Nonadherence in bipolar disorder patients: A 14-year retrospective study

Abstract

Background: Bipolar disorder is a disabling psychiatric disorder. The existing literature suggests about 41% of patients to be nonadherent. Nonadherence leads to relapses, delay in recovery besides higher inpatient care cost as well as higher global cost of the disease. Nonadherence in bipolar affective disorder (BPAD) is a complex phenomenon, its critical determinants are yet to be identified with certainty. Aims: This study aims to assess the prevalence of nonadherence in BPAD and to delineate the factors associated with it. Methods: Medical records were reviewed in this study from 2005 to 2019 at a medical college in Kerala. Patients who were diagnosed with BPAD according to International Classification of Diseases 10 and who were needing or opting for prophylaxis were included. Patients who were not taking medications for at least 1 week were termed as nonadherent. We included 150 participants in our study. Results: To test the statistical significance of the association of categorical variables between H/O of adherence and nonadherence, Chi-square test was used. In the sample, 82.7% had at least 1 week of history of noncompliance in the past. The most common reason was poor understanding of illness by the family (56%) followed by a negative aspect of the patient toward the drug (20%). Conclusion: Therefore, this study concludes that though majority of the patients have a history of nonadherence of at least 1 week on long-term follow-up, it was seen that majority of the patients were more than 80% adherent to medications.

Medication nonadherence and its associated factors in psychiatric patients in India: A systematic review and meta-analysis

“…[ 24 , 35 ] Several studies did not find any association between gender and MNA. [ 10 , 15 , 17 , 20 , 21 , 24 , 36 - 38 , 40 , 41 , 46 , 47 ] Four studies found that compliance was better in females,[ 25 , 26 , 33 , 35 ] while one study found that female gender was associated with MNA. [ 7 ] Most studies did not find any association between education and MNA.…”

“…[ 7 ] Most studies did not find any association between education and MNA. [ 7 , 10 , 15 , 17 , 21 , 24 , 33 , 35 , 37 , 39 , 40 , 46 ] Lower education was associated with noncompliance in some studies[ 20 , 26 ] and greater literacy was associated with better compliance in one study. [ 41 ] Marital status did not associate with MNA.…”

“…[ 20 , 33 , 35 - 37 , 40 , 41 ] Two other studies found a positive association between the duration of illness and MNA. [ 17 , 46 ] Some studies found an association between insight and MNA,[ 20 , 24 , 35 , 42 ] while others did not find any association. [ 14 , 37 , 41 ] Age at onset of illness was found to be associated with MNA in some studies,[ 24 , 38 ] while not in others.…”

“…Several studies have enquired about the common reasons for MNA from the patients and/or the caregivers using Rating of Medication Influences scale or other checklists. The most common reasons for MNA reported were side effects of medicines,[ 10 , 16 , 17 , 24 , 26 , 3 , 35 , 46 ] financial obstacles,[ 17 , 18 , 20 , 24 , 26 , 35 , 46 ] no perceived benefit from medications,[ 18 , 20 , 26 , 35 , 41 ] and medicines not perceived as necessary. [ 18 , 20 , 26 , 35 , 41 ] Embarrassment and stigma related to treatment[ 10 , 20 , 35 , 41 ] and lack of knowledge and awareness about the course of illness[ 10 , 21 , 26 ] were other commonly stated reasons for MNA.…”

Failure to keep psychiatric appointments at primary healthcare facilities: Mental health care users missed ongoing clinical visits in Ekurhuleni district in Gauteng province, South Africa

“…This study identified a gap in the research conducted on this phenomenon. Some other literature concentrated on poor adherence to medication in patients with bipolar mood disorders and severe depression who were non-adherent to their prescribed medications [16][17][18][19][20].…”