2.1 PSYCHOPHARMACOLOGICAL IMPORTANCE OF MEDICATION ADHERENCE AMONG ADOLESCENTS AND YOUNG ADULTS WITH BIPOLAR DISORDER

Abstract

Pharmacotherapy is effective for bipolar disorder (BD) in adolescents and young adults (AYAs); however, suboptimal adherence, often defined as missing ≥80% of prescribed medication, occurs in greater than 65% of AYAs with BD. Poor adherence is associated with relapse. The objectives of this presentation are to: 1) summarize findings of a recent systematic literature review (SLR) on adherence in pediatric BD; 2) evaluate focus group and usability data from AYAs and family stakeholders; and 3) review methods of a randomized controlled trial pilot testing Customized Adherence Enhancement AYA (CAE-AYA), a novel behavioral intervention to promote adherence. The SLR found 6 original reports specific to pediatric BD. Ten AYAs with BD and 4 caregivers participated in focus groups/interviews, and 8 AYAs provided usability testing of CAE-AYA. The randomized controlled trial is testing the feasibility and preliminary efficacy of CAE-AYA vs enhanced treatment as usual in 40 AYAs (ages 16-21 years) with BD and suboptimal adherence. The primary outcome is change from baseline in adherence assessed with the Tablets Routine Questionnaire and electronic adherence monitoring. Secondary outcomes include mental illness symptoms, quality of life, and the posited mechanisms of adherence change as it relates to the adherence barriers of inadequate bipolar knowledge, poor communication with clinicians/family, unstable medication routines, and risky behaviors. Significant factors affecting adherence in AYAs include gender, race, polypharmacy, comorbidity, socioeconomic status, family functioning, medication side effects, stability of bipolar diagnosis, and number of follow-up visits. Qualitative findings noted similar issues, as well as challenges in shared decision making in BD management with parents/guardians. Usability testing of CAE-AYA modules revealed the need to have matched language with developmental level (eg, teenager vs young adult) and appealing visual images to enhance engagement. Adherence promotion often requires a multipronged approach and ideally addresses adherence barriers specific to an individual and their family and support network. Ongoing randomized controlled trial outcomes will inform next steps in further developing effective adherence promotion approaches for high-risk BD youth.