Psychiatry Clinical Practice Guidelines: 2018 Midyear Review

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO


July 10, 2018

In This Article

Antipsychotic Adherence Testing

Expert panel on urine monitoring to assess antipsychotic medication adherence

The 6 indications for monitoring at the time of initial evaluation are as follows:

  • The patient has an established diagnosis of a serious mental illness.

  • The patient presents with new symptoms of a serious mental illness.

  • The patient has a serious mental illness and is at risk for poor adherence.

  • The patient has a serious mental illness and is homeless.

  • The patient has a co-occurring substance use disorder.

  • The patient is elderly.

Recommendations for repeated monitoring include the following:

  • Patients should undergo repeat monitoring when there is concern about a previous monitoring result.

  • Repeat monitoring is recommended when there is a change in the patient's situation, such as in level of care or living requirement, that may require medication reconciliation.

  • Repeat monitoring is recommended when the patient experiences clinical deterioration or does not respond adequately to treatment.

  • The panel recommends that periodic testing be conducted, either at set intervals or on random occasions.

  • The panel recommends that, for stable patients, testing be conducted at least annually.

The panel also made the following recommendations:

  • Urine should be collected on site where the medication is prescribed.

  • Verbal or written education should be provided on possible costs and the importance of treatment adherence before urine monitoring is conducted.

  • After testing, patients should be informed of the results.

  • A clinician should be available to address any patient concerns.



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