Academic Master


Non Concordance in the Recovery of people with Severe Mental illness (SCHIZOPHRENIA) in Nursing Perspective


This dissertation aims to present a broad and systematic review of pieces of literature on the issue of non-concordance in the recovery of people with Severe Mental Illness mainly focusing on Schizophrenia, and what therapeutic intervention could benefit service users in such instances. Also, to produce evidence-based knowledge of how non-concordance affects the recovery of people with schizophrenia, for the benefit of both nursing students and practising nurses in the field of mental health.


– Critically analysing the current problems of non-concordance in people with SMI.
– Discuss the nursing intervention that addresses non-concordance.
– Conduct a literature review that addresses the issue pertinent to non-concordance and relevant nursing therapeutic intervention.
– Conclusions will be drawn towards the discussion of the themes uncovered in the literature review, and recommendations will be made for nursing practice.


The PICO Framework (Patient or problem, intervention, comparison and outcome) was used to formulate the research question for this dissertation. Systematic literature review using electronic searches was utilised to collect articles pertinent to answer the research question. The relevant databases specific to mental health nursing searched for literature include CINAHL, MEDLINE and PsychoINFO. Secondary sources such as past psychological health dissertation from the University, textbooks and websites were also used. The search terms used for the databases are non-concordance, non-compliance, non-adherence, recovery, therapeutic intervention, mental health, severe mental illness, and schizophrenia. The year range was limited to ten years from 2007 – 2017, age group chose between 16 – 65 years, gender included both male and female, peer-reviewed articles which included qualitative and quantitative primary research, and studies of all reports carried out in the UK were used as a criterion for selection. Ten pieces were selected overall for this dissertation.


Severe mental illness contains analyses, which usually include insanity (losing trace of reality or facing illusions), or significant levels of care, and which may need hospital treatment. Its length of the interval and the incapacity it produces often describes severe mental illness. These illnesses consist of conditions that contribute psychotic signs, such as schizoaffective and schizophrenia sickness, and severe forms of other conditions, such as significant despair and bipolar syndrome. Illnesses that harvest misrepresentations of perception, hallucinations, delusions and strange behaviours are sometimes called thought disorders. Because the signs imitate a loss of interaction with perceived reality, the diseases are also occasionally recognised as psychotic disorders. Extreme mental illnesses are curable, and with good conduct and treatment of the illness, persons with these illnesses can experience recovery.

Schizophrenia is a severe mental disorder that disturbs a person thought process, and that can, therefore, modify their opinion of realism, their feelings and their conduct. Schizophrenia can be seen in about 1.1% of the world’s inhabitants, irrespective of economic, ethnic or racial background. Every so often, the start of schizophrenia happens when an individual is in their early twenties or late teens, though it can also arise in later years. Nearly one in every hundred people will be affected by schizophrenia. Amongst those with schizophrenia, the expected average possible life lost is 28.5 years. Beings with schizophrenia have a 5% lifetime suicide danger. Three-quarters of people with schizophrenia mature the disease between 16 and 25 years of age.

Researchers have recognised some possible reasons or causes of schizophrenia – from chromosomal factors to emotional grounds such as problems in the brain’s development, physical injuries to the brain, and a traumatic experience (, 2018).  Schizophrenia is believed to be caused by imbalances in brain chemicals called neurotransmitters. The natural origins of the illness are supposed to be formed by a grouping of features containing early environmental influences and genetics such as obstetric complications and prenatal nutrition. Schizophrenia affects women and men likewise, while the beginning for men is earlier. There are many operative dealings for schizophrenia, comprising of rehabilitation programs, therapy, and medicines. Moreover, family psych education courses are useful for teaching relatives and patients about the condition, how to cope it, and how to decrease pressure and conflict. The most effective treatments are antipsychotics. While these prescriptions do not treat the syndrome, they can lessen psychotic symptoms such as thinking problem, delusions, and hallucinations. Rehabilitation and therapy are also supportive in the handling of schizophrenia, mostly after people have been well balanced on medication. The objectives here are for the individual to mature skills for better relationship and communication, work, independent living, and self-care; to manage efficiently with symptoms, and to cope the illness with approaches such as developing a relapse prevention plan and taking medications regularly.

