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La schizofrenia rimane tuttora uno dei disturbi mentali piu gravi, specie sotto il profilo del funzionamento psicosociale e relazionale di chi ne e affetto. L’inadeguatezza delle interazioni interpersonali e la marcata alterazione delle abilita sociali sono, infatti, tra le caratteristiche piu costanti e invalidanti del disturbo. Negli ultimi anni, abbiamo assistito a un cambiamento di prospettiva nella ricerca sulla schizofrenia, con l’interesse primario che si e spostato progressivamente dall’obiettivo di ridurre la gravita della sintomatologia, in particolare di quella «positiva» (deliri, allucinazioni, disorganizzazione) a quello di migliorare il «funzionamento» e l’integrazione sociale del soggetto (Green e Horan, 2010). E in questo contesto che lo studio della cognitivita, della cognitivita sociale e dei loro deficit e diventato un ambito di grande interesse per il clinico e per il ricercatore.

1 Poor adherence to antipsychotic medication in people with schizophrenia: diffusion, consequences, and contributing factors.- Premise.- Role of antipsychotics in the treatment of schizophrenia.- Compliance versus adherence.- Assessment of medication adherence.- Frequency of poor adherence to antipsychotics.- Consequences of poor adherence to antipsychotics.- Determinants and moderators of adherence to antipsychotics.- Present and medium-term perspectives.- Closing Remarks.- 2 Pharmacological strategies to enhance adherence in schizophrenia.- Introduction.- Pharmacological factors contributing to non-adherence: efficacy, side effects, regimen, co-therapies.- First vs Second generation antipsychotics: efficacy, tolerability and the adherence issue.- Long-acting injectable antipsychotics.- Conclusion. 3 Non-pharmacological strategies to enhance adherence and continuity of care in schizophrenia.- Introduction.- Factors Influencing (non-)adherence in Schizophrenia.- Interventions to Enhance Adherence. Research and Clinical Evidence.- Comprehensive Review of Psychosocial and Programmatic Interventions to Enhance Adherence to Antipsychotic Medication in Schizophrenia.- Summary of Main Results and Evidences.- Conclusions and Future Directions.- 4 Psychological issues in improving adherence and alliance.- The patient-doctor relationship as a determinant of adherence to treatment.- Alliance and psychodynamic issues.- Towards the concept of concordance of the therapeutic project.

Nonadherence is highly prevalent in schizophrenia. It has been estimated that nonadherence rate for prescribed antipsychotic medications is about 50 %. Nonadherence with antipsychotic medication is a major cause of relapse and it is associated with poorer functional outcomes in patients with schizophrenia. After identifying factors that may be contributing to a patient’s adherence, it is important for clinicians to initiate strategies specifically targeted to those problems. Research has increasingly focused on psychosocial and pharmacological interventions to improve outcomes in patients with schizophrenia. Systematic reviews of various psychosocial approaches to enhance adherence to medication in schizophrenia indicate that some approaches have yielded some promising results, but they are still controversial or preliminary. The aim of this chapter is to provide a comprehensive overview of the available data on nonpharmacological strategies designed to improve adherence to medication in schizophrenia. Interventions and strategies proposed and/or tested to enhance adherence to antipsychotic medication are systematically described and discussed.

This chapter tries to present the issue of poor adherence to treatment in people with schizofrenia, by treating the following topics: role of antipsychotics in the treatment of schizophrenia, compliance versus adherence, assessment of medication adherence, frequency of poor adherence to antipsychotics and consequences of poor adherence to antipsychotics present and medium-term perspectives.