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Medication Non-Adherence in First Episode Psychosis: A Systematic Review
James Hunt1,2, Anna Georgiades1,2
1Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK.
Early Intervention in Psychiatry
|July 30, 2026
Summary
Medication non-adherence in First Episode of Psychosis (FEP) stems from complex factors. Psychosocial interventions addressing these influences can improve adherence and outcomes in early psychosis.
Area of Science:
- Psychiatry
- Clinical Psychology
- Pharmacology
Background:
- Medication non-adherence is a significant challenge in managing First Episode of Psychosis (FEP), despite the effectiveness of antipsychotic treatments.
- Understanding the multifaceted reasons behind non-adherence is crucial for developing targeted interventions.
Purpose of the Study:
- To systematically review the reasons, attitudes, and beliefs associated with medication adherence and non-adherence in FEP.
- To identify and evaluate the effectiveness of psychosocial interventions aimed at improving medication adherence in psychosis.
Main Methods:
- A systematic review adhering to PRISMA 2020 guidelines.
- Inclusion of 76 studies examining adherence factors and psychosocial interventions in FEP.
- Synthesis of identified reasons for non-adherence into overarching themes.
Main Results:
- Nineteen distinct reasons for non-adherence were identified, categorized into 10 themes including insight, autonomy, trust, side effects, stigma, and practical barriers.
- Facilitators of adherence include illness insight, motivation, trust in clinicians, positive treatment outcomes, digital reminders, and social support.
- Effective psychosocial interventions include CBT, psychoeducation, motivational interviewing, adherence therapy, and assertive community treatment, especially when combined.
Conclusions:
- Medication non-adherence in FEP is influenced by a complex interplay of personal, relational, cognitive, cultural, and systemic factors.
- Tailoring psychosocial interventions to address these specific influences is key to improving adherence in early psychosis.
- Practical tools, including a clinician-client transcript and CBT strategies, are provided to aid clinical practice in assessing and promoting adherence.
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