The idea of recovery has been famous for recent developments in mental health practices and policies. To understand the meaning of recovery much theoretical analysis and research have been done. According to these researchers, recovery has three critical dimensions known as recovery as a process, as a naturally occurring phenomenon, and as an outcome. Understanding recovery as arrival to indication-free regularity has been dared in mental health services. Persons individually affected by psychological disorder have become progressively verbal in interactive what aids in going beyond the role of “sufferer”. Recovery is an extremely particular, exclusive process of shifting one’s roles, skills, goals, feelings, values, and attitudes and a way of living a contributing, satisfying, and hopeful life even within the boundaries began by illness. Recovery from psychological disease is a procedure that includes particular decision-making in numerous regions. Caretaker/Nurses are in a distinctive position to back individuals in evaluating their individual health standing and assimilating health behaviours into their salvage plans. The use of recovery planning, motivational interviewing techniques and assessment tools can help persons make choices about their health, test new behaviours, and mix healthy living manners into recovery activities and plans.

To describe the patient and doctor relationship in severe mental illness, three terms have been used widely, i.e. compliance, adherence and concordance. Compliance is the degree to which a patient’s actions match the prescriber’s recommendation. The practice of the word compliance has been intensely disapproved, as it was supposed to carry a negative appearance of the association between prescriber and patient, in which the part of the prescriber was to give the directions and the patient’s role, was to trail the doctor’s instructions. Noncompliance, hence, could be understood as patient ineffectiveness in being incapable of following orders, or as thoughtful, self-destroying activities. Adherence is the degree to which the patient’s conduct equals decided endorsements from the adviser. It has been implemented by many as a substitute to compliance, to highlight that the patient is allowed to choose whether to follow to the doctor’s recommendations and that failure to do so should not be an intention to blame the patient. Adherence matures the description of compliance by stressing the requirement for agreement. Concordance is a comparatively fresh term that is primarily used in the United Kingdom. A complex impression involving the prescriber /patient association and the amount to which the treatment signifies a mutual resolution, in which the opinions and likings of the patient have been taken into account (Horne, 2006). When patients don’t follow the prescribed instructions, it’s called non-concordance. The consequences of non-concordance in severe mental health illness are devastating. It can worsen the condition of the patient and can life threating in some cases (Lehane and McCarthy, 2009).

No adherence to medicine happens in all chronic medical disorders. It is a specific test in schizophrenia due to the illness’s relationship with comorbid substance misuse, stigma, and social isolation, plus the result of symptom spheres on adherence, cognitive impairment, depression, containing negative and positive symptoms, and lack of insight. No adherence lies on a range, is often secret, and is underrated by doctors, but disturbs more than one-third of patients with schizophrenia each year. It surges the risk of relapse, self-harm, and re-hospitalisation, escalates inpatient charges, and drops the quality of life. It outcomes from multiple patients, service factors, medication, illness, and clinician but a crucial difference is between unintentional and intentional no adherence.

Factors for poor concordance, based on research are social context, Health beliefs and communication processes. Nurses have extended past of starting in effect interferences that have resulted in enhanced concordance in many facets of healthcare routines. For example, signifying improved health education services for women from ethnic sets, refining the acceptance of cervical screening by purifying cytology tracking systems, refining contact to mental health hospitals for young grownups with schizophrenia, supporting, and educating hypertensive clients (, 2018). It is vital to educate nurses about the significance of concordance and how they can empathise its importance to the patients.

Literature Review

Schizophrenia refers to a severe mental illness, which affects the Cognitive system, i.e., how a person behaves and feels. The sufferer may feel like they are hallucinating and have lost trace of realism. Symptoms of schizophrenia can be very immobilising, and starting age can be 16 to 30 years. There are three classes of symptoms of schizophrenia cognitive, negative, and positive. Negative symptoms related to the disturbance to normal behaviours and emotions. It can be less speaking, irregular adherence in activities, and show less facial and voice expressions (flat face). Positive symptoms include hallucinations, delusions, agitated body movements, and unusual way of thinking. Cognitive symptoms comprise of subtle and sometimes severe factors in a patient; it can change the way patient use to think and affect memory.

