Bipolar disorder in adults: Managing poor adherence to maintenance pharmacotherapy
- Eduard Vieta, MD, PhD
Eduard Vieta, MD, PhD
- Professor of Psychiatry
- University of Barcelona
- Francesc Colom, PhD, PsyD, MSc
Francesc Colom, PhD, PsyD, MSc
- Senior Researcher
- Mental Health Program
- Hospital del Mar Medical Research Institute
Adherence to pharmacotherapy is often poor in chronic medical illnesses, including bipolar disorder [1-3]. Poor adherence is usually addressed during maintenance-phase treatment when patients are euthymic and stable.
This topic reviews management of poor adherence to medications in bipolar disorder. Selecting a treatment regimen for maintenance treatment of bipolar disorder and the adjunctive psychotherapies that are used for maintenance treatment are discussed separately. (See "Bipolar disorder in adults: Choosing maintenance treatment" and "Bipolar disorder in adults: Psychoeducation and other adjunctive maintenance psychotherapies".)
Bipolar disorder — Bipolar disorder is a mood disorder that is characterized by episodes of mania (table 1), hypomania (table 2), and major depression (table 3) . The subtypes of bipolar disorder include bipolar I and bipolar II. Patients with bipolar I disorder experience manic episodes, and nearly always experience hypomanic and major depressive episodes. Bipolar II disorder is marked by at least one hypomanic episode, at least one major depressive episode, and the absence of manic episodes. Additional information about the clinical features and diagnosis of bipolar disorder is discussed separately. (See "Bipolar disorder in adults: Clinical features" and "Bipolar disorder in adults: Assessment and diagnosis", section on 'Diagnosis'.)
Medication adherence — Adherence to pharmacotherapy encompasses taking medication as prescribed with regard to dose, frequency, and timing . Adherence can be quantified on a continuum as a percentage of doses taken as prescribed during a specific interval, or expressed categorically as good, partial, and poor adherence . It is not known what level of adherence is required for good outcomes such as avoiding relapse. Common but arbitrary cutoffs for good adherence are taking at least 70 or 80 percent of prescribed doses. Adherence within patients can change over time and vary between different drugs .
EPIDEMIOLOGY OF NONADHERENCE
Prevalence — Many studies have found that poor adherence with pharmacotherapy occurs in roughly 50 percent of bipolar patients [7-19]. As an example:
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- Bipolar disorder
- Medication adherence
- EPIDEMIOLOGY OF NONADHERENCE
- - Long-acting injectable antipsychotics
- Risk factors
- General approach
- - Therapeutic alliance
- - Monitoring
- - Customized pharmacotherapy
- - Access to clinicians
- - Negative expectations
- Specific interventions
- - Group psychoeducation
- - Cognitive-behavioral therapy
- - Family therapy
- - Other