Evaluation of factors associated with medication adherence in patients with bipolar disorder using a medication event monitoring system: a 6‐month follow‐up prospective study

Abstract

Background Non-adherence in patients with bipolar disorder (BD) results in symptoms, such as aggravation, BD recurrence, emergency room visits, re-hospitalization, and poor psychosocial outcomes. Though non-adherence rates have been reported to range between 30–50% in patients with BD, the problem of adherence is often either overlooked by the physician or denied by the patient. An essential first step to enhancing medication adherence is to objectively estimate adherence. The Medication Event Monitoring System (MEMS), which is a pill bottle cap with a microprocessor, is an accurate device for assessing medication adherence. Using the MEMS, we aimed to measure medication adherence in patients with BD and evaluate the factors associated with and 6-month changes in medication adherence. Methods Participants with BD were recruited from the psychiatric outpatient clinic of the Korea University Guro Hospital. The medication adherence of each participant was assessed using the MEMS, a self-report, pill count, and clinician rating. MEMS-measured adherence was reassessed after 6 months. Patient demographics were recorded and clinical assessments were conducted. Data were analyzed using Kappa statistics and Pearson’s correlation analysis. Results Of the 59 participants, 50 records were included in the analysis. Patient adherence and adherence rate assessed by the MEMS were lower than those assessed by the other measures. MEMS-measured adherence was correlated more closely with pill counts than with self-reports or clinician ratings. MEMS-measured adherence was negatively associated with prescription duration and the Brief Psychiatric Rating Scale—Affect Subscale Score. Six-month changes in MEMS-measured adherence were positively associated with attitude toward drugs and negatively associated with weight gain assessed by the Udvalg for Kliniske Undersøgelser Side Effect Rating Scale. Conclusions Clinicians may have to consider the limited accuracy of self-reporting and clinician rating methods and exercise caution when assessing the medication adherence of patients with BD using these methods. Our findings may assist clinicians in the assessment and improvement of medication adherence in patients with BD and, consequently, may be useful for the treatment and prevention of BD recurrence.

Controversies regarding Lithium-associated weight gain: Case-control study of real-world drug safety data

“…Further, a detailed monitoring of weight and metabolic parameters before and during drug treatment may help clinicians to disentangle lithium effects from pre-existing co-morbidities, such as baseline obesity (Kemp et al, 2014;McElroy et al, 2016). Body weight has to be assessed regularly and frequently by patients and during each visit to their psychiatrists or lithium clinics (Felber et al, 2018;Youn et al, 2022). The data presented in this paper aims to increase awareness of the metabolic pro le of lithium to ensure safe and successful treatment with lithium, which is the mainstay of rst-line treatment for bipolar disorder according to leading guidelines (Yatham et al, 2018).…”

“…Obese patients with bipolar disorders may present a patient subgroup with more severe illness manifestations as they may suffer from more severe symptoms of longer duration (Fagiolini et al, 2003); a potential confounder for this pattern may be the role of adherence to pharmacological treatment, which may be negatively associated with weight gain related to the prescribed medication (Youn et al, 2022). In other words, bipolar patients suffering from weight gain related to lithium or other mood stabilizers are less likely to be adherent (Youn et al, 2022) and, thus, more likely to relapse (Bauer et al, 2019). Further, the use of multiple drugs (i.e., polypharmacy) which includes lithium, may also cause adverse metabolic reactions (Gomes-da-Costa et al, 2022).…”

Controversies regarding lithium-associated weight gain: case–control study of real-world drug safety data

“…Some underline the predictive role of obesity regarding treatment outcomes, with obese patients being at high risk for relapse in the long term (Fagiolini et al 2003 ). Obese patients with bipolar disorders may present a patient subgroup with more severe illness manifestations as they may suffer from more severe symptoms of longer duration (Fagiolini et al 2003 ); a potential confounder for this pattern may be the role of adherence to pharmacological treatment, which may be negatively associated with weight gain related to the prescribed medication (Youn et al 2022 ). In other words, bipolar patients suffering from weight gain related to lithium or other mood stabilizers are less likely to be adherent (Youn et al 2022 ) and, thus, more likely to relapse (Bauer et al 2019 ).…”

The Impact of Psychosomatic Factors on Treatment Adherence of Acute Myocardial Infarction Survivors; A Two-Year Follow-Up Study

“…[ 10 ] It seems that other psychosomatic factors can significantly affect TA. [ 14 15 16 17 ] Psychosomatic factors significantly affect treatment compliance and patients’ therapeutic behavior. These factors include, for instance, the ways patients’ experience and respond to their health statuses like health anxiety and illness denial and psychological features that have been frequently and consistently found in chronic disease patients, such as irritable mood and demoralization.…”

“…As believed by some other studies, illness denial undermine medication adherence. [ 14 17 ] Although all these studies were conducted among patients with other chronic disease, only a few of those were among CHD patients. Therefore, this present study becomes essential.…”