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Book Review   |    
Brian B. Sheitman
Psychiatric Services 2008; doi: 10.1176/appi.ps.59.3.335
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edited by Madhu Davies and Faiz Kermani; Hampshire, United Kingdom, Gower Publishing, 2006, 220 pages, $165

Dr. Sheitman is the director of adult admissions at the University of North Carolina-Chapel Hill, Raleigh.

Though it is obvious, we sometimes forget that no matter how good a treatment is, it will work only if the patient complies with it. This book focuses on one aspect of treatment: medications. The book is written from the perspective of medication compliance as it pertains to all medical disorders without any special focus on psychiatric issues. Furthermore, large segments of the book are written from the viewpoint of the pharmaceutical industry. Although I confess to being a card-carrying member of the club that is extremely skeptical of almost anything reported by the pharmaceutical industry, I found this particular volume to be very informative, well written, practical, and unbiased.

The authors are experts in the field of pharmacology, with considerable clinical trials experience. The contributors are an impressive group of experts who are mostly from the United Kingdom but also from the United States, France, Japan, and Australia. This diversity results in an interesting cross-cultural perspective on the issues.

The book is divided into four parts that comprise a total of 14 chapters. The four parts are titled "What is Compliance?," "The Challenge of Compliance," "Building for Success," and "Achieving Compliance: Looking to the Future." The final chapter, written by Kermani, helps to pull together concepts from throughout the book.

I found that the real strength of this book is the editors' approach that medication compliance is a problem that has an impact on all areas of medicine, especially chronic conditions, and that compliance is not solely an issue facing mental health professionals. Chapter 4 provides extensive data about the challenges of achieving treatment compliance with hyperlipidemia and hypertension, two conditions for which proven treatments are available. Other strengths are a thoughtful review of practical issues that affect medication compliance and new technologies that are now available to help promote compliance. The authors' aim to "explore the key factors which drive compliance and the part that healthcare professionals can play in improving this" is clearly achieved.

The weakness of the book is ironically also its strength. Outside of a few references to problems of compliance with the long-term treatment of depression there is no particular emphasis on psychiatric disorders. Given the challenge in the mental health field of treating patients with disorders that often include a lack of insight, an additional chapter on this topic would, in my opinion, be beneficial.

Overall, this volume is very informative to me as a psychiatrist despite the lack of emphasis on psychiatric conditions. In addition, anyone involved in the broader area of medication compliance could certainly benefit from reading this. Based on the data provided, expecting patients to be fully compliant with medications over a prolonged period of time is unrealistic for most people. As the authors emphasize, an enhanced effort to ensure compliance with treatment is essential to an individual patient's well-being and also remains a major public health concern.




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