CLINICAL HANDBOOK OF SCHIZOPHRENIA

27. Illness Self-Management Training 271have it. Many clients are relieved to learn they have a specific disorder for which effectivetreatments are known. For clients who are resistant to the term schizophrenia, it can behelpful to explain that it is simply a way of describing a group of symptoms that commonlyoccur together. If the client still does not accept the diagnosis, the clinician shouldexplore other terms or phrases that may be more acceptable to the client, such as mentalillness, nervous condition, chemical imbalance, or simply “these kinds of problems ” or“the experiences you’ve been having.”Information about schizophrenia needs to be taught in a lively, interactive style thatprovides the client with frequent opportunities to relate the information to his or her ownexperiences. The clinician pauses frequently and asks questions to make sure the clientunderstands the materials and to help him or her identify personal examples relevant tothe information. Educational handouts about schizophrenia, its causes, and its treatmentare available from a variety of sources (e.g., Gingerich & Mueser, 2002) that can facilitateteaching and be shared with significant others, such as family members.Improving Medication AdherencePoor adherence to antipsychotic medication is an important contributor to relapse andrehospitalization. Problems with adherence are not easy to detect, and a combination ofapproaches is usually most effective. Unexplained relapses and rehospitalizations, or severesymptoms in a client who has previously been successfully stabilized on medications,may be indications that he or she is not taking the medication as prescribed. Clients’ selfreportsof medication adherence are often inaccurate, although reports of nonadherencemay be more accurate than reports of adherence. The reports of significant others or residentialstaff members about the client’s medication adherence are sometimes more accurate,although they depend on frequent contact with the client and may be subject to thesame biases as self-reports. The most accurate way of evaluating adherence is to count theclient’s pills to determine the percentage of missed dosages of medication, although eventhis can be challenging (accounting for free samples, liquid medications, etc.).A number of strategies are useful for improving medication adherence. First, clientsbenefit from basic information about the effects of medication on reducing symptomsand preventing relapses, as well as the common side effects that may discourage adherence.Second, motivation to take medications should be developed by exploring how reducingsymptoms or hospitalizations can help clients accomplish their personal goals.Some clients benefit from constructing a list of the pros and cons of taking medication.Once clients understand the role of medications more fully and are motivated to takethem, several methods may be used to improve adherence. One of the simplest strategies,behavioral tailoring, involves taking medication at the same time as another daily activity,such as brushing teeth or watching a favorite TV program. Simplifying the medicationregimen by working with the prescriber to reduce the number of medications takenthroughout the day can facilitate adherence. Teaching clients how to use pill organizers(“pill boxes”) can make it easier for them to keep track of whether they have taken theirmedications. Alarms, including those available on some watches and cell phones, can behelpful to remind clients when it is time to take medication.Finally, clients who have had consistent problems with medication adherence despiteefforts to implement the strategies we have described may benefit from taking medicationin an injectable depot form. Many clients see the value of taking medication but havedifficulty taking oral medication regularly. Discussing the merits of taking injectable medicationscan make the client aware of a viable alternative to oral medication that is consistentwith the goals of illness self-management.