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Symptom severity, self-reported adherence, and electronic pill monitoring in poorly adherent patients with bipolar disorder.
Bipolar Disord. 2015 Sep; 17(6):653-61.BD

Abstract

OBJECTIVES

This analysis of screening and baseline data from an ongoing trial examined self-report versus automated adherence monitoring and assessed the relationship between bipolar disorder (BD) symptoms and adherence in 104 poorly adherent individuals.

METHODS

Adherence was measured with the Tablets Routine Questionnaire (TRQ) and the Medication Event Monitoring System (MEMS). Symptoms were measured with the Montgomery-Åsberg Depression Rating Scale (MADRS), the Young Mania Rating Scale (YMRS), and the Brief Psychiatric Rating Scale (BPRS).

RESULTS

The mean age of the sample was 46.3 years [standard deviation (SD) = 9.41 years], with 72% (n = 75) women and 71% (n = 74) African American subjects. Adherence improved from screening to baseline, with a mean missed drug proportion measured by TRQ of 61.43% (SD = 26.48%) versus a baseline mean of 46.61% (SD = 30.55%). The mean proportion of missed medication using MEMS at baseline was 66.43% (SD = 30.40%). The correlation between TRQ and MEMS was 0.47. The correlation between a single index drug and all BD medications was 0.95. Symptoms were generally positively correlated with TRQ (worse adherence = more severe symptoms), but in most instances was only at a trend level (p > 0.05), with the exception of the correlations between baseline TRQ and MADRS and BPRS, which were positive (r = 0.20 and r = 0.21, respectively) and significant (p ≤ 0.05).

CONCLUSIONS

In patients with BD, monitoring increased adherence by 15%. MEMS identified 20% more non-adherence than self-report. Using a standard procedure to identify a single index drug for adherence monitoring may be one way to assess global adherence in patients with BD receiving polypharmacy treatment. Greater BD symptom severity may be a clinical indicator to assess for adherence problems.

Authors+Show Affiliations

Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA. University Hospitals Case Medical Center, Neurological and Behavioral Outcomes Center, Cleveland, OH, USA. Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA. University Hospitals Case Medical Center, Neurological and Behavioral Outcomes Center, Cleveland, OH, USA.Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA. University Hospitals Case Medical Center, Neurological and Behavioral Outcomes Center, Cleveland, OH, USA.Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA.Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA.University Hospitals Case Medical Center, Neurological and Behavioral Outcomes Center, Cleveland, OH, USA.Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA.Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA.University Hospitals Case Medical Center, Neurological and Behavioral Outcomes Center, Cleveland, OH, USA. Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

26529124

Citation

Sajatovic, Martha, et al. "Symptom Severity, Self-reported Adherence, and Electronic Pill Monitoring in Poorly Adherent Patients With Bipolar Disorder." Bipolar Disorders, vol. 17, no. 6, 2015, pp. 653-61.
Sajatovic M, Levin JB, Sams J, et al. Symptom severity, self-reported adherence, and electronic pill monitoring in poorly adherent patients with bipolar disorder. Bipolar Disord. 2015;17(6):653-61.
Sajatovic, M., Levin, J. B., Sams, J., Cassidy, K. A., Akagi, K., Aebi, M. E., Ramirez, L. F., Safren, S. A., & Tatsuoka, C. (2015). Symptom severity, self-reported adherence, and electronic pill monitoring in poorly adherent patients with bipolar disorder. Bipolar Disorders, 17(6), 653-61. https://doi.org/10.1111/bdi.12326
Sajatovic M, et al. Symptom Severity, Self-reported Adherence, and Electronic Pill Monitoring in Poorly Adherent Patients With Bipolar Disorder. Bipolar Disord. 2015;17(6):653-61. PubMed PMID: 26529124.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Symptom severity, self-reported adherence, and electronic pill monitoring in poorly adherent patients with bipolar disorder. AU - Sajatovic,Martha, AU - Levin,Jennifer B, AU - Sams,Johnny, AU - Cassidy,Kristin A, AU - Akagi,Kouri, AU - Aebi,Michelle E, AU - Ramirez,Luis F, AU - Safren,Steven A, AU - Tatsuoka,Curtis, PY - 2015/01/30/received PY - 2015/06/23/accepted PY - 2015/11/4/entrez PY - 2015/11/4/pubmed PY - 2016/3/22/medline KW - adherence KW - bipolar disorder KW - compliance KW - depression KW - mania KW - mood stabilizer SP - 653 EP - 61 JF - Bipolar disorders JO - Bipolar Disord VL - 17 IS - 6 N2 - OBJECTIVES: This analysis of screening and baseline data from an ongoing trial examined self-report versus automated adherence monitoring and assessed the relationship between bipolar disorder (BD) symptoms and adherence in 104 poorly adherent individuals. METHODS: Adherence was measured with the Tablets Routine Questionnaire (TRQ) and the Medication Event Monitoring System (MEMS). Symptoms were measured with the Montgomery-Åsberg Depression Rating Scale (MADRS), the Young Mania Rating Scale (YMRS), and the Brief Psychiatric Rating Scale (BPRS). RESULTS: The mean age of the sample was 46.3 years [standard deviation (SD) = 9.41 years], with 72% (n = 75) women and 71% (n = 74) African American subjects. Adherence improved from screening to baseline, with a mean missed drug proportion measured by TRQ of 61.43% (SD = 26.48%) versus a baseline mean of 46.61% (SD = 30.55%). The mean proportion of missed medication using MEMS at baseline was 66.43% (SD = 30.40%). The correlation between TRQ and MEMS was 0.47. The correlation between a single index drug and all BD medications was 0.95. Symptoms were generally positively correlated with TRQ (worse adherence = more severe symptoms), but in most instances was only at a trend level (p > 0.05), with the exception of the correlations between baseline TRQ and MADRS and BPRS, which were positive (r = 0.20 and r = 0.21, respectively) and significant (p ≤ 0.05). CONCLUSIONS: In patients with BD, monitoring increased adherence by 15%. MEMS identified 20% more non-adherence than self-report. Using a standard procedure to identify a single index drug for adherence monitoring may be one way to assess global adherence in patients with BD receiving polypharmacy treatment. Greater BD symptom severity may be a clinical indicator to assess for adherence problems. SN - 1399-5618 UR - https://www.unboundmedicine.com/medline/citation/26529124/Symptom_severity_self_reported_adherence_and_electronic_pill_monitoring_in_poorly_adherent_patients_with_bipolar_disorder_ L2 - https://doi.org/10.1111/bdi.12326 DB - PRIME DP - Unbound Medicine ER -