Mathew Moslow
Mental Health Clinical Concept Project
NURS240: Mental Health
It is fair to say that one of the biggest problems faced by psychiatric and mental health care patients and professionals alike is medication compliance, particularly among individuals diagnosed with schizophrenia. In patients with such delicate and sometimes taking medications that have a very narrow therapeutic index the medication regimen is key and any deviation could not only cost them temporary sanity or psychosis, it could mean the end of their lives. For such a pivotal. problem you would think we would have all the answers, and you are not wrong. While we have the answers, we know what to do and have been validated in clinical and evidence based practices the reality is far from simple Can, Aydin, and Kurt (2024) investigated the effectiveness of cognitive-behavioral therapy (CBT)-based psychoeducation in improving medication adherence among individuals diagnosed with schizophrenia.
Dilla and Ciudad (2013) approached the issue of nonadherence to antipsychotic medications in schizophrenia with a systematic framework, turning their attention to the often-overlooked economic fallout. Their findings illustrated a harsh reality: the cost of noncompliance extends far beyond clinical setbacks, accumulating into a substantial financial burden for both healthcare systems and society at large. In parallel, further research echoed this concern, pointing to the considerable monetary losses that accompany medication nonadherence— losses that quietly compound with each missed dose, each relapse, each preventable hospitalization..
Collectively, these studies reveal a pattern: when patients discontinue antipsychotic medications, the consequences ripple outward—not only threatening their health, but quietly draining financial resources across healthcare systems. Despite decades of research, the issue remains stubborn. Much of that difficulty begins at the level of patient behavior. Choices around adherence are often shaped by the experience of taking the medication itself. Side effects like weight gain, fatigue, and sexual dysfunction are not rare—they are expected—and they can easily erode a patient’s willingness to continue treatment. Jayasree et al. (2021) examined these obstacles, pointing to a range of contributing factors: physiological reactions, cognitive difficulties, and the social weight of stigma. Their response is both practical and personal: interventions that meet patients where they are, using education, counseling, and simple tools such as pill organizers or scheduled routines. Corrigan and Nieweglowski (2021) extended this conversation by focusing on internalized stigma, which they found not only disrupts adherence but also deepens the sense of isolation that often shadows psychiatric illness.
| Barrier | Examples | Suggested Interventions |
|---|---|---|
| Medication Side Effects | Weight gain, sedation | Tailored psychoeducation, medication adjustment |
| Cognitive Impairment | Forgetfulness, confusion | Electronic reminders, structured daily routines |
| Perceived Stigma | Shame, fear of judgment | Supportive counseling, stigma reduction initiatives |
| Internalized Stigma | Negative self-perception | Cognitive-behavioral therapy, peer support groups |
| Ambivalence about Medication | Doubts about medication efficacy | Motivational interviewing, consistent therapeutic dialogue |
When patients achieve symptom relief and regain stability they sometimes will make an illadvised decision to discontinue their medication so that they may avoid these adverse effects. This decision frequently leads to relapse, reintroducing psychosis and other complications into their lives. Discontinuing antipsychotic medications, especially abruptly, can pose significant health risks, including increased mortality.
Studies have shown that individuals with schizophrenia who discontinue antipsychotic treatment face a higher risk of death compared to those who maintain continuous therapy. For instance, a 20-year follow-up study reported cumulative mortality rates of 46.2% for non-users, 25.7% for any antipsychotic use, and 15.6% for clozapine users, indicating a substantial decrease in mortality associated with sustained antipsychotic use.  A cyclical pattern that poses a significant challenge that research endeavors to address on an individual basis., a challenge that unfortunately often end in death. The research conducted by Can et al. (2024) is robust. In their quasi-experimental study, 73 participants—33 in the intervention group and 40 in the control group—were enrolled to assess whether structured psychoeducation sessions could enhance adherence. The researchers evaluated medication adherence using the Morisky Medication Adherence Scale (MMAS) and monitored aggression via a standardized questionnaire. Following the intervention, medication adherence significantly increased in the psychoeducation group. The MMAS scores improved from an initial average of 2.75 to 3.57 out of 8, reflecting better medication-taking behavior. The control group, however, experienced minimal change, with scores barely shifting from 2.1 to 2.17. This disparity was statistically significant (p = 0.001), demonstrating the effectiveness of the CBT-informed approach. Additionally, participants receiving psychoeducation displayed reduced aggression levels (from 80.5 to 73.1), while aggression scores in the control group slightly rose (Can et al., 2024).
| Patient Group | Mortality Rate (%) |
|---|---|
| Non-adherent patients | 46.2% |
| Patients with consistent antipsychotic use | 25.7% |
| Patients consistently using Clozapine | 15.6% |
Insights from our group discussions regarding the clinical implications of the studies included in this work reveal that the issue is both significant and often underestimated in day-to-day practice. My classmates consistently emphasized that addressing this challenge requires more than medication—it demands proactive patient education, consistent follow-up, and empathetic support systems. A few shared firsthand observations of patients struggling with adherence or misunderstanding the importance of their treatment plans, often leading to preventable complications. I recognized over anything else the practical utility of structured CBT-based psychoeducation. For instance, one group member routinely utilizes CBT techniques in clinical practice to address patient misconceptions around medications and non-adherence behaviors, supporting the need for more education that was proposed. Observations within the group emphasized the benefits of brief, repeated psychoeducational sessions over lengthy, infrequent interactions. The clear improvements observed in medication adherence and reduced aggression confirmed the group’s belief in prioritizing consistent therapeutic dialogue as central to patient-centered care.
Further supporting these findings, Moran et al. (2022) provided evidence that digital tools, such as reminder apps and electronic pill organizers, substantially improve adherence in psychiatric populations. Incorporating these tools alongside psychoeducation may create robust, multi-dimensional support strategies. Chapman and Horne (2022) added to the discussion by emphasizing motivational interviewing (MI) as a complementary approach that addresses patients’ ambivalence toward medications, thereby enhancing commitment and adherence.
Our project aims to incorporate the same way of thinking by creating a bingo style game going over the barriers and other considerations affecting medication adherence to promote education and knowledge on the subject.
Long-term is the key here. Repeated exposure over an extended period of time and from multiple sources, the findings illustrate the importance of integrating structured psychoeducation within routine nursing practices, emphasizing ongoing, empathetic communication as a fundamental component for treatment adherence (Corrigan & Nieweglowski, 2021). Gray et al. (2020) supported this by demonstrating that nurse-led educational programs notably improve patient adherence and satisfaction in clinical settings. Routine utilization of adherence scales, regular patient check-ins, and embedding psychoeducation into daily nursing workflows can systematically address adherence challenges.