Predictors of nonadherence among individuals with bipolar disorder receiving treatment in a community mental health clinic

Abstract

Background-Subjective experience of illness is a critical component of treatment adherence in populations with bipolar disorder (BPD). This cross-sectional analysis examined clinical and subjective variables in relation to adherence in 140 individuals with BPD receiving treatment with mood stabilizing medication.

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013

“…New data provide further insight into adherence to maintenance therapy in patients with BD. In several analyses, adherence was positively associated with higher satisfaction with medication, monotherapy, a college degree, and fear of relapse, and was negatively associated with illness factors (substance use, previous hospitalization, psychotic symptoms, reduced insight into illness), medication factors (side effects, no perceived daily benefit, difficulties with medication routines), and patient attitudes (belief that medications are unnecessary, negative attitudes toward medications, perceived change in appearance, perceived interference with life goals) (133)(134)(135)(136)(137)(138)(139). Under-dosing can also lead to higher discontinuation rates; patients receiving lower doses of ziprasidone had significantly higher discontinuation rates than those receiving medium or high doses (140).…”

Group psychoeducation in the bipolar disorder – its influence on the cognitive representation of illness and the basic personality dimensions. Study with control group.

“…The same holds true for studies on the influence of psychoeducation on this aspect. Some researchers believe that patients who cooperate poorly in treatment often display decidedly external locus of health control in contrast to patients who cooperate well [15,16], whereas others point to the greater ease in submitting to control from other people and greater dependence on others in patients who cooperate well [17,18]. French researchers observed that in patients diagnosed with bipolar disorders who took part in psychoeducation there was a significant increase in external locus of control, which was interpreted as a rise in trust towards healthcare staff [19].…”

Treatment adherence in bipolar disorder

“…This nonadherence is related to unsuccessful treatment results, increased relapse rates (8,9), rehospitalization (9,10), suicidal behavior, and increased care costs. Treatment nonadherence to BD is thought to be the main reason of relapse and recurrence (2,11).…”

“…A relationship has been identified between treatment nonadherence and demographic variables of patients such as age, gender, and ethnicity and illnessspecific characteristics such as the severity of the illness or other additional illnesses. Additionally, some studies report that treatment risks, personal differences in understanding the requirements of medical treatment, unbearable side effects of drugs, complicated drug applications, insufficient knowledge regarding the illness (13), the fear of being stigmatized (9), lack of insight (14), low education level, personality disorders, and abusing additional substances associated with treatment are all factors that have an adverse effect on treatment adherence (2,15). The attitude of individuals that suffer from a severe mental illness towards their illness and treatment play an extremely important role in determining the treatment adherence of individuals.…”