Illness experience and reasons for nonadherence among individuals with bipolar disorder who are poorly adherent with medication

Abstract

Aim Nonadherent individuals are the most likely to avoid participating in research studies, thus limiting potential opportunities to develop evidence-based approaches for adherence enhancement. This mixed-method analysis evaluated factors related to adherence among 20 poorly adherent community mental health clinic patients with bipolar disorder (BD). Methods Illness experience was evaluated with qualitative interview. Quantitative assessments measured symptoms (Hamilton Depression Rating Scale, Young Mania Rating Scale, Brief Psychiatric Rating Scale), adherence behavior, and treatment attitudes. Poor adherence was defined as missing 30% or more of medication. Results Minorities (80%), unmarried individuals (95%), and those with substance abuse (65%) predominated in this nonadherent group of patients with BD. Individuals were substantially depressed (mean Hamilton Depression Rating Scale, 19.2), had at least some manic symptoms (mean Young Mania Rating Scale, 13.6), and had moderate psychopathology (mean Brief Psychiatric Rating Scale, 41.2). Rates of missed medications were 41% to 43%. Forgetting to take medications was the top reason for nonadherence (55%), followed by side effects (20%). Disorganized home environments (30%), concern regarding having to take long-term medications (25%) or fear of side effects (25%), and insufficient information regarding BD (35%) were relatively common. Almost one third of patients had individuals in their core social network who specifically advised against medication. Access problems included difficulty paying for medications among more than half of patients. Interestingly, patients reported good relationships with their providers. Conclusions Forgetting to take medication and problems with side effects are primary drivers of nonadherence. Lack of medication routines, unsupportive social networks, insufficient illness knowledge, and treatment access problems may likewise affect overall adherence. Complementary quantitative and qualitative data collection can identify reasons for nonadherence and may inform specific clinical approaches to enhance adherence.

Relationship between drug compliance, coping with stress, and social support in patients with bipolar disorder

“…Low social support increases development of the disease, and decreases recovery chance (51). Sajatovic et al (52) reported that supportive social networks, and problems in access to treatment might affect the compliance, and it was determined in the study that there were individuals against drug treatment in nearly 1/3 of nuclear social network of patients. Oral et al (16) performed a study on bipolar patients, and reported that there were significantly more individuals in social networks of patients who could comply with treatment than the ones who could not.…”

Psychoeducation for Bipolar Mood Disorder

“…Treatment compliance is one of the prognostic predictors in bipolar disorder (Velligan, 2010). The influencing elements in low compliance are alcohol and drug abuse consumption, severity of symptoms, young age, negative attitude to treatment, insufficient information about the problem and inaccessibility of medical services (Sajatovic, 2011).…”

“…Adherence enhancement. Considering the fact that the most important cause of relapse in bipolar patients is non-adherence (Guscott & Taylor, 1994;Silverstone et al, 1998) and common reasons of non-adherence are incorrect information, fear of side effects and dependency, and lack of information about the illness and the necessity of treatment (Sajatovic et al, 2011), adherence enhancement is one of the main points of psychoeducation sessions. Many patients are not capable to follow the correct instruction of taking medicine and this has been pointed out as the main cause of non-adherence (Sajatovic et al, 2011); thus it is necessary that patient is kept informed about different kinds of drugs for bipolar disorder, the ways of monitoring their effects, and the side effects of each, so that they would know how to manage side effects and also gain insight to disadvantage of discontinuation of medication.…”

Improving medication adherence in patients with chronic disease using a targeted and tailored approach

“…Forgetting to take medication is a common reason that has been consistently associated with nonadherence. 46,67,105,[114][115][116] Patient medication beliefs and how these beliefs affect medication adherence have also been extensively studied. 4,41,42,44,88,89,[117][118][119][120][121][122] One of the most commonly used adherence scales, the Beliefs about Medicines Questionnaire-Specific (BMQ-S), elicits beliefs about the necessity of medicines and concerns about medicines.…”

“…214 As discussed in Section 1.4, patients are non-adherent due to many different reasons, and may be subjected to different types of non-adherence concurrently (Section 1.2.4). 1,18,87,89,90,93,96,100,114,115,145,147 Both are important to consider when selecting an appropriate intervention to address non-adherence. 33 Identifying the reasons for nonadherence facilitates a strategy to address these reasons, which can be described as a tailored intervention.…”