Department of Psychiatry, Case Western Reserve University School of Medicine, 10524 Euclid Ave., Cleveland, OH 44106, USA.
Psychiatr Serv. 2009 Sep;60(9):1182-9. doi: 10.1176/ps.2009.60.9.1182.
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.
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).
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.
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.
本研究在社区心理健康中心纳入了 164 名双相情感障碍门诊患者，他们接受了标准化心理教育（生活目标计划[LGP]）或常规治疗，旨在比较两组患者在药物治疗态度和行为方面的差异。
患者被随机分为常规治疗组（n=80）或常规治疗+LGP 组（n=84），在基线以及 3、6 和 12 个月随访时进行评估。主要结局是药物态度量表（DAI）评分和自我报告的治疗依从性行为（SRTAB）的变化。
在基线时，两组间无显著差异。略少于一半（n=41，49%）的 LGP 组患者参加了大部分（4-6 次）或全部 LGP 课程，14%（n=12）参加了 1-3 次，37%（n=31）未参加任何课程。在 12 个月随访时，所有患者均有改善，两组间 DAI 评分、SRTAB、症状、精神病理学和功能状态均无显著差异。基线时抑郁症状越严重，随着时间的推移对治疗的态度越消极，但这一发现没有统计学意义（p=.056）。对 LGP 组患者的二次分析发现，与未参加任何 LGP 课程的患者相比，参加部分或全部 LGP 课程的患者在 3 个月和 6 个月随访时对药物的态度有所改善，但到 12 个月随访时，3 个 LGP 亚组之间没有差异。
在 12 个月随访时，两组患者的治疗态度没有差异。低出勤率降低了对主要结局的影响。如果没有持续干预，LGP 的效果可能会随着时间的推移而消失，而且抑郁患者对 LGP 的反应可能会降低。
