Psychiatrists' perceptions of potential reasons for non- and partial adherence to medication: results of a survey in bipolar disorder from eight European countries.

BACKGROUND: Partial/non-adherence to medication by patients with bipolar disorder is associated with exacerbation of symptoms, neurocognitive decline and increased risk of suicide and has a major influence on patient outcomes. Understanding psychiatrists' views on the causes and management of non-adherence are vital to address adherence problems effectively.
METHODS: A 15-question survey was conducted of 2448 psychiatrists treating patients with bipolar disorder in eight European countries to ascertain their perceptions of the level and causes of non-adherence, and their preferred methods by which to assess it.
RESULTS: A majority of patients (57%) were estimated to be partially/non-adherent. Three in four psychiatrists responded that most patients who deteriorated after stopping medication were unable to attribute this to non-adherence. An irregular daily routine/living circumstance affecting adherence was considered the most important reason for patients discontinuing medication. Only 4% of psychiatrists deemed intolerable side effects had led to most patients stopping their medication; 11% responded that drug/alcohol consumption may have impacted on adherence to medication for the majority of patients. LIMITATIONS: The survey was not distributed to all psychiatrists in the countries and the impact on the results, of any difference in the demographics of the respondents with respect to the population of psychiatrists across the eight countries, is not known.
CONCLUSIONS: Partial/non-adherence remains a considerable problem amongst patients with bipolar disorder. There is a need for increased knowledge concerning partial/non-adherence at the level of the clinician-patient interaction, to reduce its impact and bring about improved clinical outcomes.