Kaitlin B Casaletto1, Sara Kwan2, Jessica L Montoya1, Lisa C Obermeit1, Ben Gouaux3, Amelia Poquette3, Robert K Heaton3, J Hampton Atkinson4, David J Moore5. 1. SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA. 2. Department of Psychology, University of Chicago, Chicago, IL, USA. 3. Department of Psychiatry, University of San Diego, CA, USA. 4. Department of Psychiatry, University of San Diego, CA, USA VA San Diego Healthcare System, San Diego, CA, USA. 5. Department of Psychiatry, University of San Diego, CA, USA djmoore@ucsd.edu.
Abstract
OBJECTIVE: HIV infection and bipolar disorder are highly comorbid and associated with frontostriatal disruption, emotional dysregulation, and neurocognitive impairment. Psychiatric and cognitive factors have been linked to antiretroviral nonadherence; however, predictors of psychotropic adherence among HIV+ individuals with psychiatric comorbidities have not been explored. We evaluated predictors of psychotropic adherence among individuals with HIV infection and bipolar disorder. METHOD: Psychiatric medication adherence of 50 participants with HIV infection and bipolar disorder was tracked for 30 days using Medication Event Monitoring Systems. Participants completed neurocognitive, neuromedical, and psychiatric batteries. RESULTS: Mean psychotropic adherence rate was 78%; 56% of participants achieved ≥90% adherence. Younger age and onset of depressive symptoms, more severe current depressive symptoms, number of previous psychiatric hospitalizations and suicide attempts, poorer neurocognition, and more negative attitudes and self-beliefs toward medications univariably predicted worse psychotropic adherence (p's < .10). A multivariable model demonstrated a combination of current depressive symptoms and more negative attitudes toward medications significantly predicting poorer adherence (R(2 )= 0.27, p < 0.003). Secondary analyses revealed an interaction between neurocognition and mood, such that individuals with HIV infection and bipolar disorder who had greater executive dysfunction and depressive symptoms evidenced the poorest psychotropic adherence (p < 0.001). CONCLUSIONS: Both psychiatric and neurocognitive factors contribute to poorer psychotropic adherence among HIV+ individuals with serious mental illness. Adherence interventions aimed at remediating these factors may be especially fruitful.
OBJECTIVE:HIV infection and bipolar disorder are highly comorbid and associated with frontostriatal disruption, emotional dysregulation, and neurocognitive impairment. Psychiatric and cognitive factors have been linked to antiretroviral nonadherence; however, predictors of psychotropic adherence among HIV+ individuals with psychiatric comorbidities have not been explored. We evaluated predictors of psychotropic adherence among individuals with HIV infection and bipolar disorder. METHOD:Psychiatric medication adherence of 50 participants with HIV infection and bipolar disorder was tracked for 30 days using Medication Event Monitoring Systems. Participants completed neurocognitive, neuromedical, and psychiatric batteries. RESULTS: Mean psychotropic adherence rate was 78%; 56% of participants achieved ≥90% adherence. Younger age and onset of depressive symptoms, more severe current depressive symptoms, number of previous psychiatric hospitalizations and suicide attempts, poorer neurocognition, and more negative attitudes and self-beliefs toward medications univariably predicted worse psychotropic adherence (p's < .10). A multivariable model demonstrated a combination of current depressive symptoms and more negative attitudes toward medications significantly predicting poorer adherence (R(2 )= 0.27, p < 0.003). Secondary analyses revealed an interaction between neurocognition and mood, such that individuals with HIV infection and bipolar disorder who had greater executive dysfunction and depressive symptoms evidenced the poorest psychotropic adherence (p < 0.001). CONCLUSIONS: Both psychiatric and neurocognitive factors contribute to poorer psychotropic adherence among HIV+ individuals with serious mental illness. Adherence interventions aimed at remediating these factors may be especially fruitful.
Authors: David J Moore; Carolina Posada; Mili Parikh; Miguel Arce; Florin Vaida; Patricia K Riggs; Ben Gouaux; Ronald J Ellis; Scott L Letendre; Igor Grant; J Hampton Atkinson Journal: AIDS Behav Date: 2012-11
Authors: Charles H Hinkin; Terry R Barclay; Steven A Castellon; Andrew J Levine; Ramani S Durvasula; Sarah D Marion; Hector F Myers; Douglas Longshore Journal: AIDS Behav Date: 2007-03
Authors: Amelia J Poquette; David J Moore; Ben Gouaux; Erin E Morgan; Igor Grant; Steven Paul Woods Journal: J Int Neuropsychol Soc Date: 2012-10-25 Impact factor: 2.892
Authors: Charles H Hinkin; David J Hardy; Karen I Mason; Steven A Castellon; Ramani S Durvasula; Mona N Lam; Marta Stefaniak Journal: AIDS Date: 2004-01-01 Impact factor: 4.177
Authors: Louise Foley; James Larkin; Richard Lombard-Vance; Andrew W Murphy; Lisa Hynes; Emer Galvin; Gerard J Molloy Journal: BMJ Open Date: 2021-09-02 Impact factor: 3.006
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