Adherence to antipsychotic treatment in schizophrenia: What role does cognitive behavioral therapy play in improving outcomes?

Relapse of schizophrenia due to poor medication adherence is a major preventable source of psychiatric morbidity. This has led to a burgeoning of interest in improving compliance based on a wide range of psychological approaches. One of the difficulties for health service providers is to establish the utility of such interventions, particularly when the economic costs of these programs are unclear. This review examines the evidence for one leading approach to improving adherence - the cognitive behavioral approach adopted in the 'compliance therapy' of Kemp et al. A context for this review is provided by way of a brief overview of both traditional medical and psychoeducational approaches to treatment adherence, along with more cognitively based formulations of nonadherence. The aims and rationale of compliance therapy are presented along with a brief description of the therapy sessions. The empirical support for the efficacy of this treatment is discussed based on the few published studies available. The review concludes that while compliance therapy may be of value, this intervention will require further empirical study before reaching definite conclusions about its utility for responding to poor adherence to medications.