Numerous dynamics contribute to the danger of developing the disease. The first factor is genetic and environmental; Schizophrenia sometimes runs in the family. Scientists think that prediction of real causes of the disease by genetic information is not possible yet (, 2018). Environmental factors can be psychosocial, the problem during birth, malnutrition before birth, and exposure to viruses. Another risk element is different brain chemistry and structure, problems in brain development before birth and changes in brain structure during puberty can trigger psychotic symptoms in genetically vulnerable people. As I mentioned above causes of this disorder are still unclear. Therefore, treatments concentrate on reducing the symptoms of the problem. Antipsychotics, psychosocial, and CSC (coordinated speciality care) are the treatments used for Schizophrenia patients. Antipsychotics prescriptions are typically taken every day in liquid or pill form. Some medicine is in the way of injections, given once or twice a month. Psychosocial treatments are useful after doctor, and their patients discover a prescription that works.  Using and learning coping abilities to deal with everyday challenges of schizophrenia aids people to chase their life aims, for instance joining school or work. CSC cure plan incorporates employment services, supported education, family involvement, case management, psychosocial therapies, and medication. Caring for and assisting a close person with schizophrenia can be challenging. It can be hard to distinguish how to react to somebody who creates odd or evidently wrong statements. It is imperative to know that schizophrenia is an inherited disorder. It is crucial for the caregiver to take care of patients with this disorder effectively.

To understand the neurotic and psychotic symptoms, Jasper tried to clarify the term by referring neurotic as understandable or psychotic as understandable symptoms. Kraepelin and Bleuler attempted to explain the reasons for psychotic symptoms. While Schneider and Crow divide these symptoms into three ranks, first-rank symptoms (e.g. hallucination, delusion), negative symptoms (e.g. social withdrawal, avolition), and cognitive symptoms (e.g. disorganised speech, poverty of thoughts).  It is important to review schizophrenia more critically before looking at how to care for a patient diagnosed with the severe mental illness. Although the cluster approach persists, there is an increasing recognition that these clusters are dimensional, changeable and fluid. Therefore, it is important to investigate this disorder as a multidimensional entity instead of strict categorical approach. To see the dimensional system impact on clinical practice, a study has been conducted by using SBAR format. This format helps explore the application of schizophrenia medication management. Clinical policies such as a critical understanding of current evidence, structured interventions, knowledge of medicines, relationship building, and active listening are crucial for aiding medication concordance in a patient identified with schizophrenia disorder (Snowden et al. 2011).

Now it is important to understand the concept of recovery because the central challenge policymakers, researchers, professionals and service users face is making sense of wide-ranging understanding and conceptualisation of recovery. Recovery is an argued idea, meanings of it are spreading across many disciplines, and contexts, subsidising to the mix-up it surrounds. There are many terms used to define recovery such as the birth of hope, resurrection etc. Likewise, the therapeutic sense has influenced the conceptualisation of healing/recovery in mental health and psychiatric nursing as well as behavioural disciplines writings, and thus the expressions ‘rehabilitation’ and ‘recovery’ are frequently used interchangeably. Indication proposes that rehabilitation can be hypothesised in a multidimensional method, the meaning of which has arisen from a systematic analysis and description fusion of scientific staff’s perceiving of recovery-oriented psychological well-being practice. It can be brief as an all-inclusive style bridging stress management, psychological physical and healthcare therapies where individuality including client-centered goals, service-user autonomy and decision-making takes superiority, and service users’ and staff work incorporation through, for example, training and supporting optimism. Individual recovery is determined by residency participation with the significant profession and social enclosure (Tuffour, 2017).

