Adherence to Antipsychotics, COVID-19 and Stigma: A Rainbow After the Storm?

Abstract

Poor adherence to antipsychotic treatment is the main reason for relapse and admission in patients with severe mental illness (SMI). In addition to apprehensions about side effects, factors for non-adherence include the stigma of mental illness, which also extends to its treatment and which is further compounded by negative perceptions of antipsychotics within the medical profession itself. By reinforcing misconceptions around antipsychotics, warnings at the outbreak of pandemic associating antipsychotic use with coronavirus disease 2019 (COVID-19) related risks could have discouraged antipsychotic prescribing when it was otherwise indicated and also disrupted adherence of SMI patients to the treatment they need. Several studies on risk of antipsychotic use during the pandemic adopted inappropriate inclusion criteria and reached conclusions that proved misleading, particularly if applied to SMI patients. Methodological flaws included ill-defined cohort groups and not accounting for adherence to treatment or clinical indication for antipsychotic prescribing. Conversely, reports from the clinical setting, which were later corroborated in clinical studies, have shown that adherence to antipsychotics may actually protect from COVID-19, thus indicating that the benefits of adhering to antipsychotic treatment extend beyond controlling psychotic symptoms alone. Evidence emerging from the COVID-19 experience adds to the view that adherence to second generation antipsychotics in SMI offers a therapeutic effect to both mental and physical health. This validation of modern antipsychotics as a vital medical asset can prove a turning point in the fight to dispel the stigma of SMI and its treatment.