Medication Adherence in Patients with Bipolar Disorder: A Comprehensive Review

Sajatovic, Martha; Krivenko, Anna; Howland, Molly; Schlachet, Rebecca; Sajatovic, Martha

doi:10.1007/s40263-016-0368-x

Cited by 85 publications

(77 citation statements)

References 137 publications

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“…However, determiners of poor treatment adherence in BD still remain a challenging problem in the management [18]. Male gender, subsyndromal symptoms during remission, comorbidities especially substance use disorder, and side effects of medical treatment were associated with poor treatment adherence in previous studies [19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Assessing the treatment adherence and clinical correlates of low adherence among bipolar disorder outpatients: a cross-sectional study

Karadağ

Kokurcan

Güriz

et al. 2018

Psychiatry and Clinical Psychopharmacology

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OBJECTIVE: The aim of this study was to assess sociodemographic and clinical correlates of poor treatment adherence among outpatients with bipolar disorder (BD) in remission period. METHODS: This was a cross-sectional study carried out in a University Hospital in Turkey, and 117 outpatients with BD according to DSM-IV-TR criteria were included. All participants were administered a sociodemographic form, the SCID-I, the Morisky 8-item Medication Adherence Questionnaire, the Hamilton Depression Scale, the Young Mania Rating Scale, Schedule for Assessing the three components of insight, and Global Assessment of Functioning Scale. Collected data were analysed via descriptive statistics and logistic regression was used to determine significant variables. RESULTS: Patients with poor treatment adherence were low educated, were more likely to be not married, and had a greater prevalence of anxiety disorder comorbidity. The patients with poor adherence also showed more subsyndromal depressive symptoms but no significant differences were seen in terms of age, gender, living status, social support, or number of episodes between patients with good and poor adherence. Logistic regression analyses revealed that comorbid anxiety disorder, lower education level, and duration of depression period were the main predictors of poor adherence. CONCLUSION: This outcome is consistent with previous studies, and assuring complete adherence in all bipolar patients is difficult, but increasing the number of adherent patients is possible and substantial for sufficient outcome. Improving subsyndromal symptoms and awareness of the patient about the features of the disorder may provide better adherence to treatment and greater functionality of the patient. Psychotherapeutic interventions and psychoeducation should be implemented along with the medical treatment to improve subsyndromal symptoms and to avoid treatment maladherence in advance. Further research is needed to assess the role of interventions in treatment adherence of patients with BD.

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Section: Introductionmentioning

confidence: 99%

Assessing the treatment adherence and clinical correlates of low adherence among bipolar disorder outpatients: a cross-sectional study

Karadağ

Kokurcan

Güriz

et al. 2018

Psychiatry and Clinical Psychopharmacology

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“…It is obvious and understandable that most patients with BD seek help and treatment during depressive episodes (often preferring the prescription of the only antidepressant without a mood stabilizer or an antipsychotic), but they often refuse the treatment with mood stabilizers or antipsychotic for hypomanic, manic or mixed episodes or may discontinue the treatment during these phases of illness [12]. Several studies and reviews had concluded that about 40% to 50% of patients with BD (range 9%-66%) do not take their medications regularly as prescribed and rates are basically the same irrespective of whether patients are taking mood stabilizers or antipsychotics [13]. Moreover, the nonadherence in DB seems unchanged or even increased over the years even with the introduction of numerous new drugs and often clinicians appear to be mostly likely to underestimate non-adherence in their patients with BD [14].…”

Section: Some Critical Challenges In the Contemporary Clinical Intervmentioning

confidence: 99%

Second Generation Long-Acting Antipsychotics in the Treatment of Bipolar Disorder: A Clinical Viewpoint

Berardis¹,

Fornaro²,

Orsolini³

et al. 2018

Bipolar Disord

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Bipolar Disorder (BD) is a severe, chronic and disabling condition. The gold standard of treatment is lithium, but the introduction of Second Generation Long-Acting Antipsychotics (SGA-LAIs) has been addressed several problems in the administration of oral SGAs in BD such as the patient's adherence to the treatment. The aim of this commentary was to provide an overview of the use of SGA-LAIs in the treatment of BD. All considered, the use of SGA-LAIs such as Risperidone Long-Acting and Aripiprazole Long-Acting may have an important impact on the maintenance treatment of BD both in monotherapy or in association with mood stabilizers. In our opinion, the treatment with a SGA-LAI should be initiated as early as possible in BD, especially when non-adherence is suspected. Moreover, as personality disorders (PD) and BD may often coexist, it is worthy to note that the PD-BD comorbidity may further decrease treatment adherence and, therefore, we believe that the early use of a SGA-LAI both in monotherapy or in association with mood stabilizers may dramatically improve the compliance and the overall outcomes in such cases. However, he safety profile should be always kept in mind when choosing an SGA-LAI in the treatment of BD.

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“…[15][16][17][18][19] However, changes in the level of the recommendations for AAP monotherapy from second-line to first-line in KMAP-BP 2018 might reflect the increased concerns for adherence and burden of adverse events that negatively affect the combination treatment. 20,21) The equivalent recommendation level for AAP monotherapy and the combination of an AAP and a MS was supported by a recent meta-analysis suggesting that the efficacy advantages of antipsychotics and MS combination versus monotherapy should be balanced with its greater burden of adverse events. 22) The difference in the recommendation grade among AAPs for monotherapy in the KMAP-BP 2018, e.g., OLZ and QUE as the first-line and ARI and RIS as the second-line, is not easy to explain.…”

Section: Mania and Hypomaniamentioning

confidence: 99%

Korean Medication Algorithm Project for Bipolar Disorder 2018 (KMAP-BP 2018): Fourth Revision

Woo

Bahk

Lee

et al. 2018

Clin Psychopharmacol Neurosci

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Objective: The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was first published in 2002 through an expert consensus of opinion, and updated in 2006, 2010, and 2014. This study constitutes the fourth revision of the KMAP-BP. Methods: A 50-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for various phases of adult bipolar disorder and six items for pediatric bipolar disorder. The review committee included 84 Korean psychiatrists and 43 child and adolescent psychiatry experts. Results: The preferred first-step strategies for acute mania were the combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP), MS monotherapy, and AAP monotherapy. A combination of a MS and an AAP, and AAP monotherapy were preferred for psychotic mania. The first-step strategies for mild to moderate bipolar depression were monotherapy with MS, AAP, or lamotrigine (LMT), and the combination of a MS and an AAP or LMT, or a combination of an AAP and LMT. The combination of two among a MS, AAP, and LMT were preferred for non-psychotic severe depression. A combination of a MS and an AAP or the combination of an AAP with an antidepressant or LMT were the first-line options for psychotic severe depression. Conclusion: The recommendations of the KMAP-BP 2018 have changed from the previous version by reflecting recent developments in pharmacotherapy for bipolar disorder. KMAP-BP 2018 provides clinicians with a wealth of information regarding appropriate strategies for treating patients with bipolar disorder.

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Medication Adherence in Patients with Bipolar Disorder: A Comprehensive Review

Cited by 85 publications

References 137 publications

Assessing the treatment adherence and clinical correlates of low adherence among bipolar disorder outpatients: a cross-sectional study

Assessing the treatment adherence and clinical correlates of low adherence among bipolar disorder outpatients: a cross-sectional study

Second Generation Long-Acting Antipsychotics in the Treatment of Bipolar Disorder: A Clinical Viewpoint

Korean Medication Algorithm Project for Bipolar Disorder 2018 (KMAP-BP 2018): Fourth Revision

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