Communication about adherence to long-term antipsychotic prescribing: an observational study of psychiatric practice

Purpose Partial or non-adherence is common in people taking antipsychotic medication. A good therapeutic alliance is thought by psychiatrists to encourage engagement with a service and improve adherence. This paper aims to examine how psychiatrists and patients communicate in outpatient consultations about partial or non-adherence to antipsychotic prescribing. Methods Ninety-two outpatient consultations involving patients prescribed antipsychotic medication and their psychiatrists were tape recorded. Parts of consultations where partial/non-adherence to antipsychotic medication was discussed were analysed using conversation analysis. Results In 22 (24 %) consultations, partial/non-adherence was disclosed. Most commonly, it was volunteered without prompting and was more likely to be presented as a deliberate choice than omission by the patient. Psychiatrists responded to all but one disclosure, and patients delivered their reports in ways that minimised the prospect of this response being disciplinary. The most common outcome was a change in prescribing: a medication omission, swap or dosage reduction. Conclusions Patients and psychiatrists work together to create a safe conversational environment in which to discuss this potentially difficult issue. Unlike previous studies of patient reports of psychotic symptoms and side effects of drowsiness being ignored, psychiatrists nearly always respond to disclosures of partial/non-adherence. Psychiatrists should apply the same listening skills to patients’ disclosures of troubling side effects and psychotic symptoms.