Treatment Adherence and Illness Insight in Veterans With Bipolar Disorder

South Texas Veterans Health Care System, VERDICT, 7400 Merton Minter (11c6), San Antonio, TX 78229-4404, USA.
The Journal of nervous and mental disease (Impact Factor: 1.69). 02/2008; 196(1):16-21. DOI: 10.1097/NMD.0b013e318160ea00
Source: PubMed


Insight into the perceived value of psychotherapy and pharmacological treatment may improve adherence to medication regimens among patients with bipolar disorder, because patients are more likely to take medication they believe will make them better. We conducted a cross-sectional survey of patients recruited into the Continuous Improvement for Veterans in Care-Mood Disorders (CIVIC-MD; July 2004-July 2006), assessing therapeutic insight and 2 measures of medication adherence: the Morisky scale of intrapersonal barriers and missing any doses the previous 4 days. Among 435 patients with bipolar disorder, 27% had poor adherence based on missed dose and 46% had poor adherence based on the Morisky. In multivariable models, greater insight into medication was negatively associated with both measures of poor adherence. Odds of poor adherence increased for women, African Americans, mania, and hazardous drinking. The association of mutable factors-hazardous drinking, manic symptoms, and insight-could represent an opportunity to improve adherence.

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    • "Even if patients continued the medications, about one-third admitted not having used them regularly. Although difficult to compare because of methodological differences, our results are broadly in line with other studies (Colom et al., 2000; Copeland et al., 2008; Gonzalez-Pinto et al., 2010; Keck et al., 1997; Manwani et al., 2007; Perlis et al., 2010; Sajatovic et al., 2006a, 2008, 2009), Table 6 Attitudes towards treatments a at the 6-month follow-up. "
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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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    • "Although there are studies demonstrating a relationship between the severity of manic symptoms and lack of insight (Copeland et al 2008), in our present study, no relation was found between the severity of manic symptoms and the three "
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    ABSTRACT: The aim of this study is to examine the relationship between insight dimensions and clinical features in bipolar disorder. One hundred and four inpatients with bipolar disorder( manic or mixed episodes) diagnosed according to DSM-IV criteria participated in the study. Patients were evaluated both during an acute episode and in remission, prior their discharge from the hospital by the Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression Rating Scale (MADRS), Positive and Negative Syndrome Scale (PANSS), The Scale of Unawareness of Mental Disorders (SUMD), and a questionnaire regarding demographic and clinical characteristics. In remission, 57 patients (54.8%) had insight of their illness while 14 (13.5%)did not have insight. Besides %6.7 of patients did not have the Insight into the effects of medication. We also found that 27.9% of patients were unaware of the social consequences of their illness. Patients with psychotic symptoms had a significantly low level of awareness to the effects of their medication as well as the severeness of their manic episode. We found an unawareness of delusion in these patients. In terms of all SUMD items, female patients had significantly poorer insight compared to men. No correlation was found between the number of hospitalizations, the number of episodes or the first episode type and insight dimensions. Lack of insight in bipolar disorder is not rare. The assesment of insight addresses different components of the illness and the treatment awareness. The severity of illness, aggressive impulse control difficulties, psychotic symptoms especially the presence of delusions, female sex may be important predictors of impaired insight.
    Full-text · Article · Dec 2011 · Turk psikiyatri dergisi = Turkish journal of psychiatry
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    • "The study of insight in mood disorders has traditionally received limited attention, despite its possible impact on both treatment compliance and outcome.1–3 Although impaired insight has been a focus of study in schizophrenia4–10 and depression,11,12 it has been less well studied in bipolar disorder. "
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    ABSTRACT: The study of insight in bipolar disorder has received limited attention, despite its potential impact on treatment compliance and prognosis. In the current study we compare insight levels during different phases of bipolar disorder, and consider its relationship to symptoms dimensions and epidemiologic variables. Insight ratings obtained from 156 bipolar subjects in any phase of bipolar disorder were compared. A regression analysis was also conducted to identify symptom dimensions predictive of insight levels. Greater impairments in insight were observed during pure manic episodes than during mixed or depressed episodes, or during euthymia. Depressive symptoms were associated with better insight. Improvements in insight with treatment were neither complete nor universal. Lack of insight was unrelated to age, years of illness, age of first psychiatric illness, or lifetime number of hospitalizations. Although psychosis may be associated with impaired insight, other variables also impact on degree of impaired insight. Specifically, depressed mood appears to be associated with preservation of insight. That relationship may transcend strict syndromal diagnosis.
    Preview · Article · Oct 2010 · Neuropsychiatric Disease and Treatment
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