Treatment Adherence In Bipolar Disorder Research Articles

Efficacy of Psychoeducation to Improve Medication Adherence among Bipolar Affective Disorder

Bipolar affective disorder is a chronic disorder with evidence of lack of medication adherence, a high relapse rate, significant general disability and burden of psychosocial impairment that often persists for long time. Therefore, Enhancement of treatment adherence in bipolar disorder is a necessary and promising management component as an adjunct to pharmacotherapy. The objective of this systematic review is to determine the effects of psycho-educational interventions on medication adherence among BPAD patients. An electronic literature search was performed using PubMed, cochrane library and google scholar other sources like reports, thesis, or dissertation from May 2012 to March 2020. Search was focused on full text articles available in english, studies had been conducted among adult patients, quantitative RCTs, experimental studies on individual and group psychoeducational intervention. The present review included 10 experimental studies published online. The most literature supports the usefulness psychoeducation on medication adherence in bipolar affective disorder.

Treatment alliance and adherence in bipolar disorder

The clinician patient relationship lies at the core of psychiatric practice and delivery of mental health care services. The concept of treatment alliance in psychiatry has its origins in psychotherapy, but has also been influenced by several other constructs such as patient-centred care (PCC) and shared decision-making (SDM). Similarly, there has been a shift in conceptualization of treatment-adherence in psychiatric disorders including bipolar disorder (BD) from illness-centred and clinician-centred approaches to patient-centred ones. Moreover, the traditional compliance based models are being replaced by those based on concordance between clinicians and patients. Newer theories of adherence in BD place considerable emphasis on patient related factors and the clinician patient alliance is considered to be one of the principal determinants of treatment-adherence in BD. Likewise, current notions of treatment alliance in BD also stress the importance of equal and collaborative relationships, sensitivity to patients’ viewpoints, sharing of knowledge, and mutual responsibility and agreement regarding decisions related to treatment. Accumulated evidence from quantitative research, descriptive accounts, qualitative studies and trials of psychosocial interventions indicates that efficacious treatment alliances have a positive influence on adherence in BD. Then again, research on the alliance-adherence link in BD lags behind the existing literature on the subject in other medical and psychiatric conditions in terms of the size and quality of the evidence, the consistency of its findings and clarity about underlying processes mediating this link. Nevertheless, the elements of an effective alliance which could have a positive impact on adherence in BD are reasonably clear and include PCC, collaborative relationships, SDM, open communication, trust, support, and stability and continuity of the relationship. Therefore, clinicians involved in the care of BD would do well to follow these principles and improve their interpersonal and communication skills in order to build productive alliances with their patients. This could go a long way in confronting the ubiquitous problem of non-adherence in BD. The role of future research in firmly establishing the alliance-adherence connection and uncovering the processes underlying this association will also be vital in devising effective ways to manage non-adherence in BD.

Feasibility and Acceptability of a Mobile Intervention to Improve Treatment Adherence in Bipolar Disorder

We evaluated the feasibility and acceptability of a 2-week-long ecological momentary intervention (EMI), delivered via personal digital assistants (PDAs), to improve treatment adherence in bipolar disorder. EMIs use mobile technology to deliver treatment as clients engage in their typical daily routines, in their usual settings. Overall, participants (N = 14) stated that EMI sessions were helpful, user-friendly, and engaging, and reported satisfaction with the timing and burden of sessions, as well as the method of delivery. All participants completed the study, and all PDAs were returned undamaged. On average, participants completed 92% of EMI sessions. Although this study was not designed to assess efficacy, depression scores decreased significantly over the study period and data suggest relatively high rates of treatment adherence; missed medication was reported 3% of the time and three participants reported missing a total of six mental health appointments. Negative feedback largely involved technical and logistical issues, many of which are easily addressable. These preliminary findings add to the growing body of literature indicating that mobile-technology-assisted interventions are feasible to implement and acceptable to patients with serious mental illnesses.

Effect of Psycho-Educative Intervention on Adherence to Treatment, Knowledge and Attitude among Persons with Bipolar Affective Disorder (BPAD) – Randomized Controlled Trial

Introduction: Enhancement of treatment adherence in bipolar disorder is a necessary and promising management component as an adjunct to pharmacotherapy. The main purpose of the study was to find the effect of psycho-educative intervention on adherence to treatment among persons with BPAD. Method: A randomized controlled trial was conducted with a sample size of 50; 24 in experimental and 26 in control group. Four sessions of psycho-education was given to the patient in experimental group and the outcome was measured immediately after the intervention and at 1 month and 3 months. Results: The study findings shows that there was a significant improvement of knowledge and attitude scores among the experimental group to the control group(p =0.001).There was a difference in adherence seen between the groups, however the difference was not statistically significant (p = 0.111). Conclusion: From the present study it was concluded that psycho educative intervention along with pharmacotherapy is one of the most easy, flexible and cost effective intervention to enhance treatment adherence in bipolar disorder.

Suboptimal treatment adherence in bipolar disorder: impact on clinical outcomes and functioning

BackgroundThe 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.MethodsA 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.ResultsThree 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).ConclusionA 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.

Strategies for Increasing Treatment Adherence in Bipolar Disorder

Although bipolar disorder cannot be cured, effective medications are available that can shorten the duration of illness episodes and reduce the rates of relapse. Unfortunately, treatment nonadherence is common among patients with bipolar disorder. Factors contributing to nonadherence vary, and nonadherence can be deliberate or accidental. Strategies to improve medication adherence include forming a strong alliance with patients, educating patients and their caregivers about the disorder and the importance of adherence, simplifying medication regimens, monitoring tolerability and proactively addressing adverse effects, and treating comorbid illnesses.

