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Association Between Symptom Severity and Medication Adherence in Adolescents with Bipolar Disorder Demonstrating
Martha Sajatovic1, Jennifer B Levin2, Avani Modi3
1Sajatovic, Department of Psychiatry and Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Psychopharmacology Bulletin
|August 21, 2023
Summary
Medication non-adherence is common in adolescents and young adults with bipolar disorder (BD). Bipolar disorder symptoms did not consistently predict adherence challenges in this population.
Area of Science:
- Psychiatry
- Adolescent Medicine
- Clinical Psychology
Background:
- Medication non-adherence is a significant challenge in managing bipolar disorder (BD), particularly among adolescents and young adults (AYAs).
- Limited research has specifically investigated adherence patterns and predictors in AYAs with BD.
- Understanding adherence in this demographic is crucial for optimizing treatment outcomes.
Purpose of the Study:
- To examine the relationship between bipolar disorder symptoms and medication adherence in poorly adherent AYAs.
- To assess adherence using both self-report and electronic monitoring methods.
- To identify potential demographic or clinical predictors of non-adherence in AYAs with BD.
Main Methods:
- Screening and baseline data from a randomized controlled trial of AYAs (ages 13-21) with BD were analyzed.
- Sub-optimal adherence was defined as missing ⩾ 20% of prescribed BD medication.
- Adherence was measured using the Tablets Routine Questionnaire (TRQ) and electronic pill monitoring (SimpleMed).
- Bipolar disorder symptoms were assessed using the Hamilton Depression Rating Scale (HAM-D), Young Mania Rating Scale (YMRS), and Clinical Global Impression Scale (CGI).
Main Results:
- Mean missed BD medications were 34.9% (TRQ) and 42.1% (SimpleMed) at baseline.
- The correlation between TRQ and SimpleMed was moderate (r = 0.36, p = 0.13).
- Young Mania Rating Scale (YMRS) scores positively correlated with worse adherence on TRQ (r = 0.36, p = 0.03), but not with SimpleMed.
- Neither CGI nor age were correlated with adherence; adherence did not differ by other demographic attributes.
Conclusions:
- Adherence levels in AYAs with BD exhibit wide variability.
- Adherence monitoring interventions showed a modest increase in adherence (approx. 4.5%).
- Electronic pill monitoring captured a higher proportion of missed doses compared to self-report.
- Bipolar disorder symptoms, including depression and global impression, may not consistently predict adherence challenges in AYAs.
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