Predictors of nonadherence among individuals with bipolar disorder receiving treatment in a community mental health clinic

Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Comprehensive psychiatry (Impact Factor: 2.25). 03/2009; 50(2):100-7. DOI: 10.1016/j.comppsych.2008.06.008
Source: PubMed


Subjective experience of illness is a critical component of treatment adherence in populations with bipolar disorder (BPD). This cross-sectional analysis examined clinical and subjective variables in relation to adherence in 140 individuals with BPD receiving treatment with mood-stabilizing medication.
Nonadherence was defined as missing 30% or more of medication on the Tablets Routine Questionnaire, a self-reported measure of medication treatment adherence. Adherent and nonadherent groups were compared on measures of attitudes toward illness and treatment including the Attitudes toward Mood Stabilizers Questionnaire, the Insight and Treatment Attitudes Questionnaire, the Rating of Medication Influences, and the Multidimensional Health Locus of Control Scale.
Except for substance abuse comorbidity, adherent individuals (n = 113, 80.7%) did not differ from nonadherent individuals (n = 27, 19.3%) on clinical variables. However, nonadherent individuals had reduced insight into illness, more negative attitudes toward medications, fewer reasons for adherence, and more perceived reasons for nonadherence compared with adherent individuals. The strongest attitudinal predictors for nonadherence were difficulties with medication routines (odds ratio = 2.2) and negative attitudes toward drugs in general (odds ratio = 2.3).
Results interpretation is limited by cross-sectional design, self-report methodology, and sample size.
Comorbid substance abuse, negative attitudes toward mood-stabilizing medication, and difficulty managing to take medication in the context of one's daily schedule are primary determinants of medication treatment adherence. A patient-centered collaborative model of care that addresses negative attitudes toward medication and difficulty coping with medication routines may be ideally suited to address individual adherence challenges.

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    • "We found negative attitude to be an important predictor of non-adherence. Attitudes and beliefs have been shown to be related to medication adherence also in previous studies (Jamison et al., 1979; Pope and Scott, 2003; Sajatovic et al., 2009; Schumann et al., 1999; Scott and Pope, 2002). In fact, Schumann et al. (1999) observed that only a negative attitude towards prophylaxis correlated significantly with non-adherence. "
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    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.
    Full-text · Article · Oct 2013 · Journal of Affective Disorders
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    • "There is significant overlapping between behaviours in some types of psychiatric disorders and drug-related behaviours: maladaptive behaviours, such as those commonly displayed by drug-addicts, may sometimes be due to, or accentuated by, concurrent psychiatric disorders. Thus, a low degree of compliance with therapies is a common symptom of drug addiction and of several forms of psychiatric disorders; this may be devastating in bipolar 1 diagnosis heroin addicts, whose history often includes an earlier onset of drug abuse, a worse course of illness, and a frequent need for hospitalization (Baigent, 2012; Brady and Sonne, 1995; Gonzalez-Pinto et al., 2010; Sajatovic et al., 2009). However, patients were followed up for 3 years on average, and diagnoses were subject to revision whenever further clinical evidence or retrospective information was gathered – a factor that reduces the likelihood of false NDDs. "
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    ABSTRACT: The aim of this study was to compare the long-term outcomes of treatment-resistant bipolar 1 heroin addicts with peers who were without DSM-IV axis I psychiatric comorbidity (dual diagnosis). 104 Heroin-dependent patients (TRHD), who also met criteria for treatment resistance - 41 of them with DSM-IV-R criteria for Bipolar 1 Disorder (BIP1-TRHD) and 63 without DSM-IV-R axis I psychiatric comorbidity (NDD-TRHD) - were monitored prospectively (3 years on average, min. 0.5, max. 8) along a Methadone Maintenance Treatment Programme (MMTP). The rates for survival-in-treatment were 44% for NDD-TRHD patients and 58% for BIP1-TRHD patients (p=0.062). After 3 years of treatment such rates tended to become progressively more stable. BIP1-TRHD patients showed better outcome results than NDD-TRHD patients regarding CGI severity (p<0.001) and DSM-IV GAF (p<0.001). No differences were found regarding urinalyses for morphine between groups during the observational period. Bipolar 1 patients needed a higher methadone dosage in the stabilization phase, but this difference was not statistically significant. The observational nature of the protocol, the impossibility of evaluating a follow-up in the case of the patients who dropped out, and the multiple interference caused by interindividual variability, the clinical setting and the temporary use of adjunctive medications. Contrary to expectations, treatment-resistant patients with bipolar 1 disorder psychiatric comorbidity showed a better long-term outcome than treatment-resistant patients without psychiatric comorbidity.
    Full-text · Article · Aug 2013 · Journal of Affective Disorders
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    • "Medication adherence plays a key role in patients with bipolar disorder.7 Several specific factors associated with nonadherence in bipolar disorder have been reported, including young age, male gender, lower education level, being single, comorbid alcohol and drug abuse, psychotic symptoms during mania or mixed episodes, cognitive impairment, lack of insight, poor attitude towards medication, and work impairment.11–14,29,30 Better understanding of the factors involved in suboptimal adherence with medication for bipolar disorder is crucial because modifiable risk factors could become targets for future interventions. "
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    ABSTRACT: The primary aim of this study was to assess drug treatment adherence in patients with bipolar disorder and to identify factors associated with adherence. The secondary aim was to analyze the impact of suboptimal adherence on clinical and functional outcomes. A cross-sectional study was conducted in a sample of outpatients receiving an oral antipsychotic drug. Medication adherence was assessed combining the 10-item Drug Attitude Inventory, the Morisky Green Adherence Questionnaire, and the Compliance Rating Scale. Logistic regression was used to determine significant variables associated with suboptimal adherence to medication. Three hundred and three patients were enrolled into the study. The mean age was 45.9 ± 12.8 years, and 59.7% were females. Sixty-nine percent of patients showed suboptimal adherence. Disease severity and functioning were significantly worse in the suboptimal group than in the adherent group. Multivariate analysis showed depressive polarity of the last acute episode, presence of subsyndromal symptoms, and substance abuse/dependence to be significantly associated with suboptimal treatment adherence (odds ratios 3.41, 2.13, and 1.95, respectively). A high prevalence of nonadherence was found in an outpatient sample with bipolar disorder. Identification of factors related to treatment adherence would give clinicians the opportunity to select more adequately patients who are eligible for potential adherence-focused interventions.
    Full-text · Article · Jan 2013 · Patient Preference and Adherence
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