L'alliance thérapeutique, un enjeu dans la schizophrénie

Medication adherence problems increase hospitalisation, morbidity and mortality. Social consequences, professional and family problems linked to hospitalisations lead to low quality of life for patients and high cost for society. Indicators of poor adherence to a medication regimen are a useful resource for physicians to help identify patients who are most in need of interventions to improve adherence. It is usual to identify quatre categories of factors causing disparity: 1: factors due to psychiatric disorders; 2: factors due to medication; 3: factors linked to patients; 4: factors depending on the therapeutic relationship with the clinician. Patients with psychiatric illness typically have great difficulty following a medication regimen, but they also have the greatest potential for benefiting from adherence. Some effective actions to improve compliance are described in reply to the factors influencing the adherence. The communication attitude of the clinician, therapeutic relationship and prescription use are main points of alliance. Information and communication with the patient, simplification of the therapeutic plan, consultation planning and account of side effect are simple and effective actions. Social support is very important for improvement of therapeutic alliance. Poor therapeutic alliance is common, contributing to substantial worsening of disease and more research on compliance and therapeutic alliance evaluation is needed. Information and tools must be proposed to practitioners.