Bipolar disorder treatment nonadherence ‘needs more attention’

Nov 19 2013

By Joanna Lyford, Senior medwireNews Reporter

More than half of patients with bipolar disorder fail to take their medication as prescribed, a study of Finnish inpatients and outpatients has found.

Given the profound clinical implications of nonadherence, the authors call for patients’ attitudes toward their medication to be closely monitored.

A team led by Erkki Isometsä (University of Helsinki, Finland) analyzed data from the Jorvi Bipolar Study, an 18-month observational study of patients newly diagnosed with bipolar disorder I and II in three Finnish cities.

A total of 191 patients were included in the study, of whom around one third received psychiatric inpatient treatment at some point during follow-up. At the end of the 18-month period, 87.5% were still receiving treatment for their condition, usually in psychiatric settings.

The most frequently prescribed drugs were mood stabilizers and atypical antipsychotic drugs, taken by nearly 90% of patients; around 70% also received psychosocial therapy. Rates of treatment discontinuation were high, at 40.3% and 63.0% for mood stabilizers and antipsychotic drugs, respectively, of which 42.7% and 30.0%, respectively, were autonomous discontinuations that were not in accordance with the treatment plan.

Self-reported treatment adherence at 18 months differed by treatment type, being worst with mood stabilizers, best with anxiolytics, and intermediate with antidepressants and psychotherapy/supportive therapy.

The most common reasons for nonadherence given by patients were side effects, lack of motivation, and a negative attitude toward the particular treatment. In logistic regression analysis, a low educational attainment was a significant predictor of nonadherence to mood stabilizers, with an odds ratio of approximately 4–5, depending on the definition used.

Finally, multivariate models found that predictors of nonadherence were specific to the treatment. For instance, nonadherence to antipsychotics was predicted by substance dependence, negative attitudes to antipsychotics, and borderline personality disorder, whereas nonadherence to mood stabilizers was predicted by negative attitudes toward mood stabilizers and anxiety disorder.

Writing in the Journal of Affective Disorders, Isometsä and colleagues say that “pharmacological treatments were autonomously discontinued by one-quarter of patients, and of the medication continued, one third were not used regularly enough to provide a benefit.”

Noting that “patients’ adherence often changed during the follow-up, the team concludes: “Non-adherence to psychosocial treatment is an important problem and should be given more attention. Attitudes towards treatments influence adherence to all treatments and should therefore be monitored.”

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