Medication nonadherence is common in patients with schizophrenia. Nonadherence affects approximately half of all patients and may increase the risk of relapse and hospitalization. Although it is an intensively studied phenomenon, we have little understanding of underlying mechanisms leading to nonadherence. In this article, using quantitative and qualitative study results and psychological decision theory, we present a model of medication adherence decisions in patients with schizophrenia that may be useful for clinicians and those involved in the development of adherence interventions or adherence research. The model focuses on the function and meaning of medication from a patient perspective. Although the model is a simplified description of the decision-making process related to medication use, it does explain the role of some important aspects such as insight, side effects, efficacy, and social influences. We also discuss how this may explain the high and persistent rates of nonadherence. Finally, we discuss some implications for clinical practice..
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