Promoting medication adherence among patients with bipolar disorder: a multicenter randomized controlled trial of a multifaceted intervention

Pakpour, Amir H.; Modabbernia, A.; Lin, Chung‐Ying; Saffari, Mohsen; Ahmadzad-Asl, Masoud; Webb, Thomas L.

doi:10.1017/s003329171700109x

Cited by 33 publications

(32 citation statements)

References 43 publications

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“…Subjective well-being, although being desirable, may increase the risk of treatment discontinuation. Strategies, such as shared decision-making (SDM) [ 18 , 19 ], motivational interviewing, psychoeducation and involvement of relatives [ 7 , 20 ], dedicated mood disorder clinics [ 7 ], taking account of executive function in older patients [ 21 ], or offering financial incentives for patients with psychotic disorders [ 22 ], may improve adherence. However, we do not know how well such strategies work specifically in the context of lithium treatment.…”

Section: Discussionmentioning

confidence: 99%

Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study

et al. 2018

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BackgroundLithium remains first choice as maintenance treatment for bipolar affective disorder. Yet, about half of all individuals may stop their treatment at some point, despite lithium’s proven benefits concerning the prevention of severe affective episodes and suicide.MethodsRetrospective cohort study in the Swedish region of Norrbotten into the causes of lithium discontinuation. The study was set up to (1) test whether patients with bipolar affective disorder or schizoaffective disorder, treated with lithium maintenance therapy, were more likely to discontinue lithium because of adverse effects than lack of therapeutic effectiveness, (2) explore gender differences, (3) understand the role of diagnosis and (4) identify who, patient or doctor, took the initiative to stop lithium. Review of medical records for all episodes of lithium discontinuation that had occurred between 1997 and 2013 with the intent to stop lithium for good.ResultsOf 873 patients treated with lithium, 54% discontinued lithium, corresponding to 561 episodes of lithium discontinuation. In 62% of episodes, lithium was discontinued due to adverse effects, in 44% due to psychiatric reasons, and in 12% due to physical reasons interfering with lithium treatment. The five single most common adverse effects leading to lithium discontinuation were diarrhoea (13%), tremor (11%), polyuria/polydipsia/diabetes insipidus (9%), creatinine increase (9%) and weight gain (7%). Women were as likely as men to take the initiative to stop lithium, but twice as likely to consult a doctor before taking action (p < 0.01). Patients with type 1 BPAD or SZD were more likely to discontinue lithium than patients with type 2 or unspecified BPAD (p < 0.01). Patients with type 1 BPAD or SZD were more likely to refuse medication (p < 0.01). Conversely, patients with type 2 or unspecified BPAD were three times as likely to discontinue lithium for lack or perceived lack of effectiveness (p < 0.001).ConclusionsStopping lithium treatment is common and occurs mostly due to adverse effects. It is important to discuss potential adverse effects with patients before initiation and continuously during lithium treatment, to reduce the frequency of potentially unnecessary discontinuations.

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Section: Discussionmentioning

confidence: 99%

Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study

et al. 2018

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“…The intervention used for the control group or the other arm of the study varied in different studies. It was treatment as usual in 31 studies (18-21, 25, 27-29, 34-37, 39-43, 45, 46, 49-51, 53-58, 61, 62, 65-67, 70-75, 78, 79), active intervention in four studies (22, 23, 26, 31, 32, 59, 60), and both treatment as usual and active intervention in five studies (38, 44, 47, 48, 64, 68). Seven studies had no control group (13, 15-17, 33, 69, 76), and one study had both control and placebo groups (14).…”

Section: Resultsmentioning

confidence: 99%

“…The first study was published in 1995. Twenty-one studies took place in Tehran, 23 in the capital cities of provinces, two in towns (35, 69), and two were multicenter (64, 75).…”

