Treatment adherence with antipsychotic medications in bipolar disorder
Open accessAbstract
Objectives: Atypical antipsychotic medications are a relatively new, increasingly prominent component of the treatment armamentarium for bipolar disorder. Information on adherence with antipsychotics among individuals with bipolar disorder in general, and atypical antipsychotics in particular, is currently quite limited. Using data from the VA National Psychosis Registry, we examined adherence with antipsychotic medications among patients with bipolar disorder (n = 73,964). Methods: Antipsychotic medication adherence among veterans with bipolar disorder was evaluated using the medication possession ratio and categorizing patients into three groups: fully adherent, partially adherent and non‐adherent. We compared characteristics of bipolar patients who received versus those who did not receive antipsychotic medication, and also identified predictors of poor adherence with antipsychotic medications. Results: Approximately 45% (n = 32,993) of all individuals with bipolar disorder were prescribed antipsychotic medication. Individuals who were prescribed antipsychotic medications were younger and more often had comorbid substance abuse or post‐traumatic stress disorder compared to individuals with bipolar disorder who were not prescribed antipsychotic medication. Just over half (51.9%) of individuals appear to be fully adherent with antipsychotic medications, while 48.1% of individuals are either partially adherent or non‐adherent with antipsychotic medications. Factors associated with treatment non‐adherence were younger age, minority ethnicity, comorbid substance abuse and homelessness. Conclusions: Treatment non‐adherence is a major issue for close to half of individuals with bipolar disorder prescribed antipsychotic medication. Additional studies are needed to better understand treatment adherence within the full range of pharmacologic therapies among individuals with bipolar disorder.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Psychotropic medication adherence was compromised where there were co-morbidities of mental illness and other physical illnesses in three studies.
“In three studies, psychotropic medication adherence was compromised where there were co-morbidities of mental illness and other physical illnesses. Studies [11, 43, 64] reported that medication non-adherence was associated with patients having co-morbidities with their current psychiatric disorders.”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [43]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Davenport, Y. B., Adland, M. L., Gold, P. W., & Goodwin, F. K. (1984) · The Lancet · doi:10.1016/s0140-6736(84)92810-1 · Cited by 2,925 · see citing works
DiMatteo, M. R. (2004) · Medical Care · doi:10.1097/01.mlr.0000114908.90348.f9 · Cited by 2,169 · see citing works
Papageorgis, D. (1991) · Behaviour Research and Therapy · doi:10.1016/0005-7967(91)90087-j · Cited by 1,542 · see citing works
A systematic review of adherence with medications for diabetes
Cramer, J. A. (2004) · Diabetes Care · doi:10.2337/diacare.27.5.1218 · Cited by 1,203 · see citing works
Extending Indications for Long-Term Pharmacotherapy: Opportunities and Challenges
Kane, J. M. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.1.1 · Cited by 989 · see citing works
Treatment non‐adherence in affective disorders
Lingam, R., & Scott, J. (2002) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2002.1r084.x · Cited by 635 · see citing works
Gilmer, T. P., Dolder, C. R., Lacro, J. P., Folsom, D. P., Lindamer, L., Garcia, P., & Jeste, D. V. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.4.692 · Cited by 603 · see citing works
Practice Guideline for the Treatment of Patients With Bipolar Disorder (Revision)
Hirschfeld, R. M. A., Bowden, C. L., Gitlin, M. J., Keck, P. E., Perlis, R. H., Suppes, T. M., Thase, M. E., & Wagner, K. D. (2003) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/foc.1.1.64 · Cited by 586 · see citing works
Risk of Recurrence Following Discontinuation of Lithium Treatment in Bipolar Disorder
Suppes, T. (1991) · Archives of General Psychiatry · doi:10.1001/archpsyc.1991.01810360046007 · Cited by 392 · see citing works
Clinical Factors Associated With Treatment Noncompliance in Euthymic Bipolar Patients
Colom, F., Vieta, E., Martínez‐Arán, A., Reinares, M., Benabarre, A., & Gastó, C. (2000) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v61n0802 · Cited by 340 · see citing works
