Treatment adherence with antipsychotic medications in bipolar disorder

Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Bipolar Disorders (Impact Factor: 4.97). 07/2006; 8(3):232-41. DOI: 10.1111/j.1399-5618.2006.00314.x
Source: PubMed


Atypical antipsychotic medications are a relatively new, increasingly prominent component of the treatment armamentarium for bipolar disorder. Information on adherence with antipsychotics among individuals with bipolar disorder in general, and atypical antipsychotics in particular, is currently quite limited. Using data from the VA National Psychosis Registry, we examined adherence with antipsychotic medications among patients with bipolar disorder (n = 73,964).
Antipsychotic medication adherence among veterans with bipolar disorder was evaluated using the medication possession ratio and categorizing patients into three groups: fully adherent, partially adherent and non-adherent. We compared characteristics of bipolar patients who received versus those who did not receive antipsychotic medication, and also identified predictors of poor adherence with antipsychotic medications.
Approximately 45% (n = 32,993) of all individuals with bipolar disorder were prescribed antipsychotic medication. Individuals who were prescribed antipsychotic medications were younger and more often had comorbid substance abuse or post-traumatic stress disorder compared to individuals with bipolar disorder who were not prescribed antipsychotic medication. Just over half (51.9%) of individuals appear to be fully adherent with antipsychotic medications, while 48.1% of individuals are either partially adherent or non-adherent with antipsychotic medications. Factors associated with treatment non-adherence were younger age, minority ethnicity, comorbid substance abuse and homelessness.
Treatment non-adherence is a major issue for close to half of individuals with bipolar disorder prescribed antipsychotic medication. Additional studies are needed to better understand treatment adherence within the full range of pharmacologic therapies among individuals with bipolar disorder.

Download full-text


Available from: Marcia Valenstein, Apr 07, 2015
  • Source
    • "Individual patients′ adherence often changed during the follow-up; thus, adherence at one time-point does not guarantee adherence at another. While adherence rates were not fully consistent, we found them to be very similar between different mood stabilizers, in accord with many previous studies (Baldessarini et al., 2008; Colom et al., 2000; Gianfrancesco et al., 2006; Sajatovic et al., 2006b, 2007), suggesting that nonadherence is more a question of patient factors. Although correlations between categories of drugs were strong, adherence to one drug does not guarantee adherence to another. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Poor treatment adherence among patients with bipolar disorder (BD) is a common clinical problem. However, whether adherence is mostly determined by patient characteristics or attitudes, type of treatment or treatment side-effects remains poorly known. The Jorvi Bipolar Study (JoBS) is a naturalistic prospective 18-month study representing psychiatric in- and outpatients with DSM-IV BD I and II in three Finnish cities. During the 18-month follow-up we investigated the continuity of, attitudes towards and adherence to various types of psychopharmacological and psychosocial treatments among 168 psychiatric in- and outpatients with BD I or II. One-quarter of the patients using mood stabilizers or atypical antipsychotics discontinued medication during at least one treatment phase of the follow-up autonomously, mostly during depression. When pharmacotherapy continued, adherence was compromised in one-third. Rates of non-adherence to mood stabilizers or antipsychotics did not differ, but the predictors did. One-quarter of the patients receiving psychosocial treatments were non-adherent to them. Serum concentrations were not estimated. More than one-half of BD patients either discontinue pharmacotherapy or use it irregularly. Autonomous discontinuation takes place mostly in depression. Although rates of non-adherence do not necessarily differ between mood-stabilizing medications, the predictors for nonadherence do. Moreover, adherence to one medication does not guarantee adherence to another, nor does adherence at one time-point ensure later adherence. Attitudes towards treatments affect adherence to medications as well as to psychosocial treatments and should be repeatedly monitored. Non-adherence to psychosocial treatment should be given more attention.
    Journal of Affective Disorders 10/2013; 155(1). DOI:10.1016/j.jad.2013.10.032 · 3.38 Impact Factor
  • Source
    • "Atypical antipsychotics have become a widely used for the treatment of bipolar disorder. Using data from the Veterans Affairs National Psychosis Registry, Sajatovic and colleagues reported that 45% of subjects with bipolar disorder were on antipsychotics (n = 73,964) as monotherapy or combination therpay.9 The great majority of individuals prescribed antipsychotic agents received atypical compounds (n = 25,559, 94.7%). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Atypical antipsychotics have become a widely utilized component of the bipolar disorder treatment armamentarium, with approximately 45% of bipolar patients prescribed atypicals. Over the last decade all atypical drugs except for clozapine have received a Food and Drug Administration (FDA) bipolar indication. In October 2008, the FDA approved quetiapine XR monotherapy for the treatment of acute depressive episodes of bipolar disorder and acute manic or mixed episodes in bipolar I disorder based on two placebo-control trials. Quetiapine was also approved as adjunct therapy with lithium and divalproex for the treatment of acute manic or mixed episodes as well as maintenance of bipolar I disorder. In contrast to immediate release quetiapine which may require a twice-daily regimen, the XR formulation is intended for once-daily administration. This drug profile of quetiapine XR will address chemistry, pharmacodynamics, pharmacokinetics, metabolism, safety and tolerability and clinical trials in bipolar disorder.
    Neuropsychiatric Disease and Treatment 03/2010; 6(1):29-35. DOI:10.2147/NDT.S4903 · 1.74 Impact Factor
  • Source
    • "For long-term prophylaxis, far fewer agents are available; they include lithium, aripiprazole, and lamotrigine, but of these only lamotrigine has been shown to help prevent depressive relapses (McElroy et al., 2004). In addition, some patients are unable to tolerate existing therapies for BPD, which leads to frequent changes in medications or non-adherence (Sajatovic et al., 2006; Zarate et al., 1999; Zarate and Tohen, 2004). Thus, currently available therapies for BPD are insufficient, and demand the development of new therapeutics that are more effective and better tolerated. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Bipolar disorder (BPD) is a devastating psychiatric illness marked by recurrent episodes of mania and depression. While the underlying pathophysiology of BPD remains elusive, an abnormal hypothalamic-pituitary-adrenal (HPA) axis and dysfunctional glucocorticoid receptor (GR) signaling are considered hallmarks. This review will examine how targeting resiliency signaling cascades at the cellular level may serve as a mechanism to treat BPD. Here, cellular resiliency is defined as the ability of a cell to adapt to an insult or stressor. Such resiliency at the cellular level could confer resiliency at the systems level and, ultimately, help individuals to cope with stressors or recover from depressive or manic states. This review will focus on four molecular targets of mood stabilizers that are known to play integral roles in these cellular resiliency signaling pathways: (1) B-cell CLL/lymphoma 2 (Bcl-2), (2) Bcl-2-associated athanogene (BAG-1), (3) glucocorticoid receptors (GRs), and (4) 51 kDa FK506-binding protein (FKBP5). These targets have emerged from neurobiological and human genetic studies and employ mechanisms that modulate GR function or promote anti-apoptotic processes critical to affective resilience. Future research should focus on elucidating sustainable treatments that target resiliency factors-such as BAG-1 or FKBP5-which could ultimately be used to treat individuals suffering from BPD and prevent relapses in afflicted individuals. Further identification of resiliency and susceptibility factors will also be vital. Ultimately, these developments would allow for the treatment of susceptible individuals prior to the development of BPD.
    Brain research 08/2009; 1293:76-84. DOI:10.1016/j.brainres.2009.06.103 · 2.84 Impact Factor
Show more