The burden on mental health workers and nurses to guarantee that individuals with severe psychological disorder agree to take their treatment has never been more significant. Schizophrenia is affecting almost 29 million people worldwide. One element of treatment cannot take care of patients, for the ideal treatment of schizophrenia psychiatrists, healthcare professionals and nurses, and patients should work together. The Spanish ADHES program was introduced in 2003 and targeted at nurturing the awareness of fractional and non-concordance to prescription in the cure of mental illness in Spain, Europe, the Middle East and Africa. A survey was conducted across 116 countries in association with EUFAMI (European federation of association of families of people with mental illness). The two main reason for this research was to complement the findings from previous surveys conducted by ADHES among nurses and to measure the views of carers due to the essential part they perform in the care of patients. Among carers joining in this review, there was great attentiveness of the subject involved in assisting patients with schizophrenia and the standing of their part in taming concordance to medication. Three differences in opinion emerged between the views of psychiatrists and carers; psychiatrist relay more on patients themselves when assessing adherence than carers would recommend; on the contrary. Many carers consider the disease itself adds to non-concordance; two third of carer reason that medicine harms the well-being of schizophrenia patients. The results from the present survey, taken together with the findings of the previous survey conducted on nurses and psychiatrists, suggest the importance for the cooperative tactic to the problem of treating non-concordance (Macleod, Elliott, and Brown, 2011).

For seriously mentally ill patients, failure to follow the recommended treatment has overwhelming concerns. Nurses, hence, attempt to get users to take the psychotropic prescription for the long-standing time. The goal of this is to control non-adherence and noncompliance. However, compliance because of its implications of coercion has been abandoned from current nursing literature. The ideal term is adherence, which allows the patient to actively participate in the process. However, for a severely psychotic person, treatment may be involuntary. Psychiatric nurses contribute to forced treatment and therefore should recognise the moral implications of compliance as a goal and not vague the subject by calling compliance adherence (Vuckovich, 2010).

Patients with schizophrenia need upkeep treatment with psychosocial therapy and antipsychotic medication to uphold symptom control. Degrees of treatment devotion or follow-through are little in users with schizophrenia. This surges the jeopardy of setback and adds to the underprivileged excellence of life. As instructors and mentors, psychiatric nurses can cooperate with customers to recover adherence and other results using mutual decision-making practices and gears that involve and authorise consumers to dynamically contribute to choices about their cure. There are some operational approaches nurses employ as they work together with schizophrenia patients. The first strategy is shared decision-making, discussing and confirming patient preferences and emphasising on the standing of client’s viewpoint in treatment.

Taking patient into confidence by selecting suitable medications and behavioural therapy can develop concordance in them. A study suggests 85% of the clients prefer to give their opinion about the treatment and the options they have. One more current literature review determined that most patients need more significant contribution in mental health treatment decisions and that they wish to be involved in treatment choices is greater in clients with schizophrenia than sufferers in primary care facilities. Rates of medication follow-up in patients go on as low as 40% during first three months of treatment. According to a recent study, non-concordance in treatment escalate the risk of criminal arrest, suicide, hospitalisation and relapse (Mahone, Maphis and Snow, 2016). This leads to disturbance in housing and relationship and consequently subsidised to the poor excellence of life.

Many client-specific factors are acting on medication follow-throughs such as lack of awareness of illness, lack of social support, financial constraints, lack of access to healthcare services and substance abuse. Addition to that four factors, i.e. a weak therapeutic alliance, attitude towards treatment, side effects, and medication non-effectiveness. Therapeutically association refer to the relationship between the medical provider and patients, this alliance takes on more prominence when addressing follow-through with patients with schizophrenia who experience anosognosia (Haddad et al., 2014; Shuler, 2014). To increase medication follow-through, psychosocial involvements with established competence are obtainable for clients with this disorder. It is important to consider patients view about medication and their perception about how the treatment works. There is a need for upcoming clinical trials with mutual decision-making tools. Thoughtfulness should be focused on classifying obstacles and organisers to the application of shared decision-making.

With schizophrenia illness, it is vital to highlight that nurses are obligatory to see the sign of any delusion or hallucination. Asking a clear, direct query such as the patient is hearing any voices, during each communication is expected. A hallucination could include a deep, loud, forceful, masculine expression ceaselessly reproving an individual that she/he is insignificant and must decease. The caretaker must detect for signals such as eye darting to one side, mumbling to self or looking to an empty zone. After identifying delusion, the nurse should avoid reacting immediately and do not claim back to the speeches.

