Citation

Perlis RH, Ostacher MJ, Miklowitz DJ, Hay AC, Nierenberg AA, Thase ME, Sachs GS. J. Clin. Psychiatry 2010; 71(3): 296-303.

Affiliation

Bipolar Clinic and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. rperlis@partners.org

Copyright

(Copyright © 2010, Physicians Postgraduate Press)

DOI

10.4088/JCP.09m05514yel

PMID

20331931

Abstract

BACKGROUND: Poor medication adherence is common among bipolar patients. METHOD: We examined prospective data from 2 cohorts of individuals from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study (1999-2005) with bipolar disorder. Clinical and sociodemographic features associated with missing at least 25% of doses of at least 1 medication were assessed using logistic regression, and a risk stratification model was developed and validated. RESULTS: Of 3,640 subjects with 48,287 follow-up visits, 871 (24%) reported nonadherence on 20% or more study visits. Clinical features significantly associated (P < .05) with poor adherence included rapid cycling, suicide attempts, earlier onset of illness, and current anxiety or alcohol use disorder. Nonadherence during the first 3 months of follow-up was associated with less improvement in functioning at 12-month follow-up (P < .03). A risk stratification model using clinical predictors accurately classified 80.6% of visits in an independent validation cohort. CONCLUSION: Risk for poor medication adherence can be estimated and may be useful in targeting interventions.

Language: en