BACKGROUND: There are few psychosocial interventions specifically focused on improved treatment adherence in people with bipolar disorder (BD). Customized adherence enhancement (CAE) is a needs-based, manualized approach intended to improve medication adherence in individuals with BD. This was a six-month prospective trial of a CAE among 43 medication non-adherent individuals with BD who were receiving treatment in a community mental health clinic (CMHC). METHODS: CAE was flexibly administered in modules applied as indicated by an initial adherence vulnerabilities screening. Screening identified reasons for non-adherence and modules were then administered using pre-set criteria. CAE effects were evaluated at six-week, three-month, and six-month follow-up. The six-month follow-up was our primary time point of interest. The primary outcome was change from baseline in adherence using the Tablets Routine Questionnaire (TRQ) and pill counts. Secondary outcomes included change from baseline in BD symptoms [Hamilton Depression Rating Scale (HAM-D), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS)]. RESULTS: Subjects completed 86% of scheduled sessions, with only two individuals (5%) not participating in any sessions. The number of dropouts at six months was 12 (28%). Mean baseline non-adherence by TRQ was 48% [standard error (SE) 4.8%] missed tablets within the previous week and 51% (4.1%) missed tablets within the previous month. At six-month follow-up, mean TRQ non-adherence improved to 25% (6.8%) missed tablets for the previous week (p = 0.002) and 21% (5.5%) for the previous month (p < 0.001). Symptoms improved, with a change in the baseline mean (SE) BPRS of 43.6 (1.8) versus an endpoint of 36.1 (2.3) (p = 0.001), and baseline mean (SE) HAM-D of 17.8 (1.1) versus an endpoint of 15.3 (1.6) (p = 0.044). CONCLUSION: CAE was associated with improvements in adherence, symptoms, and functional status. Controlled trials are needed to confirm these preliminary findings.
BACKGROUND: There are few psychosocial interventions specifically focused on improved treatment adherence in people with bipolar disorder (BD). Customized adherence enhancement (CAE) is a needs-based, manualized approach intended to improve medication adherence in individuals with BD. This was a six-month prospective trial of a CAE among 43 medication non-adherent individuals with BD who were receiving treatment in a community mental health clinic (CMHC). METHODS:CAE was flexibly administered in modules applied as indicated by an initial adherence vulnerabilities screening. Screening identified reasons for non-adherence and modules were then administered using pre-set criteria. CAE effects were evaluated at six-week, three-month, and six-month follow-up. The six-month follow-up was our primary time point of interest. The primary outcome was change from baseline in adherence using the Tablets Routine Questionnaire (TRQ) and pill counts. Secondary outcomes included change from baseline in BD symptoms [Hamilton Depression Rating Scale (HAM-D), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS)]. RESULTS: Subjects completed 86% of scheduled sessions, with only two individuals (5%) not participating in any sessions. The number of dropouts at six months was 12 (28%). Mean baseline non-adherence by TRQ was 48% [standard error (SE) 4.8%] missed tablets within the previous week and 51% (4.1%) missed tablets within the previous month. At six-month follow-up, mean TRQ non-adherence improved to 25% (6.8%) missed tablets for the previous week (p = 0.002) and 21% (5.5%) for the previous month (p < 0.001). Symptoms improved, with a change in the baseline mean (SE) BPRS of 43.6 (1.8) versus an endpoint of 36.1 (2.3) (p = 0.001), and baseline mean (SE) HAM-D of 17.8 (1.1) versus an endpoint of 15.3 (1.6) (p = 0.044). CONCLUSION:CAE was associated with improvements in adherence, symptoms, and functional status. Controlled trials are needed to confirm these preliminary findings.