While much discussion has been done on poor adherence in the cure of this illness, there has been a little debate on the concordance between psychiatrists and patients, a significant helping aspect to patient-centred care. According to Oxford definition of concordance is agreeing on something; harmony. This term is later used in medical decision-making and the patient-doctor relationship. However, it is undecided to whether concordance smears only to the choice of the most exquisite obtainable cure, the position of all possible remedies or arrangement as to why treatment is selected. While it is essential that patients and doctors must settle on the selected treatments, the choice needs a planned procedure by which the assistance and hazards of all actions are debated. Methodically, two tactics can be used in measuring the concordance of the purposes of patients and doctors.

Precisely, we could relate the urgencies of the two groups, or we could associate the total value got by each element. Technically, the previous needs an evaluation of the ordinal sides of value through the contrast of positions of the results provided by doctors and patients. The next method involves the same assessment but wants standards delivered by doctors and patients to be calculated on the particular basic scale. Increasing an improved understanding of the patient’s viewpoint in the valuation of treatment objectives and endorsing a program to the concordance, is serious assumed that schizophrenia touches so many surfaces of the sufferers’ life. Also, the customary obstacles to patient-centeredness in schizophrenia are being continually worn as it becomes clearer that such people are capable of both define and assess their excellence of life and treatment choices consistently and effectively. 

(Bridges et al., 2013) Has also open essential methodological results that are straight applicable to the dimension of partialities and the learning of concordance more largely. Especially, they have established the usefulness of the self‐explained approaches of assessing specified choices as a method to evaluating defendants’ beliefs across a significant number of cure objectives and for giving a statistically healthy technique for the valuation of concordance between participants.

This study brands numerous main influences to the works of literature on concordance, specified‐preference procedures and schizophrenia; yet, it does have some restrictions. Primarily, assumed the staffing approach, the degree to which such outcomes are generalizable to the broader people, or other realms is uncertain. That said, their sample scope is higher than other liking revisions in schizophrenia and parallel to those for different mental fitness situations. Given that preferences are frequently mixed, it is indeterminate to what degree one could mark generalizable reports in any occasion (Bridges et al., 2013).


After going through past discoveries and research, the importance of non-concordance is undeniable. The first important thing is to understand the severe mental illness and its consequences in person’s life. Awareness about recovery in mental health prospective and what factors affect the recovery of patients suffering from serious mental illness. In this paper, my focus is on schizophrenia illness, its description, causes and effects and the factors involved in the treatment of schizophrenia disorder. Let us begin with the detailed analysis of severe mental illness with the focus on schizophrenia.

Serious mental illness (SMI) and persistent and severe mental illness (SPMI) raise to different circumstances; this is because, while all kinds of critical mental illness may be restricting in some way, they are not continually persistent and severe (that is, long-lasting and always immobilising). Therefore, though all alarming and persistent mental sickness may be critical, not all-severe mental disorder may be extreme or persistent. Many mental health advocates, peers, consumers and professionals use the word SMI to mention severe mental disorder, while the national organisations call the term to denote serious mental illness. Presumed this condition and the likelihood of confusion and classification effects, it may be good to dodge the abbreviation.

It is also essential to note that meanings of serious mental illness differ, relying on whether the term is utilised for legal purposes (to start entitlement for incapacity or additional social security assistance), epidemiological purposes (to track its occurrence and frequency over time) or clinical purposes. While legal meanings may diverge, epidemiological descriptions must be founded on standardised measures and continue appropriate over time. Neurotic or psychotic. Neurotic conditions are connected to usual sentiments and are the most ordinary kind of mental disease. Many of us sense depression for example and at the same time as its occurrence is awful. Nevertheless, if you have clinical despair, it is an extremely more profound experience than being feeling low or unhappy. Experiencing clinical depression is a disease that has a noticeable consequence on one’s life, stopping people from being able to look after themselves properly or work and in extreme circumstances, hints to suicide. Other instances of neurotic illnesses are anxiety, phobias, and obsessive-compulsive disorder.