Pharmacy Data Identify Poorly Adherent Patients With Schizophrenia at Increased Risk for Admission
Valenstein, M. M., Copeland, L. A., Blow, F. C., McCarthy, J. F., Zeber, J. E., Gillon, L., Bingham, C. R., & Stavenger, T. (2002) · Medical Care · doi:10.1097/00005650-200208000-00002 · Cited by 333 · see citing works
Self-citationNonadherence With Mood Stabilizers: Prevalence and Predictors
Scott, J., & Pope, M. (2002) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v63n0502 · Cited by 315 · see citing works
Svarstad, B. L., Shireman, T. I., & Sweeney, J. K. (2001) · Psychiatric Services · doi:10.1176/appi.ps.52.6.805 · Cited by 281 · see citing works
Poor Antipsychotic Adherence Among Patients With Schizophrenia: Medication and Patient Factors
Valenstein, M. M., Blow, F. C., Copeland, L. A., McCarthy, J. F., Zeber, J. E., Gillon, L., Bingham, C. R., & Stavenger, T. (2004) · Schizophrenia Bulletin · doi:10.1093/oxfordjournals.schbul.a007076 · Cited by 273 · see citing works
Self-citationPosttraumatic Stress, Nonadherence, and Adverse Outcome in Survivors of a Myocardial Infarction
Shemesh, E., Yehuda, R., Milo, O., Dinur, I., Rudnick, A., Vered, Z., & Cotter, G. (2004) · Psychosomatic Medicine · doi:10.1097/01.psy.0000126199.05189.86 · Cited by 232 · see citing works
Patient and Physician Attitudes Toward Lithium
Jamison, K. R. (1979) · Archives of General Psychiatry · doi:10.1001/archpsyc.1979.01780080040011 · Cited by 203 · see citing works
Suicides and parasuicides in a high-risk patient group on and off lithium long-term medication
Müller-Oerlinghausen, B., Müser-Causemann, B., & Volk, J. (1992) · Journal of Affective Disorders · doi:10.1016/0165-0327(92)90084-j · Cited by 173 · see citing works
Enhancement of Treatment Adherence Among Patients With Bipolar Disorder
Sajatovic, M., Davies, M. A., & Hrouda, D. R. (2004) · Psychiatric Services · doi:10.1176/appi.ps.55.3.264 · Cited by 162 · see citing works
Self-citationCompliance with maintenance treatment in bipolar disorder.
Keck, P. E., McElroy, S. L., Strakowski, S. M., Bourne, M. L., & West, S. A. (1997) · PubMed · Cited by 154 · see citing works
Factors associated with pharmacologic noncompliance in patients with mania.
Keck, P. E., McElroy, S. L., Strakowski, S. M., Stanton, S. P., Kizer, D. L., Balistreri, T. M., Bennett, J. A., Tugrul, K. C., & West, S. A. (1996) · PubMed · Cited by 154 · see citing works
Medication Compliance Among Patients With Bipolar Disorder and Substance Use Disorder
Weiss, R. D., Greenfield, S. F., Najavits, L. M., Soto, J. A., Wyner, D., Tohen, M. F., & Griffin, M. L. (1998) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v59n0405 · Cited by 137 · see citing works
Schumann, C., Lenz, G., Berghöfer, A., & Müller-Oerlinghausen, B. (1999) · Psychiatry Research · doi:10.1016/s0165-1781(99)00108-0 · Cited by 107 · see citing works
Adherence to Lithium Prophylaxis: I. Clinical Predictors and Patient's Reasons for Nonadherence
Maarbjerg, K., Aagaard, J., & Vestergaard, P. (1988) · Pharmacopsychiatry · doi:10.1055/s-2007-1014662 · Cited by 89 · see citing works
Self-Reported Medication Treatment Adherence Among Veterans With Bipolar Disorder
Sajatovic, M., Bauer, M. S., Kilbourne, A. M., Vertrees, J. E., & Williford, W. O. (2006) · Psychiatric Services · doi:10.1176/appi.ps.57.1.56 · Cited by 83 · see citing works
Self-citationAdherence to Treatment Regimen in a Lithium Carbonate Clinic
Connelly, C. E. (1982) · Archives of General Psychiatry · doi:10.1001/archpsyc.1982.04290050057011 · Cited by 81 · see citing works
Sajatovic, M., Davies, M. A., Bauer, M. S., McBride, L., Hays, R. W., Safavi, R., & JENKINS, J. H. (2005) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2004.10.007 · Cited by 72 · see citing works
Self-citationAn ever-increasing pharmacopoeia for the management of patients with bipolar disorder.
Nemeroff, C. B. (2000) · PubMed · Cited by 60 · see citing works
Miklowitz, D. J. (1992) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199211000-00004 · Cited by 55 · see citing works
Implications of noncompliance on research in affective disorders.
Frank, E., Prien, R. F., Kupfer, D. J., & Alberts, L. B. (1985) · PubMed · Cited by 54 · see citing works
Predicting medication non-adherence in severe affective disorders
Scott, J. L. (2000) · Acta Neuropsychiatrica · doi:10.1017/s0924270800035584 · Cited by 50 · see citing works
Bipolar disorders and the effectiveness of novel anticonvulsants.
