Jennifer B Levin1, Curtis Tatsuoka2, Kristin A Cassidy3, Michelle E Aebi3, Martha Sajatovic4. 1. Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA; Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, OH, USA. Electronic address: Jennifer.levin@uhhospitals.org. 2. Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, OH, USA; Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA. 3. Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA. 4. Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA; Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
Abstract
OBJECTIVES: While medication treatment is necessary for the successful management of bipolar disorder (BD), non-adherence rates are up to 60%. Although medication attitudes are believed to be relevant to adherence behavior, few studies have investigated the trajectories of adherence change. This study evaluated attitudinal correlates of adherence conversion in 86 poorly adherent individuals with BD. METHODS: This secondary analysis pooled data from two uncontrolled prospective trials of customized adherence enhancement (CAE), a psychosocial intervention delivered over 4-6 weeks. Poor adherence was defined as missing at least 20% of prescribed BD medication based on the self-reported Tablets Routine Questionnaire (TRQ). The sample was dichotomized into converters who achieved good adherence (N=44) and non-converters who remained poorly adherent (N=21). Converters vs. non-converters were compared on adherence, attitudes, and symptoms at baseline, 6 weeks and 3 months. RESULTS: At baseline, converters and non-converters were similar demographically and clinically, but converters were less non-adherent (32% doses missed) than non-converters (59% missed). At 6 weeks, converters had better attitudes than non-converters. At 3 months, converters maintained improvements, but group differences were less pronounced due to some improvement in non-converters. Converters had better adherence at 3 months and trajectories differed for the groups on attitudes. Symptoms gradually improved for both converters and non-converters. CONCLUSIONS: Over two-thirds of poorly adherent BD patients who received CAE converted to good adherence. Improved medication attitudes may be a driver of improved adherence behavior and ultimately reduce BD symptoms.
OBJECTIVES: While medication treatment is necessary for the successful management of bipolar disorder (BD), non-adherence rates are up to 60%. Although medication attitudes are believed to be relevant to adherence behavior, few studies have investigated the trajectories of adherence change. This study evaluated attitudinal correlates of adherence conversion in 86 poorly adherent individuals with BD. METHODS: This secondary analysis pooled data from two uncontrolled prospective trials of customized adherence enhancement (CAE), a psychosocial intervention delivered over 4-6 weeks. Poor adherence was defined as missing at least 20% of prescribed BD medication based on the self-reported Tablets Routine Questionnaire (TRQ). The sample was dichotomized into converters who achieved good adherence (N=44) and non-converters who remained poorly adherent (N=21). Converters vs. non-converters were compared on adherence, attitudes, and symptoms at baseline, 6 weeks and 3 months. RESULTS: At baseline, converters and non-converters were similar demographically and clinically, but converters were less non-adherent (32% doses missed) than non-converters (59% missed). At 6 weeks, converters had better attitudes than non-converters. At 3 months, converters maintained improvements, but group differences were less pronounced due to some improvement in non-converters. Converters had better adherence at 3 months and trajectories differed for the groups on attitudes. Symptoms gradually improved for both converters and non-converters. CONCLUSIONS: Over two-thirds of poorly adherent BD patients who received CAE converted to good adherence. Improved medication attitudes may be a driver of improved adherence behavior and ultimately reduce BD symptoms.
Authors: Marcia Valenstein; Frederic C Blow; Laurel A Copeland; John F McCarthy; John E Zeber; Leah Gillon; C Raymond Bingham; Thomas Stavenger Journal: Schizophr Bull Date: 2004 Impact factor: 9.306
Authors: Jennifer B Levin; Anna Krivenko; Ashley Bukach; Curtis Tatsuoka; Kristin A Cassidy; Martha Sajatovic Journal: J Nerv Ment Dis Date: 2017-03 Impact factor: 2.254
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