Psychosis disorders are different from neuroses being unconnected to usual feelings. It is a term utilised to label signs or practices that occur together. These indications affect the patient to not understanding realism like most persons. The person suffering from psychosis disorder can see, smell, hear or feel things, which others do not also know as hallucinations. The person can have strange beliefs, thoughts that can make them feel captivated, or being controlled, this is called delusions. The patient may not be able to tell if he/she is unwell, may avoid contact with people, and isolate himself or herself. These signs can happen with some psychotic disorders together with schizophrenia. People have psychotic depression and Bipolar Disorder (also known as Manic–Depression), which are attitude conditions, can also experience these signs.

Schizophrenia is a major disorder affecting about 1 in 6 people in the United Kingdom, and 1 in 100 people will suffer from this illness in their lifetime. It is spreading in all nations and countries of the world. It affects women and men equally and people from every social background. The patient of schizophrenia has a 5% to 10% chance of dying by committing suicide within ten years of diagnosis. It attacks in the early twenties or late teens and runs in the family. If a member of the family is suffering from the disorder more likely, other members can diagnose it too. The sufferer can experience a schizophrenia episode because of stress or hormonal changes such as childbirth or puberty. About 25% patients, suffering from an episode of disorder go on to recover completely.

About 25% of individuals with schizophrenia show physical changes in their brains that can be observed on CT scan. There are relations between schizophrenia and certain physical disorders. For example, coeliac disease and schizophrenia are often started in the similar household, and people with schizophrenia may be less helpless to certain physical circumstances such as rheumatoid arthritis. The financial price of schizophrenia is very high. The rate of treating a patient with schizophrenia over their life is near six times the price of treating a patient with heart illness. In the United Kingdom, mental illness signifies around 10% of the total disease burden yet receives only 5.5 % of the research funding.

When we talk about mental illness, recovery came along with the concept, but in mental health, recovery does not mean thorough recovery in a way that we may improve from a physical health issue. The term has different meaning depending on the perspective of the person. Some people believe recovery is when you are in charge of your life despite suffering from a mental health issue. In mental illness, there is no one definition of recovery; the hope that a person can regain his life and carry out his living normally after being affected by serious mental disorder is referred as recovery. Now if we talk about the treatment of schizophrenia, there are two main levels of treatment, medication and therapies. Schizophrenia needs lifetime treatment, even when signs have diminished. Treatment with medications and psychosocial therapy can assist cope the disorder. In the serious scenario, hospitalisation can need. The objective of dealing with antipsychotic medications is to efficiently cope signs and indications at the smallest possible dose.

The psychiatrist may attempt different medications, different quantities or mixtures over time to attain the preferred outcome. Other prescriptions also may support, such as antianxiety or anti-depression pills. It can take many days to see an improvement in symptoms. Because medicines for schizophrenia can root severe side effects, people with schizophrenia may be unwilling to have them. The inclination to collaborate with cure may affect drug choice. For example, someone who is resilient to taking medicine constantly may want to be given vaccinations instead of having a tablet. This reluctant behaviour towards medication or other treatments in mental illness is defined by three terms interchangeably. Compliance, adherence or non-concordance. Medication alone is not enough in this treatment, so psychosocial interventions are important in addition to antipsychotics.

These interventions may include individual therapy, family therapy, cognitive therapy and social skill training. Individual therapy aid to regularise thought patterns. It helps to learn the coping strategies and identify early warning signs of relapse. Family therapy provides education and support to families suffering from schizophrenia. Some test centre in the United Kingdom has conveyed very encouraging discoveries for interventions that appoint cognitive behaviour therapy practices, e.g. rational analysis, self-talking to minimise anxiety related to both delusion and hallucinations. As specified above, schizophrenia is marked by neurocognitive damages that have a major effect on community operation and are only partly bettered by medication. Therefore, substantial effort has been dedicated to the expansion of cognitive rehabilitation programs to escalate high-level problem-solving skills, attention and memory capacity.

