Development of the treatment attitudes questionnaire in bipolar disorder

Abstract

Despite the success of pharmacotherapy in the management of bipolar disorder, as many as one-half of those in treatment discontinue their medication over time. Currently, no self-report measure is available that predicts treatment engagement in bipolar disorder. The goal of the current study was to develop a measure of awareness of symptoms and attitudes toward treatment among those with bipolar disorder. Sixty-six participants diagnosed with bipolar I disorder on the SCID completed the Treatment Attitudes Questionnaire (TAQ) and were then followed for up to 2 years to assess symptom levels. Medication data were available for 37 participants. Analyses of the TAQ were conducted to examine reliability, predictors of subscales, and how well scores predicted medication and symptom levels over time. Results indicate that previous episodes of depression, but not episodes of mania, correlated with increased scores on the Insight and the Enjoyment of Mania subscales. Scores on the Nonbiological Attributions subscale predicted lower levels of lithium as well as increased depressive symptoms over time. Although the current study includes limited measurement of treatment engagement and a small sample size, this easily administered scale may help treatment planning for those with bipolar disorder. Keywords bipolar disorder; treatment adherence; treatment attitudes; treatment attitudes questionnaire "I had become addicted to my high moods; I had become dependent upon their intensity, euphoria, assuredness, and their infectious ability to induce high moods and enthusiasms in other people" (Jamison, 1996).With the introduction of lithium treatment in the late 1960s (Baastrup & Schou, 1967), and the development of other pharmacotherapy approaches, including divalproex, carbamazepine, lamotrigine, and atypical antipsychotics, a range of effective treatments are now available (Muzina & Calabrese, 2005). Although symptoms remain a concern for some on these medications (Judd et al., 2003), evidence has accrued to suggest that mood-stabilizing medications substantially diminish symptoms as well as hospitalization rates (cf., Smith, Cornelius, Warnock, Bell, & Young, 2007). Despite this, estimates suggest that one-third to one-half of patients with bipolar disorder discontinue medication treatment over time (Basco & Rush, 1995;Svarstad, Shireman, & Sweeney, 2001). Lack of adherence to mood stabilizers has been shown to contribute to poorer course of disorder and more frequent hospitalization (Scott & Pope, 2002). Thus, a fundamental challenge in the effective care of bipolar disorder appears to be promoting medication adherence. © 2008 Wiley Periodicals, Inc. Correspondence concerning this article should be addressed to: Daniel Fulford, 5665 Ponce de Leon Blvd, Coral Gables, FL; e-mail: dfulford@psy.miami.edu. NIH Public AccessAuthor Manuscript J Clin Psychol. Author manuscript; available in PMC 2010 January 29. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptTo date, adherence has been a fairly p...

Treatment-adherence in bipolar disorder: A patient-centred approach

“…The exclusive focus on these factors appeared to be driven by biologically and medically orientated conceptualizations of the illness, although the primacy of the biological approach had been the object of criticism for long. Unfortunately, these efforts to predict non-adherence on the basis of demographic and illness-related factors were not very successful[40-44]. This failed quest could be due to several reasons, the principal one being the equivocal and inconsistent results obtained from different studies[40,45,46].…”

“…In other studies attitudinal factors such as doubts about the need for medications, as well as concerns about their adverse effects have been found to account for a substantial proportion of variance in intentional non-adherence[11,19,37,41,87,96]. All kinds of negative attitudes have been found in these studies though the commonest ones appear to be fear of side effects and harm caused by medications[17,19,37,51,75,97], denial of severity of illness and the need for treatment[11,41,46,86,98,99], the negative impact of long-term medications on daily routines and competing priorities of life[37,85,86,98,100,101], perceived ineffectiveness of medications[19,51,69,46,98,102], fears regarding dependence, being controlled or stigmatized by taking medications[35,37,60,75,103], and missing the pleasure experienced during manic episodes because of the mood-controlling effects of medications[37,44,101,104,105]. On the other hand, some patients perceive medications to be helpful and seem to realize the necessity of taking medications to prevent relapses, hospitalizations and other negative consequences[11,69,79,98,106,107].…”

Positive Affect Enhances the Association of Hypomanic Personality and Cognitive Flexibility

“…There are two broader implications for this finding. First, it is important to note that protecting creativity is reported as a major reason for treatment nonadherence among people with bipolar disorder (Johnson & Fulford, 2008; Polatin & Fieve, 1971). Thus, there is a significant need to understand the role of creativity in mania to build acceptable intervention programs for people with bipolar disorder (Murray & Johnson, 2010).…”

“…Similarly, people with affective disorders report that their periods of heightened everyday creativity tended to occur during periods of mildly positive mood states (Richards & Kinney, 1990). Clinically, the idea that positive mood states bolster creativity is often cited as a reason for nonadherence to mood stabilizing medications (Johnson & Fulford, 2008). These studies point toward the need to experimentally examine the role of positive affect in promoting creativity among persons with varying degrees of mania vulnerability.…”

Treatment adherence in bipolar disorder

“…The nonadherence rate is still high, regardless of numerous improvements in medications (16). The patient's treatment adherence is extremely important in obtaining successful long-term results in BD.…”