A prototype approach toward antipsychotic medication adherence in schizophrenia

Antipsychotic nonadherence in psychotic disorders is a vexing clinical problem. While many risk factors are associated with nonadherence, a risk factor model per se is a poor guide for clinical decisions. We propose a pragmatic clinical prototype approach that incorporates two variables, medication drug attitude and worldview (with regard to mental illness and psychiatric treatment), to create five patient prototypes of adherence: patients with good adherence for the right reasons ("True Believer"), with good adherence for the wrong reasons ("Clinic Trouper"), with reluctant and tenuous adherence ("Reluctant Recruit"), with passive adherence ("The Coffee Guy"), and with unwillingness to take medications ("Constitutional Combatant"). Actual patients can be compared and assigned to one of the prototypes, with the group membership predicting level and character of adherence, and suggesting specific interventions. In this scheme, drug attitude and worldview are key variables for adherence; both can be ascertained during the clinical interview and quantified with rating scales.