There are some limitations to be considered in the implementation and design of psychological treatments for schizophrenia patients. Growth in cure should be assumed to be slow and manifest by episodic disturbances and periods of reversion. Subsequently, it is essential that treatment be long term, spreading over months and years. The procedure should also be directed by tangible, short-term objectives that are likely to be accomplished (e.g., to join day hospital twice a week for one month). While there are some sickness faces that are mutual to most sufferers, there are wide-ranging individual dissimilarities, as well as variances within the same patient over time. Thus, therapy must be personalised to the requirements of each patient and accustomed as the patient changes. Nonetheless, of the ruthlessness of disease, the patient must be involved as a companion in treatment designing and goal setting to ensure operational collaboration. Treatment should be directed in association with the patient, not done to the sufferer. Effective medical care marks definite problem areas or skills that the receiver can settle to work on (e.g., vocational skills, social skills or drug use). Generic individual or group psychotherapy is not effective. The disease is targeted by important shortfalls in memory, thoughtfulness, and supervisory functioning that have major effects on the treatment course. Treatment must be altered to these impairments if people are to be capable to retain and learn what is discussed in meetings. Treatment should unintentionally become an attention or memory test.

Now I will discuss what limitation patient behaviour can impose on the treatment. As stated above medication to mental illness treatment can have the severe side effect, this patient show non-concordance towards medication and treatment in general. Let us examine the factor in schizophrenia patients that impact devotion and the concerns of nonadherence to the sufferers, healthcare scheme and people. Nonadherence to treatment contains a variety of patient behaviours, from treatment rejection to uneven use or fractional alteration of daily medicine amounts. Half adherence to treatment is at least as regular as complete nonadherence. There is not one model that clarifies adherence problems, but somewhat a series of theories with their powers and restrictions. Possible aspects for nonadherence may be connected to illness severity, treatment faces or even peripheral environmental influences such as therapeutic support. Adherence causes may also be special to the features of schizophrenia; issues such as lack of illness insight or cognitive impairment may play an significant part. A fresh, reflective record revision in schizophrenia originate that the finest analyst of decent adherence was an important development in positive symptoms, depressive symptoms and hostility, regardless of treatment.

Nonadherence to prescription has a harmful effect on the path of illness after an attempted suicide, longer time to remission, relapse, and re-hospitalisation. A modern surveying database learning which inspected statistics from eight sixty one sufferers in Sweden linked non-concordance to antipsychotic medication soon after release to early re-hospitalisation. The magnitudes of no adherence add to the already high budgets of the disease to healthcare systems. Thus, nonadherence can have a considerable negative impact on patients’ health and work as well as an economic burden on society. Reducing nonadherence to antipsychotic treatments has the perspective to decrease psychiatric illness and costs of care considerably. That would recover the wellbeing of patients with schizophrenia and decrease the use of assets for severe psychotic experiences. Thus it is significant to classify the key aspects subsidising to nonadherence in schizophrenia, and their concerns. Also, evaluating grounds and magnitudes of nonadherence together may emphasise the prominence and complication of adherence to medication in schizophrenia.

Treatment-related factors such as hostile events and kind of antipsychotic routine may influence adherence. Outside or environment-related elements incorporated relationship with the medical doctor, a humiliation of illness, living condition and family support. According to a study both adherent and non-adherent patients have good relationships with their physician. However, the level of trust that their physician will help them cure the disease between them is higher in adherent patients. Patients consider a positive relationship with therapists and physician to be good for medication adherence. However, problems in constructing a therapeutic association and poor clinician-patient relationship were amongst important analysts of nonadherence. Another significant environmental factor that is a common hurdle to sufferer adherence is lack of support and the stigma of taking medications. For good adherence, family support is vital along with financial stability and housing problems. The potential of side effects caused by medication and lack of insight into having a disease, substance abuse and social support is another important factor affecting adherence in schizophrenia patients.

Now let us take a look at the consequence of nonadherence in schizophrenia patients. Many sufferers may primarily feel healthy succeeding their removal from antipsychotics, possibly because unwanted side effects vanish. Still, relapse is a threat to these patients. Three natures of concerns to patients were stated: impact on prognosis, re-hospitalisation rates, and suicide rates. Non-adherence patients have a higher rate of re-hospitalisation as compare to adherence patients. There are no quantitative measures for comparing low adherence and high re-hospitalisation rates, but all study suggests a link between lower adherence and high re-hospitalisation. Suicide is one of the growing roots of early death in the patient with schizophrenia, but it is greatly avoidable. Patients with schizophrenia develop suicide behaviour with time, and it is because of non-adherence to antipsychotic medications.

