Objectives This analysis of screening and baseline data from an ongoing trial examined self-report versus automated adherence monitoring and assessed the relationship between bipolar disorder (BD) symptoms and adherence in 104 poorly adherent individuals. Methods Adherence was measured with the Tablets Routine Questionnaire (TRQ) and the Medication Event Monitoring System (MEMS). Symptoms were measured with the Montgomery–Åsberg Depression Rating Scale (MADRS), the Young Mania Rating Scale (YMRS), and the Brief Psychiatric Rating Scale (BPRS). Results Mean age of the sample was 46.3 years [standard deviation (SD) = 9.41], with 72% (n = 75) women and 71% (n = 74) African American subjects. Adherence improved from screening to baseline with a mean missed drug proportion measured by TRQ of 61.43% (SD = 26.48) versus baseline mean of 46.61% (SD = 30.55). Mean proportion of missed medication using MEMS at baseline was 66.43% (SD = 30.40). Correlation between TRQ and MEMS was 0.47. Correlation between a single index drug and all BD medications was 0.95. Symptoms were generally positively correlated with TRQ (worse adherence = more severe symptoms), but in most instances was only at a trend level (p > 0.05) with the exception of correlation between baseline TRQ and MADRS and BPRS, which were positive (r = 0.20 and r = 0.21, respectively) and significant (p ≤ 0.05). Conclusions In patients with BD, monitoring increased adherence by 15%. MEMS identified 20% more non-adherence than self-report. Using a standard procedure to identify a single index drug for adherence monitoring may be one way to assess global adherence in patients with BD receiving polypharmacy treatment. Greater BD symptom severity may be a clinical indicator to assess for adherence problems.

This analysis compared medication attitudes and reasons for non-adherence in three distinct groups of patients with serious mental illness (SMI), Cohort 1 had 43 patients with bipolar disorder (BD) treated in community mental health setting, Cohort 2 had 43 patients with BD taking an atypical antipsychotic and treated in an academic medical center, and Cohort 3 had 30 patients with schizophrenia or schizoaffective disorder who had been homeless in the last year. Standardized attitudinal scales found generally negative attitudes towards medication and limited illness insight. While the 3 cohorts differed with regard to severity of symptoms, age of onset, education, baseline adherence, and race, groups had similar medication attitudes prior to and following treatment. Despite group differences in demographic and clinical variables, our analyses found more similarities than differences in medication attitudes among these three discrete groups of poorly adherent, symptomatic patients with SMI. The common attitudinal characteristics have implications for delivery of healthcare services that can enhance treatment adherence in high-risk SMI patients.

Objective The present study explored both embedded symptom (SVT) and performance (PVT) validity test scores within a post-9/11 veteran sample to elucidate the degree to which there is concordance between validity indicators, as well as how frequently one SVT and four PVT indicators were failed in screened mild traumatic brain injury (mTBI) and diagnosed posttraumatic stress disorder (PTSD). Method A total of 114 post-9/11 veterans were evaluated utilizing the Neurobehavioral Symptom Inventory (NSI) Validity-10, four embedded PVTs, mTBI screening, and a diagnostic interview for PTSD. Results While we found concordance between embedded PVTs and the NSI Validity-10 at select cutoffs (i.e., ≥13, ≥19), symptom and performance validity indicators were clinically dissociable in that only SVT significantly predicted diagnosed PTSD and screened mTBI. Conclusions Dissociation between symptom and performance validity may be clinically useful when interpreting neuropsychological evaluation findings in post-9/11 veterans with a history of mTBI or PTSD.

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