El following work tries to show the difficulty of adherence to the treatment of our patients and the factors that influence the same one.

To establish an alliance terapeútica in a patient with diagnosis of paranoid Esuizofrenia submitted to dialysis with void conscience of disease.

Secondary chronicle treats itself about a 49-year-old male diagnosed of paranoid Schizophrenia with a renal disease to a chronic familiar GN in phase V in dialysis nowadays. He does not arouse of mental illness.

Renal chronic insufficiency in daily dialysis. Badly TA’s control and irregular follow-up of the diet. From Nefrología’s consultation they request interconsultation and psychiatric treatment.It is sent for nefróloga for valuation of pharmacological treatment by the aim to improve the adherence to his dialysis. From the first moment it considers to work together with nefrología to adapt treatment, being the mediating one the sister-in-law. We initiate treatment with paliperidona 3mgr/día. We remind that it of the nefróloga every day on having come to dialysis. Later we initiate treatment with injectable Risperidona of long duration 25mgr/14 days in increasing dose up to 75mgr/14días with good response.

Though it keeps small conscience of presenting a mental illness, he accepts the treatment, improving both the psychotic symptomatology and the acceptance of his physical ailments.

The multidisciplinary attention in the psychiatric patient and especially in the mental serious patient it is fundamental to obtain a good alliance and adherence to the treatment, and therefore to improve the forecast.