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Treatment adherence a 'crucial problem' in patients with bipolar disorder
By Andrew Czyzewski
31 August 2007
J Clin Psychiatry 2007; 68: 1172-1176

Nearly a third of bipolar disorder patients with co-occurring substance use disorder (SUD) fail to adhere to their mood stabilizing medication, reports a team from Harvard Medical School in Boston, Massachusetts, USA.

SUDs are common in patients with bipolar disorder - 60% with bipolar I disorder develop a SUD in their lifetime. Research suggests that patients in this prevalent subgroup are less likely to adhere to treatment.

In the present study, Sumita Manwani and colleagues enlisted 115 patients with bipolar disorder, 58 of whom had an SUD, and interviewed them about their lifetime experience with mood stabilizers. Adherence was defined as taking two thirds or more of the prescribed dose over one's lifetime.

The researchers found that the overall lifetime adherence to mood stabilizers in patients with bipolar disorder was 82.5%. This fell significantly to 65.5% in bipolar patients who had co-occurring SUDs.

Writing in the Journal of Clinical Psychiatry, the team comments: "These differences in adherence point out the importance of screening SUD in patients with bipolar disorder and addressing the substance use issues when present."

The researchers note that nonadherence to medication has been consistently associated with poor treatment outcomes in bipolar disorder patients, including relapse, hospitalization, social and occupational dysfunction, and violence and suicide. This makes it important to identify the underlying causes of nonadherence, argue the researchers.

Interviewing the participants, the researchers also found that the reasons for nonadherence differed significantly between patients with and without SUDs. In the SUD group, 22% of patients cited "substance-related reasons" to explain non-adherence, compared with just 3% of those in the non-SUD group. In contrast, "pill and dosage-related reasons" were cited by 23% of non-SUD patients, compared with only 10% of SUD patients.

The researchers conclude that medication adherence is a crucial and understudied problem in patients with bipolar disorder. In light of their findings, they advise physicians to be alert to these differences when prescribing medications.

Abstract
 

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