Section: Resultsmentioning

confidence: 99%

“…Sample sizes ranged from 15 to 270 in the included studies. Diagnosis of participants was SMD in 13 studies (13, 17, 27-29, 33, 40, 41, 47, 48, 55, 57, 61, 62, 64, 65, 68, 76), schizophrenia in 23 studies (14-16, 18-20, 31-33, 35-39, 42-46, 53, 54, 58-60, 66, 67, 71, 74, 78), and bipolar disorder in 11 studies (21, 25, 26, 34, 49, 50, 56, 69, 70, 74, 75, 79). First episode psychosis was included in 3 studies (22, 23, 33, 51).…”

Section: Resultsmentioning

confidence: 99%

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Family and Patient Psychoeducation for Severe Mental Disorder in Iran: A Review

Mottaghipour

Tabatabaee

2019

IJPS

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Objective: There are evidence-based practices in the field of family and patient psychoeducation for patients suffering from severe mental disorders. However, given the variation in resources and cultural contexts, implementation of these services, especially in low- and middle-income countries is faced with challenges. This study aimed to review articles on family and patient psychoeducation of severe mental disorders in Iran and to find the characteristics of the main components necessary for the implementation of such practices in clinical settings. Method: All published studies on family and patient psychoeducation for severe mental disorders (schizophrenia, schizoaffective, and bipolar disorder) conducted in Iran were searched up to May 2018; and key features and findings of each study were extracted and presented. Results: Forty-eight studies were included in this review, of which 27 were randomized controlled trials, and 20 were quasi-experimental. One study was an implementation and service development report. The main findings of these studies were a significant decrease in relapse rate and/or rehospitalization rate and a significant decrease of burden and distress of families. Conclusion: Despite a wide diversity in approaches, this review showed that different psychosocial interventions in which psychoeducation is one of their core and main components have promising results, demonstrating the significance of this intervention in Iranian mental health research. In our opinion, based on evidence, even with limited resources, it is no longer acceptable to deprioritize some forms of psychoeducation for patients and their families in clinical settings.

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“…In other words, people with BD have a high degree of disability with respect to personal and social domains, which causes a large burden on society. 3 To tackle syndromes and other health outcomes in people with BD, studies have focused on different therapies, including psychoeducation, medication, occupational therapy, psychotherapy, and family therapy. 4,5 An important issue in treating people with BD is their family system, as family members are usually frontline or primary caregivers, providing direct assistance to the patient.…”

Section: Bipolar Disorder (Bd)mentioning

confidence: 99%

Associations between family cohesion, adaptability, and functioning of patients with bipolar disorder with clinical syndromes in Hebei, China

Zhang

Ming

et al. 2019

J Int Med Res

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Objective We aimed to investigate the symptoms of inpatients with bipolar disorder (BD) in different types of families, and to explore the correlations between family coherence, family adaptability, and family functioning among inpatients with BD. Methods Inpatients with BD in Hebei, China (n = 61; mean age = 33.85±10.54; 39 males) participated in this study. Participants’ symptoms were evaluated using the Bech–Rafaelsen Mania Scale (BRMS) and Hamilton Depression Rating Scale (HDRS) at weeks 1, 4, and 8 after their admission to the hospital. Participants’ family type was assessed using the Family Adaptability and Cohesion Scale II–Chinese Version. Family functioning was assessed using Family Assessment Device. Results Participants were classified into three family types: balanced (n = 13), mid-range (n = 28), and extreme (n = 20). BRMS scores improved over time in patients from all three family types. Improvement was slightly better with the balanced than the extreme family type. HDRS scores showed an improving trend over time, although this was not significant. Family coherence, adaptability, and functioning were mutually correlated. Conclusion The family system and family functioning are important factors that clinicians should keep in mind when treating people with BD.

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Promoting medication adherence among patients with bipolar disorder: a multicenter randomized controlled trial of a multifaceted intervention

Abstract: Background: The present research aimed to investigate the efficacy of a multifaceted

Cited by 33 publications

References 43 publications

Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study

Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study

Family and Patient Psychoeducation for Severe Mental Disorder in Iran: A Review

Associations between family cohesion, adaptability, and functioning of patients with bipolar disorder with clinical syndromes in Hebei, China

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