Psychiatry Clinical Practice Guidelines: 2018 Midyear Review

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.

References

• Brauser D. New Consensus on Urine Test Recommendations for Antipsychotic Adherence. Medscape News. WebMD Inc. December 29, 2017. https://www.medscape.com/viewarticle/890744

• Cohen AN, Collins G, Nucifora FC Jr. Clinical Consensus Recommendations for Urine Testing of Adherence to Antipsychotics Among People With Serious Mental Illness. Psychiatr Serv. 2017 Dec 15. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201700082

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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: John Anello, Brian Feinberg, John Heinegg, et. al. Psychiatry Clinical Practice Guidelines: 2018 Midyear Review - Medscape - Jul 10, 2018.