Treatment adherence in bipolar disorder

Purpose: A high level of treatment adherence is essential in patients with bipolar disorder for effective treatment, due to chronic progressive nature of the illness requiring maintenance treatment. Treatment nonadherence in individuals with bipolar disorder is the main reason for relapse and recurrence. The purpose of this study is to investigate the relationship between treatment adherence and the level of medication treatment adherence in the last month, socio-demographic and clinic characteristics affecting adherence, and the number of follow-up examinations within the last year in euthymic bipolar patients who registered at a psychiatry outpatient clinic at least a year ago. Method: The sample group of this study comprised of 147 euthymic patients, aged over 18, who visited the Psychiatry Outpatient Clinic of Malatya State Hospital, and diagnosed with a Bipolar Disorder in accordance with DSM-IV, and had been monitored at the clinic for at least a year because of this diagnosis. The hospital records were examined simultaneously for patients attending their follow-up examinations between 02.01.2011 and 02.28.2011. The patients, who had computerized records as of February 01, 2010, were included in this study, and their number of follow-up examinations was obtained from hospital records. The information regarding participating patients’ demographic variables, clinical properties, and their attitude towards their illness and treatment were recorded in the Data Gathering Form. The patients were categorized in two groups; those that had taken their medication or taken it irregularly for less than seven days within the last month were categorized as “treatment adherent,” and those that had not taken their medication or taken it irregularly for more than seven days within the last month were categorized as “treatment nonadherent.” SPSS 16.0 was used for the statistical data analysis. The data of treatment adherent group was compared to the data of treatment nonadherent group. Results: 108 (73.5%) patients were treatment adherent, while 39 (26.5%) patients were treatment nonadherent. The level of education (based on 8 years) was higher in the treatment adherent group (pl0.001). The rate of hospitalization was lower in the treatment adherent group in comparison to the treatment nonadherent group (pl0.05). The rate of attending to follow-up examinations within the last year (t= -5.42) and the level of insight towards their illness was higher in the treatment adherent group (pl0.001). There was no difference between the two groups in terms of their present medication or drug combinations (pg0.05). The treatment adherent group believed that they were more informed about their illness and treatment in comparison to the nonadherent group (pl0.001). The treatment nonadherent group believed that treatment had no effect on their disorder more than the treatment adherent group (pl0.05); the rate of disregarding medication because they thought they had recovered was higher in the treatment nonadherent group in comparison to the treatment adherent group (pl0.001). The rate of abandoning treatment, because of thinking that they had recovered, was higher in comparison to the rate of not taking medication, because they thought the treatment was not effective (p=0.04, ?2=8.64). The number of patients, who were discontent about taking medication, was higher in the treatment nonadherent group (pl0.05). Conclusion: In this study, some characteristics such as a lower education level, thinking that they had inadequate information regarding their illness, lack of insight, and dissatisfaction with treatment, were significantly higher in the treatment nonadherent group. The most common reason behind discontinued treatment was that individuals believed that they had recovered from their disorder and discontinued their medication(s).

Improving treatment adherence in bipolar disorder: a review of current psychosocial treatment efficacy and recommendations for future treatment development.

Treatment adherence is a frequent problem in bipolar disorder, with research showing that more than 60% of bipolar patients are at least partially nonadherent to medications. Treatment nonadherence is consistently predictive of a number of negative outcomes in bipolar samples, and the discontinuation of mood stabilizers places these patients at high risk for relapse. Several types of adjunctive treatment (family, psychoeducational, cognitive-behavioral) have been investigated for improving symptoms and functioning in bipolar patients with some success. To date, less attention has been paid to developing treatments specifically to promote treatment adherence to and engagement with pharmacological as well as behavioral treatments in patients with bipolar disorder. First, we review the effects of adjunctive interventions specifically on treatment adherence outcomes in 14 published clinical trials. Based on this empirical knowledge base, we present a preliminary description of the treatment strategies that appear most promising for improving adherence. The article also provides research recommendations for developing more effective interventions for the purpose of improving bipolar treatment adherence. Finally, special treatment considerations, including the potential impact of comorbid substance abuse and bipolar depression, are discussed.

LS-04. Satellite symposium: Overcoming common barriers to treatment adherence in bipolar disorder

LS-04. Satellite symposium: Overcoming common barriers to treatment adherence in bipolar disorder

Mood stabilizers and treatment adherence in bipolar disorder: addressing adverse events.

Adverse events associated with lithium and anticonvulsant use in patients with bipolar disorder have been determined to decrease rates of treatment adherence; however, research that explores how adverse events influence treatment adherence, and which events have the greatest impact, is sparse and limited. This paper reviews the existing literature regarding common side effects encountered with lithium and anticonvulsant use in patients with bipolar disorder and presents data regarding their impact on treatment adherence. Guidelines for reducing and limiting adverse events are highlighted, as are recommendations for improving compliance associated with the experience of adverse events in the bipolar disorder population.

Mood Stabilizers and Treatment Adherence in Bipolar Disorder: Addressing Adverse Events

Mood Stabilizers and Treatment Adherence in Bipolar Disorder: Addressing Adverse Events