Petri Arvilommi1, Kirsi Suominen1, Outi Mantere2, Sami Leppämäki3, Hanna Valtonen1, Erkki Isometsä4. 1. Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki, Finland; Psychiatric and substance abuse services, Helsinki City Department of Social Services and Health Care, Helsinki, Finland. 2. Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland. 3. Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland; Finnish Institute of Occupational Health, Helsinki, Finland. 4. Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland; Department of Psychiatry, University of Helsinki, Finland. Electronic address: erkki.isometsa@hus.fi.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. LIMITATIONS: Serum concentrations were not estimated. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. LIMITATIONS: Serum concentrations were not estimated. CONCLUSIONS: 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.
Authors: Jennifer B Levin; Michelle E Aebi; Molly Howland; Marina Barboza; Logan Eskew; Curtis Tatsuoka; Kristin A Cassidy; Martha Sajatovic Journal: J Nerv Ment Dis Date: 2020-02 Impact factor: 1.899
Authors: Arthur D P Mak; Sebastiaan F W Neggers; Owen N W Leung; Winnie C W Chu; Jenny Y M Ho; Idy W Y Chou; Sandra S M Chan; Linda C W Lam; Sing Lee Journal: Int J Bipolar Disord Date: 2021-12-08