Berk Lesley, Hallam Karen T, Colom Francesc, Vieta Eduard, Hasty Melissa, Macneil Craig, Berk Michael
University of Melbourne, Victoria, Australia.
Hum Psychopharmacol. 2010 Jan;25(1):1-16. doi: 10.1002/hup.1081.
Medication adherence contributes to the efficacy-effectiveness gap of treatment in patients with bipolar disorder. This paper aims to examine the challenges involved in improving medication adherence in bipolar disorder, and to extract some suggestions for future directions from the core psychosocial studies that have targeted adherence as a primary or secondary outcome.
A search was conducted for articles that focused on medication adherence in bipolar disorder, with emphasis on publications from 1996 to 2008 using Medline, Web of Science, CINAHL PLUS, and PsychINFO. The following key words were used: adherence, compliance, alliance, adherence assessment, adherence measurement, risk factors, psychosocial interventions, and psycho-education.
There are a number of challenges to understanding non-adherence including the difficulty in defining and measuring it and the various risk factors that need to be considered when aiming to enhance adherence. Nevertheless, the importance of addressing adherence is evidenced by the connection between adherence problems and poor outcome. Despite these challenges, a number of small psychosocial studies targeting adherence as a primary outcome point to the potential usefulness of psycho-education aimed at improving knowledge, attitudes, and adherence behavior, but more large scale randomized controlled trials are needed in this area. Evidence of improved outcomes from larger randomized controlled trials of psychosocial interventions that target medication adherence as a secondary outcome suggests that tackling other factors besides medication adherence may also be an advantage. While some of these larger studies demonstrate an improvement in medication adherence, the translation of these interventions into real life settings may not always be practical. A person centered approach that considers risk factors for non-adherence and barriers to other health behaviors may assist with the development of more targeted briefer interventions. Integral to improving medication adherence is the delivery of psycho-education, and attention needs to be paid to the implementation, and timing of psycho-education. Progress in the understanding of how medicines work may add to the credibility of psycho-education in the future.
Enhancement of treatment adherence in bipolar patients is a necessary and promising management component as an adjunct to pharmacotherapy. The current literature on psychosocial interventions that target medication adherence in bipolar disorder points to the possibility of refining the concept of non-adherence and adapting psycho-education to the needs of certain subgroups of people with bipolar disorder. Large scale randomized controlled trials of briefer or more condensed interventions are needed that can inform clinical practice.
药物依从性导致双相情感障碍患者治疗的疗效-效果差距。本文旨在探讨改善双相情感障碍患者药物依从性所涉及的挑战，并从以依从性作为主要或次要结果的核心社会心理研究中提取一些未来方向的建议。
检索聚焦于双相情感障碍患者药物依从性的文章，重点检索1996年至2008年发表在Medline、科学引文索引、护理学与健康领域数据库（CINAHL PLUS）和心理学文摘数据库（PsychINFO）上的文献。使用了以下关键词：依从性、顺应性、联盟、依从性评估、依从性测量、危险因素、社会心理干预和心理教育。
理解不依从存在诸多挑战，包括难以对其进行定义和测量，以及在旨在提高依从性时需要考虑的各种危险因素。然而，依从性问题与不良结局之间的关联证明了解决依从性问题的重要性。尽管存在这些挑战，但一些将依从性作为主要结果的小型社会心理研究表明，旨在提高知识、态度和依从行为的心理教育可能有用，但该领域需要更多大规模随机对照试验。以药物依从性作为次要结果的大型社会心理干预随机对照试验显示结局有所改善，这表明除了药物依从性之外，解决其他因素可能也具有优势。虽然其中一些大型研究显示药物依从性有所改善，但将这些干预措施转化为实际生活场景可能并不总是可行的。一种以患者为中心的方法，考虑不依从的危险因素和其他健康行为的障碍，可能有助于开发更具针对性的简短干预措施。改善药物依从性不可或缺的是提供心理教育，并且需要关注心理教育的实施和时机。对药物作用方式理解的进展可能会在未来增加心理教育的可信度。
提高双相情感障碍患者的治疗依从性作为药物治疗的辅助手段是必要且有前景的管理组成部分。目前关于双相情感障碍患者药物依从性的社会心理干预文献表明，有可能完善不依从的概念，并使心理教育适应双相情感障碍特定亚组人群的需求。需要开展更简短或更浓缩干预措施的大规模随机对照试验，为临床实践提供参考。
