure to concord with medical advice, and predictors of and solutions to the problem of non-adherence.

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