Depp Colin A, Cain Ashley E, Palmer Barton W, Moore David J, Eyler Lisa T, Lebowitz Barry D, Patterson Thomas L, Jeste Dilip V
Department of Psychiatry, University of California, San Diego, CA, USA.
J Clin Psychopharmacol. 2008 Apr;28(2):225-9. doi: 10.1097/JCP.0b013e318166dfed.
Medication nonadherence is a key clinical concern in bipolar disorder (BD) across the life span. Cognitive deficits in older adults with BD may hinder medication management ability, which, in turn, may lead to nonadherence. Using an innovative performance-based measure of medication management ability, the Medication Management Ability Assessment (MMAA), we compared performance of 29 middle-aged older community-dwelling outpatients with BD who were clinically stable (mean age, 61 years; SD, 11 years; range, 45-86 years) with those of 59 normal control subjects (NCs) and 219 outpatients with schizophrenia. The MMAA is a role-play task that simulates a medication regimen likely to be encountered by older adults. Within the BD group, we examined the relationships of MMAA scores to demographic, psychiatric symptoms severity, and the Mattis Dementia Rating Scale (DRS) scores. The BD group made 2.8 times the errors on the MMAA than NCs (BD group, 6.2; SD, 5.5 vs NCs, 2.2; SD, 2.5) and did not significantly differ from the Schizophrenia group in errors on the MMAA. Errors in the BD group were more likely to be taking in too few medications as taking in too many. Within the BD group, a significant correlation was seen between MMAA scores and the DRS Total score, but not with age, education, Brief Psychiatric Rating Scale, Hamilton Depression Rating Scale, number of psychiatric medications, or medical conditions. Among DRS subscales, the Memory Subscale correlated most strongly with MMAA errors. This small cross-sectional study suggests that deficits in medication management ability may be present in later-life BD. Neurocognitive deficits may be important in understanding problems with unintentional nonadherence.
在双相情感障碍（BD）患者的整个生命周期中，药物治疗依从性不佳是一个关键的临床问题。患有BD的老年人认知缺陷可能会妨碍药物管理能力，进而导致治疗依从性不佳。我们使用一种基于创新表现的药物管理能力测量方法——药物管理能力评估（MMAA），比较了29名临床稳定的中年及老年社区居住BD门诊患者（平均年龄61岁；标准差11岁；范围45 - 86岁）与59名正常对照者（NCs）以及219名精神分裂症门诊患者的表现。MMAA是一项角色扮演任务，模拟了老年人可能会遇到的药物治疗方案。在BD组中，我们研究了MMAA得分与人口统计学、精神症状严重程度以及马蒂斯痴呆评定量表（DRS）得分之间的关系。BD组在MMAA上的错误是NCs的2.8倍（BD组，6.2；标准差5.5 vs NCs，2.2；标准差2.5），并且在MMAA错误方面与精神分裂症组没有显著差异。BD组的错误更可能是药物服用过少而非过多。在BD组中，MMAA得分与DRS总分之间存在显著相关性，但与年龄、教育程度、简明精神病评定量表、汉密尔顿抑郁评定量表、精神科药物数量或医疗状况无关。在DRS分量表中，记忆分量表与MMAA错误的相关性最强。这项小型横断面研究表明，晚年BD患者可能存在药物管理能力缺陷。神经认知缺陷可能在理解无意的治疗依从性问题方面很重要。
