Medication Non‐Adherence in First Episode Psychosis: A Systematic Review

Objective Despite the efficacy of antipsychotics, medication non‐adherence remains common among individuals with a First Episode of Psychosis (FEP). Methods A systematic review was conducted in accordance with the PRISMA 2020 guidelines to summarise the existing evidence base regarding the reasons, attitudes, and beliefs underlying both medication non‐adherence and adherence in FEP, as well as psychosocial interventions designed to promote medication adherence in psychosis. Results Seventy‐six studies were eligible for inclusion. Nineteen reasons for medication non‐adherence in FEP were identified, which were synthesised into 10 overarching themes: Insight and Perceived Need, Autonomy and Control, Trust and the Therapeutic Relationship, Cultural and Spiritual Factors, Side Effects and Perceived Inefficacy, Social and Family Influences, Stigma, Practical Barriers, Substance Use and Symptom‐Driven Factors. Facilitators of adherence included illness insight, motivation to recover and fear of relapse, trust in clinicians, acceptance of the bio‐psychosocial model, experiencing positive treatment outcomes, use of digital reminders and social support. A range of psychosocial interventions demonstrated effectiveness for enhancing medication adherence in psychosis. This included Cognitive Behaviour Therapy, psychoeducation, motivational interviewing, adherence therapy, assertive community treatment, and adherence‐focused psychosocial skills training, particularly when delivered in combination. Conclusion Medication non‐adherence in FEP is shaped by a complex interplay of personal, relational, cognitive, cultural and systemic influences. Addressing these factors in the design and delivery of psychosocial interventions may serve to improve medication adherence outcomes in early psychosis. To support clinical application, this review also provides a fictitious clinician–client transcript along with Socratic questions and CBT strategies to assist clinicians in assessing and promoting medication adherence in FEP.