Bipolar disorder and adherence: implications of manic subjective experience on treatment disruption

Abstract

ObjectiveTherapeutic observance is one of the cornerstones of bipolar disease prognosis. Nostalgia of previous manic phase has been described as a cause of treatment retrieval in bipolar disorder. But to date no systematic study has examined manic episode remembering stories. Our aim was to describe manic experience from the patient’s point of view and its consequences on subjective relation to care and treatment adherence.Patients and methodsTwelve euthymic patients with bipolar I disorder were interviewed about their former manic episodes and data was analyzed, thanks to a grounded theory method.ResultsNostalgia was an anecdotal reason for treatment retrieval in bipolar I disease. Although the manic experience was described as pleasant in a certain way, its consequences hugely tarnish the memory of it afterward. Treatment interruption appears to be mostly involuntary and state-dependent, when a euphoric subject loses insight and does not see any more benefit in having treatment.ConclusionConsciousness destructuring associated with mood elation should explain treatment disruption in bipolar I patients more than nostalgia. Taking a manic episode story into account may help patients, family, and practitioners to achieve better compliance by improving their comprehension and integration of this unusual experience.

Mundo de Pólus serious game for people with bipolar disorder

“…This helps them set and fulfill the tasks at the scheduled times. The literature indicates that routines are an important treatment target for people with BD 30 …”

“…One of the missions in the game is to address the difficulties in adherence to drug treatments. Difficulties in adherence to drug treatments are a serious, prevalent problem among people with BD 29,30,31,32 . To encourage players to take their medication correctly, special conditions are applied to the avatar based on the player's medication consumption, in addition to the reminders and rewards from the missions.…”

“…The literature indicates that routines are an important treatment target for people with BD. 30 One of the missions in the game is to address the difficulties in adherence to drug treatments. Difficulties in adherence to drug treatments are a serious, prevalent problem among people with BD.…”

“…Difficulties in adherence to drug treatments are a serious, prevalent problem among people with BD. 29,30,31,32 To encourage players to take their medication correctly, special conditions are applied to the avatar based on the player's medication consumption, in addition to the reminders and rewards from the missions. In other words, when the player does not take their medication as scheduled, it will be more difficult to maintain the stability of their avatar's mood.…”

Relation of medication adherence to cognitive functions in egyptian patients with bipolar I disorder

“…As with other chronic disorders, medication nonadherence is a common problem in bipolar I disorder (BDI), with an approximate rate of 20-60% of the patients (Lingam and Scott, 2002;Gonzalez-Pinto et al, 2006;Sajatovic et al, 2009;Belzeaux et al, 2013;Murru et al, 2013;Col et al, 2014). It is the main reason for relapse and rehospitalization, and suicidality (Pompili et al 2009), as well as a key prognostic factor at 15 years follow-up (Bulteau et al, 2018).…”