Authors: Martha Sajatovic; Mark S Bauer; Amy M Kilbourne; Julia E Vertrees; William Williford Journal: Psychiatr Serv Date: 2006-01 Impact factor: 3.084
Authors: David J Miklowitz; Michael W Otto; Stephen R Wisniewski; Mako Araga; Ellen Frank; Noreen A Reilly-Harrington; Anna Lembke; Gary S Sachs Journal: Psychiatr Serv Date: 2006-07 Impact factor: 3.084
Authors: Mauricio Tohen; Waldemar Greil; Joseph R Calabrese; Gary S Sachs; Lakshmi N Yatham; Bruno Müller Oerlinghausen; Athanasios Koukopoulos; Giovanni B Cassano; Heinz Grunze; Rasmus W Licht; Liliana Dell'Osso; Angela R Evans; Richard Risser; Robert W Baker; Heidi Crane; Martin R Dossenbach; Charles L Bowden Journal: Am J Psychiatry Date: 2005-07 Impact factor: 18.112
Authors: Martha Sajatovic; Marilyn Davies; Mark S Bauer; Linda McBride; Robert W Hays; Roknedin Safavi; Janis Jenkins Journal: Compr Psychiatry Date: 2005 Jul-Aug Impact factor: 3.735
Authors: Lakshmi N Yatham; Sidney H Kennedy; Claire O'Donovan; Sagar Parikh; Glenda MacQueen; Roger McIntyre; Verinder Sharma; Peter Silverstone; Martin Alda; Philippe Baruch; Serge Beaulieu; Andree Daigneault; Roumen Milev; L Trevor Young; Arun Ravindran; Ayal Schaffer; Mary Connolly; Chris P Gorman Journal: Bipolar Disord Date: 2005 Impact factor: 6.744
Authors: David J Miklowitz; Michael W Otto; Ellen Frank; Noreen A Reilly-Harrington; Stephen R Wisniewski; Jane N Kogan; Andrew A Nierenberg; Joseph R Calabrese; Lauren B Marangell; Laszlo Gyulai; Mako Araga; Jodi M Gonzalez; Edwin R Shirley; Michael E Thase; Gary S Sachs Journal: Arch Gen Psychiatry Date: 2007-04
Authors: L G Sylvia; N A Reilly-Harrington; A C Leon; C I Kansky; J R Calabrese; C L Bowden; T A Ketter; E S Friedman; D V Iosifescu; M E Thase; M J Ostacher; M Keyes; D Rabideau; A A Nierenberg Journal: Acta Psychiatr Scand Date: 2013-10-03 Impact factor: 6.392
Authors: Jennifer B Levin; Nasim Seifi; Kristin A Cassidy; Curtis Tatsuoka; Johnny Sams; Kouri K Akagi; Martha Sajatovic Journal: J Nerv Ment Dis Date: 2014-11 Impact factor: 2.254
Authors: Thomas Canales; Samuel Rodman; Danette Conklin; Kaylee Sarna; Martha Sajatovic; Jennifer B Levin Journal: Psychopharmacol Bull Date: 2022-06-27
Authors: Martha Sajatovic; Jennifer Levin; Luis F Ramirez; David Y Hahn; Curtis Tatsuoka; Christopher S Bialko; Kristin A Cassidy; Edna Fuentes-Casiano; Tiffany D Williams Journal: J Clin Psychiatry Date: 2013-12 Impact factor: 4.384
Authors: Martha Sajatovic; Curtis Tatsuoka; Kristin A Cassidy; Peter J Klein; Edna Fuentes-Casiano; Jamie Cage; Michelle E Aebi; Luis F Ramirez; Carol Blixen; Adam T Perzynski; Mark S Bauer; Steven A Safren; Jennifer B Levin Journal: J Clin Psychiatry Date: 2018-09-25 Impact factor: 4.384
Authors: Martha Sajatovic; Jennifer B Levin; Johnny Sams; Kristin A Cassidy; Kouri Akagi; Michelle E Aebi; Luis F Ramirez; Steven A Safren; Curtis Tatsuoka Journal: Bipolar Disord Date: 2015-09 Impact factor: 6.744