Depp Colin A, Lebowitz Barry D, Patterson Thomas L, Lacro Jonathan P, Jeste Dilip V
Department of Psychiatry, University of California, San Diego, CA 92161, USA.
Bipolar Disord. 2007 Sep;9(6):636-45. doi: 10.1111/j.1399-5618.2007.00397.x.
To present the rationale, development, and pilot study of a medication adherence skills training (MAST-BD) intervention for older adults with bipolar disorder (BPD). We developed a 12-week manualized group intervention that combined educational, motivational, medication management skills and symptom management training adapted for older adults.
Among 21 older outpatients with BPD (mean age = 60 years; SD = 6), the feasibility and acceptability of MAST-BD were assessed in a quasi-experimental clinical trial. We also obtained preliminary effect sizes associated with pre-post change on measures of self-reported adherence to psychiatric medications, performance-based medication management ability, attitudes toward medication, depressive and manic symptoms, and health-related quality of life.
At baseline, 55% of participants reported recent non-adherence to psychiatric medications and were, on average, suffering from moderately severe depressive symptoms and minimal symptoms of mania. A total of 76% of participants completed the intervention, and 86% of sessions were attended by completers. Participants reported high levels of satisfaction with the intervention and manual. Pre-post improvement by small to medium effect sizes (Cohen's d = 0.30-0.57) was seen in medication adherence, medication management ability, depressive symptoms, and selected indices of health-related quality of life.
Notwithstanding the limitations of this small preliminary study, the results are encouraging in that the MAST-BD intervention was feasible, acceptable to patients, and associated with improvement in key outcomes. Suggestions for further development of medication adherence interventions for this neglected group of patients are discussed.
介绍针对老年双相情感障碍（BPD）患者的药物依从性技能培训（MAST-BD）干预措施的基本原理、开发过程及初步研究。我们开发了一种为期12周的手册化小组干预措施，该措施结合了针对老年人的教育、动机、药物管理技能以及症状管理培训。
在21名老年BPD门诊患者（平均年龄 = 60岁；标准差 = 6）中，通过一项准实验性临床试验评估了MAST-BD的可行性和可接受性。我们还获得了与自我报告的精神科药物依从性、基于表现的药物管理能力、对药物的态度、抑郁和躁狂症状以及健康相关生活质量的测量指标的前后变化相关的初步效应量。
在基线时，55%的参与者报告近期未坚持服用精神科药物，平均患有中度严重的抑郁症状和轻微的躁狂症状。共有76%的参与者完成了干预，完成者参加了86%的课程。参与者对干预措施和手册的满意度很高。在药物依从性、药物管理能力、抑郁症状以及健康相关生活质量的选定指标方面，观察到了小到中等效应量（科恩d值 = 0.30 - 0.57）的前后改善。
尽管这项小型初步研究存在局限性，但结果令人鼓舞，因为MAST-BD干预措施是可行的，患者可以接受，并且与关键结局的改善相关。讨论了针对这一被忽视患者群体进一步开发药物依从性干预措施的建议。
