Britney Kasmir, Psychiatric Nurse Practitioner, Houston Adult Psychiatry

This article is Sponsored by Otsuka America Pharmaceutical, Inc. The author is a paid consultant for Otsuka America Pharmaceutical, Inc.

People living with serious mental illness (SMI) are at higher risk for a wide range of chronic physical conditions1, are more likely to visit the emergency department, be admitted to the hospital and have longer hospital stays compared to those without SMI2. Nonadherence to drug treatments for major depressive disorder (MDD)3, schizophrenia and bipolar disorder is common4. Several studies illustrate the problem, estimating that up to half of patients with bipolar disorder4, MDD3 and/or schizophrenia5 do not take their medication as directed.

The Importance of Patient Buy-in and Connections

Treating patients with SMI can be complicated by the illness impairing the person’s ability to properly manage their disorder. Some patients experience anosognosia, a condition that prevents them from recognizing that they have a mental illness, making it challenging to convince them of the need for treatment6. Establishing patient trust and buy-in on the treatment approach is one of the most important steps in caring for patients with SMI. Building that rapport requires working with the patient as a team, and when possible, with the people in their lives who provide support, to engage in shared decision-making and goal-setting7. I have found in my own practice that educating patients about medication options and allowing them to be an active partner in those decisions effectively supports the patient in their journey, rather than simply dictating the medications to be prescribed.

Once a treatment approach is agreed upon, information regarding the patient’s daily experience, such as medication-taking behavior and other lifestyle factors, is essential knowledge for health practitioners, but also for the patient and those supporting them. For clinicians, this information can provide potential insights into how the patient is experiencing their condition, their medication taking behaviors, and can help inform ongoing treatment strategies. For patients, it may provide a more tangible connection between their medication-taking behavior and how it affects the way they feel and their daily functioning. For family members, it can potentially open up a productive dialogue.

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References
1. Mental Health and Chronic Diseases. CDC. (2012, October). https://www.cdc.gov/workplacehealthpromotion/tools-resources/pdfs/issue-brief-no-2-mental-health-and-chronic-disease.pdf 2. Ronaldson, A., Elton, L., Jayakumar, S., Jieman, A., Halvorsrud, K., & Bhui, K. (2020, September). Severe mental illness and health service utilisation for Nonpsychiatric Medical Disorders: A systematic review and meta-analysis. PLOS Medicine. https://doi.org/10.1371/journal.pmed.1003284
3. Sansone RA, Sansone LA. Antidepressant adherence: are patients taking their medications? Innov Clin Neurosci. 2012;9(5-6):41-46. 4. Stephenson JJ, Tunceli O, Gu T, et al. Adherence to oral second-generation antipsychotic medications in patients with schizophrenia and bipolar disorder: physicians’ perceptions of adherence vs. pharmacy claims. Int J Clin Pract. 2012;66(6):565-573. doi:10.1111/j.1742-1241.2012.02918.x 5. Haddad PM, Brain C, Scott J. Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies. Patient Rel Outcome Meas. 2014;5:43-62. doi:10.2147/PROM.S42735 6.Anosognosia. NAMI. (n.d.). https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Anosognosia 7. Lehman, A. F., Lieberman, J. A., Dixon, L. B., McGlashan, T. H., Miller, A. L., Perkins, D. O., Kreyenbuhl, J., American Psychiatric Association, & Steering Committee on Practice Guidelines (2004). Practice guideline for the treatment of patients with schizophrenia, second edition. The American journal of psychiatry, 161(2 Suppl), 1–56.