Abstract
Objective
Since sustained treatment‐adherence is often problematic and may limit clinical outcomes among bipolar disorder (BPD) patients, we sought risk factors to guide clinical prediction of nonadherence.
Methods
Data were from a 2005 US national sample providing questionnaire responses by 131 randomly selected prescribing psychiatrists and their adult BPD patients. We contrasted demographic and clinical factors in treatment‐adherent versus nonadherent patients (strictly defined as missing ≥1 dose within 10 days) in univariate analyses followed by multivariate logistic‐regression modeling.
Results
Of 429 DSM‐IV BPD patients (79% type‐I; 62% women; 17% minorities), 34% reported missing ≥ 1 dose of psychotropic medication within 10 days, 20% missed entire daily doses at least once, and only 2.5% missed all doses for 10 days. However, their prescribing psychiatrists considered only 6% as treatment‐nonadherent. Factors significantly associated with nonadherence in multivariate modeling ranked: alcohol‐dependence > youth > greater affective morbidity > various side effects ≥ comorbid obsessive‐compulsive disorder ≥ recovering from mania‐hypomania. Unrelated were sex, diagnostic subtype, and other comorbidities. Since most patients received ≥ 2 psychotropics, potential relationships between treatment‐complexity and adherence were obscured.
Conclusions
Prevalent treatment‐nonadherence among American BPD patients, and striking underestimation of the problem by prescribing clinicians may encourage increasingly complex treatment‐regimens of untested value, but added expense, risk of adverse effects, and uncertain impact on treatment‐adherence itself. Copyright © 2007 John Wiley & Sons, Ltd.