Calabrese, J. R., Shelton, M. D., RAPPORT, D. J., & Kimmel, S. E. (2002) · PubMed · Cited by 49 · see citing works
Compliance with Long-term Lithium Treatment in Major Affective Disorders
Danion, J., Neunreuther, C., Krieger-Finance, F., Jl, I., & Singer, L. (1987) · Pharmacopsychiatry · doi:10.1055/s-2007-1017111 · Cited by 41 · see citing works
Case Manager Ratings of the Clinical Status of Dually Diagnosed Outpatients
Comtois, K. A., Ries, R. K., & Armstrong, H. E. (1994) · Psychiatric Services · doi:10.1176/ps.45.6.568 · Cited by 28 · see citing works
Lenzi, A., Lazzerini, F., PLACIDI, G.-F., Cassano, G. B., & Akiskal, H. (1989) · Pharmacopsychiatry · doi:10.1055/s-2007-1014574 · Cited by 25 · see citing works
Compliance with Lithium Regimens
Kucera-Bozarth, K., Beck, N. C., & Lyss, L. (1982) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/0279-3695-19820701-04 · Cited by 11 · see citing works
Flagged first, then by citations
Research works printed but not linked: 3
- Colom F, Vieta E. Treatment adherence in bipolar patients. Clinical Approaches Bipolar Disorders 2002; 1: 49-56.
- Perlick DA, Rosenheck RA, Kaczynski R, Kozma L. Medication non-adherence in bipolar disorder: a patient- centered review of research findings. Clin Approach Bipolar Disord 2004; 3: 56-64.
- Mukherjee S, Rosen AM, Shukla S. Acceptance by patients of maintenance lithium treatment. Lithium 1993; 2: 63-69.
Cited by
Sorted by citations
Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2020) · Systematic Reviews · doi:10.1186/s13643-020-1274-3 · Cited by 555 · see citing works
Velligan, D. I., Sajatovic, M., Hatch, A., Kramata, P., & Docherty, J. (2017) · Patient Preference and Adherence · doi:10.2147/ppa.s124658 · Cited by 333 · see citing works
Self-citationSuppes, T., Vieta, E., Liu, S., Brecher, M., Paulsson, B., & Trial 127 Investigators (2009) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.08020189 · Cited by 230 · see citing works
Martin, B. C., Wiley-Exley, E. K., Richards, S., Domino, M. E., Carey, T. S., & Sleath, B. L. (2009) · Annals of Pharmacotherapy · doi:10.1345/aph.1k671 · Cited by 226 · see citing works
Risperidone Long-Acting Injectable Monotherapy in the Maintenance Treatment of Bipolar I Disorder
Quiroz, J. A., Yatham, L. N., Palumbo, J. M., Karcher, K., Kushner, S., & Kusumakar, V. (2010) · Biological Psychiatry · doi:10.1016/j.biopsych.2010.01.015 · Cited by 200 · see citing works
Factors associated with treatment nonadherence among US bipolar disorder patients
Baldessarini, R. J., Perry, R., & Pike, J. (2008) · Human Psychopharmacology: Clinical and Experimental · doi:10.1002/hup.908 · Cited by 198 · see citing works
Bissonnette, J. M. (2008) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2008.04745.x · Cited by 172 · see citing works
Treatment Adherence With Lithium and Anticonvulsant Medications Among Patients With Bipolar Disorder
Sajatovic, M., Valenstein, M., Blow, F., Ganoczy, D., & Ignacio, R. (2007) · Psychiatric Services · doi:10.1176/ps.2007.58.6.855 · Cited by 172 · see citing works
Self-citationEnhancing medication adherence in patients with bipolar disorder
Berk, L., Hallam, K. T., Colom, F., Vieta, E., Hasty, M., Macneil, C., & Berk, M. (2010) · Human Psychopharmacology: Clinical and Experimental · doi:10.1002/hup.1081 · Cited by 149 · see citing works
Velligan, D. I., Weiden, P. J., Sajatovic, M., Scott, J., Carpenter, D., Ross, R., & Docherty, J. P. (2010) · Journal of Psychiatric Practice · doi:10.1097/01.pra.0000367776.96012.ca · Cited by 134 · see citing works
Self-citationCalabrese, J. R., Sanchez, R., Jin, N., Amatniek, J., Cox, K., Johnson, B., Perry, P., Hertel, P., Such, P., Salzman, P. M., et al. (2017) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.16m11201 · Cited by 135 · see citing works
Mood disorders medications: predictors of nonadherence – review of the current literature
