Maximizing Treatment Success for Patients with SMI: Promoting Adherence and Treatment Engagement-View Presentation Slides

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The American Psychiatric Association’s 2019 webinar "Maximizing Treatment Success for Patients with Serious Mental Illness (SMI)" addresses the challenges of treatment non-adherence in patients with conditions such as bipolar disorder, schizophrenia, and treatment-resistant depression. Non-adherence, defined as a patient’s behavior not aligning with healthcare recommendations, affects about 50% of individuals with SMI, mirroring rates seen in other chronic medical conditions.<br /><br />Major causes of non-adherence include complicated medication regimens, access barriers to services and medications, side effects, cognitive impairments, lack of insight, denial of illness, and personal values. Side effects are assessed using tools like the FIBSER scale, which evaluates frequency, intensity, and burden of adverse medication reactions.<br /><br />Non-adherence leads to relapse, increased hospitalizations, poor quality of life, and social and occupational disruptions. To combat this, behavioral interventions based on the Health Belief Model emphasize patient control, positive provider relationships, and sensitivity to patient preferences.<br /><br />Long-acting injectable (LAI) medications are highlighted as effective for improving adherence, offering stable medication levels and reducing daily pill burden. Though LAIs have pros such as sustained drug delivery and consistent clinical contact, challenges include injection site pain and historical stigma.<br /><br />Additional strategies include pharmacy-based supports (automatic refills, psycho-education), oral medication aids (pill boxes, reminders), and managing adverse reactions through open patient-provider communication. Technological tools like mobile health apps support medication adherence, self-management, and symptom monitoring.<br /><br />Engagement in care is enhanced by supportive psychotherapy, strong therapeutic alliances, shared decision-making incorporating patient values, and family involvement, with resources like NAMI providing education and peer support.<br /><br />This comprehensive approach aims to improve adherence and treatment engagement, thereby optimizing outcomes for patients with serious mental illness.

Keywords

Serious Mental Illness

Treatment Non-adherence

Bipolar Disorder

Schizophrenia

Treatment-resistant Depression

Long-acting Injectables

Health Belief Model

Medication Side Effects

Behavioral Interventions

Patient Engagement