“Medication non-adherence in First Episode Psychosis 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 help to improve medication adherence outcomes in early psychosis. To support clinical application, we have developed a fictional clinician–client transcript, alongside Socratic questions and CBT strategies, to assist clinicians in assessing and promoting medication adherence in FEP.
Senior Lecturer in Early Intervention in Psychosis, Deputy Director, MSc Early Intervention in Psychosis
24 August 2026
Why might people experiencing a First Episode of Psychosis not take their medication as prescribed?
A new systematic review has examined the reasons, attitudes and beliefs associated with medication non-adherence in people experiencing a First Episode of Psychosis (FEP).
Despite the efficacy of antipsychotic medication, it is common for people experiencing a First Episode of Psychosis (FEP) not to take their medication as prescribed, known as medication non-adherence. This systematic review, published in the journal Early Intervention in Psychiatry, examined the existing evidence regarding the reasons, attitudes and beliefs underlying medication non-adherence and adherence in FEP, as well as psychosocial interventions designed to promote medication adherence in psychosis.
This review comprised of 76 studies and identified 19 reasons for medication non-adherence, which were synthesised into ten 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
- Symptom-Driven Factors
These themes suggest that medication non-adherence can arise from a range of interrelated influences. One example is the medication paradox, whereby people experience an improvement in symptoms after starting medication and consequently perceive less need for ongoing treatment, which can lead to medication discontinuation.
Some of the factors associated with improved medication 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
- Social support
Overall, this review found that medication adherence is influenced by a combination of personal, relational, cognitive and practical factors.
Using the findings of this review, researchers then developed a fictional dialogue between a clinician and a client to effectively demonstrate how Socratic questioning may help explore someone’s beliefs about medication adherence. The team have also developed a list of Socratic questions and CBT strategies for addressing the reasons identified in this review.
‘Medication Non-Adherence in First Episode Psychosis: A Systematic Review’ by James Hunt and Anna Georgiades was published in Early Interventions in Psychiatry.
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Senior Lecturer in Early Intervention in Psychosis Education