Sajatovic Martha, Valenstein Marcia, Blow Frederick, Ganoczy Dara, Ignacio Rosalinda
Department of Psychiatry, Case Western Reserve University, OH 44106-5000, USA.
Psychiatr Serv. 2007 Jun;58(6):855-63. doi: 10.1176/ps.2007.58.6.855.
Nonadherence limits the effectiveness of medications among patients with bipolar disorder. This study examined adherence with lithium and anticonvulsant medication among patients with bipolar disorder receiving treatment in Department of Veterans Affairs (VA) settings.
Patients receiving treatment in the VA for bipolar disorder during federal fiscal year 2003 (FY03) and receiving lithium or anticonvulsant medication were identified (N=44,637) by using the VA's National Psychosis Registry. Medication adherence was assessed by using the medication possession ratio (MPR) for lithium, valproate or divalproex, carbamazepine, and lamotrigine. Patients were categorized into three groups: fully adherent (MPR greater than .80), partially adherent (MPR from more than .50 to .80), and nonadherent (MPR less than or equal to .50).
A slight majority of individuals (54.1%) were fully adherent, 24.5% were partially adherent, and 21.4% were nonadherent. Nonadherent individuals were more likely to be younger, unmarried, nonwhite, or homeless or to have diagnoses of a substance use disorder or fewer outpatient psychiatric visits in FY03. Adherence intensity was somewhat lower for valproate, compared with lithium or other anticonvulsants. Individuals given prescriptions for two agents to stabilize mood had better adherence than individuals given prescriptions for a single agent. Unexpectedly, in multivariate analyses adjusting for prior hospitalization, number of outpatient psychiatric visits, and a diagnosis of substance use disorder, poorer adherence was associated with decreased rates of hospitalization.
Nearly one in two individuals given prescriptions for lithium or anticonvulsant medication to treat bipolar disorder did not take their medications as prescribed. The effectiveness of bipolar medication treatments is reduced by high rates of nonadherence in clinical settings.
治疗依从性不佳限制了双相情感障碍患者药物治疗的效果。本研究调查了在退伍军人事务部（VA）机构接受治疗的双相情感障碍患者对锂盐和抗惊厥药物的依从性。
利用VA的国家精神病登记系统，确定了2003财年（FY03）在VA接受双相情感障碍治疗且正在服用锂盐或抗惊厥药物的患者（N = 44,637）。通过计算锂盐、丙戊酸盐或丙戊酸二钠、卡马西平和拉莫三嗪的药物持有率（MPR）来评估药物依从性。患者被分为三组：完全依从（MPR大于0.80）、部分依从（MPR在0.50至0.80之间）和不依从（MPR小于或等于0.50）。
略超过半数（54.1%）的个体完全依从，24.5%部分依从，21.4%不依从。不依从的个体更可能较年轻、未婚、非白人、无家可归，或被诊断患有物质使用障碍，或在FY03的门诊精神科就诊次数较少。与锂盐或其他抗惊厥药物相比，丙戊酸盐的依从强度略低。开具两种稳定情绪药物处方的个体比开具单一药物处方的个体依从性更好。出乎意料的是，在对既往住院情况、门诊精神科就诊次数和物质使用障碍诊断进行校正的多变量分析中，依从性较差与住院率降低相关。
在接受锂盐或抗惊厥药物治疗双相情感障碍的患者中，近二分之一的人未按医嘱服药。临床环境中高比例的不依从性降低了双相情感障碍药物治疗的效果。
