Objective-This randomized controlled study of 164 outpatients with bipolar disorder in a community mental health center who received standardized psychoeducation (Life Goals Program [LGP]) or treatment as usual sought to determine whether there were differences between the groups in medication adherence attitudes and behaviors.Methods-Patients were randomly assigned to treatment as usual (N=80) or treatment as usual plus LGP (N=84) and were assessed at baseline and at the three-, six-, and 12-month follow-up. Primary outcomes were change in score from baseline on the Drug Attitude Inventory (DAI) and on self-reported treatment adherence behaviors (SRTAB).Results-At baseline, there were no significant differences between the two groups. Slightly less than half (N=41, 49%) of the LGP group participated in most or all (four to six) LGP sessions, 14% (N=12) participated in one to three sessions, and 37% (N=31) did not participate in any sessions. At the 12-month follow-up there was improvement among all patients, with no significant differences between the two groups, in DAI scores, SRTAB, symptoms, psychopathology, and functional status. Greater depressive severity at baseline was associated with more negative attitudes toward treatment over time, although this finding was not significant (p=.056). Secondary analysis of persons in the LGP group found that compared with those who did not go to any LGP sessions, those with partial or full participation in LGP sessions had improved attitudes toward medication at the three-and six-month follow-up, but no difference was found between the three LGP subgroups by the 12-month follow-up.Conclusions-There were no differences between two groups in treatment attitudes at the 12-month follow-up. Low attendance rates mitigated effects on primary outcomes. Effects of LGP may become lost over time without ongoing intervention, and individuals with depression may have reduced response to LGP. Disclosures:The other authors report no competing interests. Although many patients with bipolar disorder have been helped by the rapid expansion of pharmacopoeia for the treatment of bipolar disorder (1), treatment effectiveness remains suboptimal. Rates of treatment nonadherence are variable, but they are generally substantial and in the order of 12% to 64% (2-5). Although mood stabilizers are the cornerstone of treatment for bipolar disorder, previous studies have demonstrated that psychotherapies, including psychoeducational interventions specific to bipolar disorder, may enhance pharmacotherapy and improve clinical outcome (6-9). It has been suggested that various psychoeducational interventions from briefer stepped-care packages (10,11) to more comprehensive group packages (6) also can aid in treatment adherence. However, effects of psychosocial approaches, including psychoeducation, on treatment adherence are not consistent, and there is a need to identify core components of psychosocial interventions that most affect treatment adherence because of the resource limitations found...
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