Non-adherence behaviour can impact on society as increasing violence rates in patients with schizophrenia (Higashi et al., 2013). Healthcare facilities also affected by non-adherence as this lead to relapse, which can mean frequent appointments to emergency rooms, higher need for clinician interventions and re-hospitalisation. All of this tip to amplified budget to healthcare systems.

Our literature review recognised an extensive range of issues and costs of poor adherence in schizophrenia. Based on the data found, the most repeatedly described driver and concern of nonadherence seemed to be the absence of sickness understanding and the higher threat of hospitalisation, correspondingly. Aspects positively connected to adherence incorporated a good therapeutic relationship with physician/nurses and observing the benefits of treatment. Working physicians should be conscious of the significance of constructing a therapeutic relationship with the patient build on belief as well as teaching the patient on the medication’s effect on the illness and symptoms. Since the considerable liability of nonadherence in schizophrenia on patients and society as a whole, enhanced adherence in schizophrenia is of great worth to society and patients.


Schizophrenia is a severe mental illness with symptoms of delusion and hallucination, affected 1% of world’s population. Patient with schizophrenia needs antipsychotic medication as well as psychosocial interventions. Non-concordance to medication among these patients are likely because of the side effects they experience, but this non-adherence leads to critical health problems in patients. To conclude this research, I would stress on the importance of problem-specific psychosocial treatments for patients with schizophrenia. Educational opportunities for family, caretaker and the patients to enhance the importance of concordance in medication. There is now a new era of psychosocial management methods that have produced very encouraging results. It is likely that as more advances occur in the biological treatment of schizophrenia. Psychological treatments along with medications can yield better results and improve concordance in patients with various cognitive and behavioural therapies. Findings suggest that there is an essential need to provide sufficient info about mental illness and medications recommended, to improve medication compliance and to grow community mental health maintenance services. The relation between doctor and patient should improve, and opinion of the patient should consider while suggesting treatment is important to increase adherence in patients.

References (2018). Severe Mental Illness | Behavioral Health Evolution. [online] Available at: [Accessed 17 Feb. 2018].

Bridges, J.F., Slawik, L., Schmeding, A., Reimer, J., Naber, D. and Kuhnigk, O., 2013. A test of concordance between patient and psychiatrist valuations of multiple treatment goals for schizophrenia. Health Expectations16(2), pp.164-176.

Higashi, K., Medic, G., Littlewood, K.J., Diez, T., Granström, O. and De Hert, M., 2013. Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review. Therapeutic advances in psychopharmacology3(4), pp.200-218.

Horne, R., 2006. Compliance, adherence, and concordance: implications for asthma treatment. Chest130(1), pp.65S-72S.

Lehane, E. and McCarthy, G., 2009. Medication non‐adherence—exploring the conceptual mire. International journal of nursing practice15(1), pp.25-31.

Macleod, S.H., Elliott, L. and Brown, R., 2011. What support can community mental health nurses deliver to carers of people diagnosed with schizophrenia? Findings from a review of the literature. International journal of nursing studies48(1), pp.100-120.

Mahone, I.H., Maphis, C.F. and Snow, D.E., 2016. Effective strategies for nurses empowering clients with schizophrenia: medication use as a tool in recovery. Issues in mental health nursing37(5), pp.372-379. (2018). Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence | Guidance and guidelines | NICE. [online] Available at: [Accessed 17 Feb. 2018]. (2018). NIMH » Schizophrenia. [Online] Available at: [Accessed 15 Feb. 2018].

Snowden, A., Flemming, M., Marland, G. and McNay, L., 2011. Towards concordance in schizophrenia: a case study. Nurse Prescribing9(5), pp.234-242.

Tuffour, I., 2017. The concept of recovery and its practical application. Mental Health Practice (2014+)20(9), p.37

Vuckovich, P.K., 2010. Compliance versus adherence to serious and persistent mental illness. Nursing Ethics17(1), pp.77-85



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