Treatment adherence in bipolar disorder

Abstract

Purpose: A high level of treatment adherence is essential in patients with bipolar disorder for effective treatment, due to chronic progressive nature of the illness requiring maintenance treatment. Treatment nonadherence in individuals with bipolar disorder is the main reason for relapse and recurrence. The purpose of this study is to investigate the relationship between treatment adherence and the level of medication treatment adherence in the last month, socio-demographic and clinic characteristics affecting adherence, and the number of follow-up examinations within the last year in euthymic bipolar patients who registered at a psychiatry outpatient clinic at least a year ago. Method: The sample group of this study comprised of 147 euthymic patients, aged over 18, who visited the Psychiatry Outpatient Clinic of Malatya State Hospital, and diagnosed with a Bipolar Disorder in accordance with DSM-IV, and had been monitored at the clinic for at least a year because of this diagnosis. The hospital records were examined simultaneously for patients attending their follow-up examinations between 02.01.2011 and 02.28.2011. The patients, who had computerized records as of February 01, 2010, were included in this study, and their number of follow-up examinations was obtained from hospital records. The information regarding participating patients’ demographic variables, clinical properties, and their attitude towards their illness and treatment were recorded in the Data Gathering Form. The patients were categorized in two groups; those that had taken their medication or taken it irregularly for less than seven days within the last month were categorized as “treatment adherent,” and those that had not taken their medication or taken it irregularly for more than seven days within the last month were categorized as “treatment nonadherent.” SPSS 16.0 was used for the statistical data analysis. The data of treatment adherent group was compared to the data of treatment nonadherent group. Results: 108 (73.5%) patients were treatment adherent, while 39 (26.5%) patients were treatment nonadherent. The level of education (based on 8 years) was higher in the treatment adherent group (p<0.001). The rate of hospitalization was lower in the treatment adherent group in comparison to the treatment nonadherent group (p<0.05). The rate of attending to follow-up examinations within the last year (t= -5.42) and the level of insight towards their illness was higher in the treatment adherent group (p<0.001). There was no difference between the two groups in terms of their present medication or drug combinations (p>0.05). The treatment adherent group believed that they were more informed about their illness and treatment in comparison to the nonadherent group (p<0.001). The treatment nonadherent group believed that treatment had no effect on their disorder more than the treatment adherent group (p<0.05); the rate of disregarding medication because they thought they had recovered was higher in the treatment nonadherent group in comparison to the treatment adherent group (p<0.001). The rate of abandoning treatment, because of thinking that they had recovered, was higher in comparison to the rate of not taking medication, because they thought the treatment was not effective (p=0.04, ?2=8.64). The number of patients, who were discontent about taking medication, was higher in the treatment nonadherent group (p<0.05). Conclusion: In this study, some characteristics such as a lower education level, thinking that they had inadequate information regarding their illness, lack of insight, and dissatisfaction with treatment, were significantly higher in the treatment nonadherent group. The most common reason behind discontinued treatment was that individuals believed that they had recovered from their disorder and discontinued their medication(s).