Pompili, M., Venturini, P., Palermo, M., Stefani, H., Seretti, M. E., Lamis, D. A., Serafini, G., Amore, M., & Girardi, P. (2013) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.2013.811976 · Cited by 120 · see citing works
Hayes, J. F., Marston, L., Walters, K., Geddes, J. R., King, M., & Osborn, D. P. J. (2016) · World Psychiatry · doi:10.1002/wps.20298 · Cited by 115 · see citing works
Kemp, D. E., Gao, K., Ganocy, S. J., Elhaj, O., Bilali, S. R., Conroy, C., Findling, R. L., & Calabrese, J. R. (2009) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.07m04022 · Cited by 103 · see citing works
Deng, M., Zhai, S., Ouyang, X., Liu, Z., & Ross, B. (2022) · BMC Psychiatry · doi:10.1186/s12888-021-03681-6 · Cited by 75 · see citing works
Sylvia, L. G., Hay, A., Ostacher, M. J., Miklowitz, D. J., Nierenberg, A. A., Thase, M. E., Sachs, G. S., Deckersbach, T., & Perlis, R. H. (2013) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e3182900c6f · Cited by 62 · see citing works
Psychotropic Medication Nonadherence Among United States Latinos: A Comprehensive Literature Review
Lanouette, N. M., Folsom, D. P., Sciolla, A., & Jeste, D. V. (2009) · Psychiatric Services · doi:10.1176/ps.2009.60.2.157 · Cited by 61 · see citing works
Harvey, P. D., Hassman, H., Mao, L., Gharabawi, G. M., Mahmoud, R. A., & Engelhart, L. M. (2007) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v68n0804 · Cited by 52 · see citing works
Ibrahim, A. W., Yahya, S., Pindar, S. K., Wakil, M. A., Garkuwa, A., & Sale, S. (2015) · Pan African Medical Journal · doi:10.11604/pamj.2015.21.39.6664 · Cited by 43 · see citing works
De, R., Smith, E. C. C., Navagnanavel, J., Au, E., Maksyutynska, K., Papoulias, M., Singh, R., Panganiban, K. J., Humber, B., Mohr, G. H., et al. (2025) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13758 · Cited by 39 · see citing works
Indirect costs associated with nonadherence to treatment for bipolar disorder
Bagalman, E., Yu-Isenberg, K. S., Durden, E., Crivera, C., Dirani, R., & Bunn, W. B. (2010) · Journal of Occupational & Environmental Medicine · doi:10.1097/jom.0b013e3181db811d · Cited by 32 · see citing works
The effect of housing first on adherence to methadone maintenance treatment
Parpouchi, M., Moniruzzaman, A., Rezansoff, S. N., Russolillo, A., & Somers, J. M. (2018) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2018.03.012 · Cited by 29 · see citing works
Robertson, A. G., Swanson, J. W., Van Dorn, R. A., & Swartz, M. S. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201400247 · Cited by 21 · see citing works
Ibrahim, W, A., Pindar, K, S., Yerima, M, M., Rabbebe, B, I., Shehu, S, et al. (2015) · Journal of Neuroscience and Behavioral Health · doi:10.5897/jnbh2015.0128 · Cited by 20 · see citing works
- Authors
- Sajatovic, M., Valenstein, M., Blow, F. C., Ganoczy, D., & Ignacio, R. V.
- Affiliations
- Case Western Reserve University (US)
- University of Michigan (US)
- Corresponding author
- Sajatovic, Martha
- Venue
- Bipolar Disorders
- Publisher
- Wiley
- Published
- 2006-05-12
- Volume
- 8
- Issue
- 3
- Pages
- 232-241
- ISSN
- 1398-5647 (ISSN-L)
- 1399-5618
- OpenAlex
- W2143913225
- Cited by
- 242
- References
- 35
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 7 · 2023: 8 · 2022: 12 · 2021: 12 · 2020: 16 · 2019: 8 · 2018: 13 · 2017: 11 · 2016: 18 · 2015: 12 · 2014: 11 · 2013: 14 · 2012: 9
- FWCI
- 11.47
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Bipolar Disorders (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- National Institutes of Health
- National Institute of Mental Health (K23MH065599)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- bipolar disorder, antipsychotic drugs, medication adherence, medication possession ratio, veterans, predictors of non-adherence, substance use comorbidity, homelessness, ethnic minorities, post-traumatic stress disorder
- MeSH terms
- Bipolar Disorder, Demography, Ethnicity, Female, Humans, Male, Middle Aged, Patient Compliance, Retrospective Studies, Antipsychotic Agents
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
