Devulapalli Kavi K, Ignacio Rosalinda V, Weiden Peter, Cassidy Kristin A, Williams Tiffany D, Safavi Roknedin, Blow Frederic C, Sajatovic Martha
Case Western Reserve University, School of Medicine, Cleveland, OH, USA.
Psychopharmacol Bull. 2010;43(3):5-14.
Non-adherence to maintenance medication regimens is a major problem, limiting outcomes for many persons with bipolar disorder. The aim of this paper is to determine the most relevant aspects of adherence attitudes in a sample of bipolar patients selected for problems with adherence behavior.
Among a larger sample of bipolar disorder patients participating in a prospective follow-up study (N = 140), a subsample of patients were selected for non-adherent behavior defined as missing ≥ 30% of medication during the past month (n = 27; 19.3%). Adherence attitudes were assessed with the Rating of Medication Influences scale (ROMI), a self-reported attitudinal measure assessing reasons for and against adherence. Multiple logistic regression models for non-adherence vs. adherence were estimated with each of the 19 ROMI items in the model, while controlling for sex, age, ethnicity, education, duration of illness, and substance abuse.
Mean score of ROMI items corresponding to reasons for treatment adherence was greater among adherent participants, whereas the mean score of ROMI items corresponding to reasons for treatment non-adherence was greater among nonadherent participants. The ROMI item identifying that the individual believes that medications are unnecessary had the strongest influence for non-adherence (p < 0.0001). This was followed by ROMI items corresponding to no perceived daily benefit (p = 0.0008), perceived change in appearance (p = 0.0057), and perceived interference with life goals (p = 0.0033). The ROMI item identifying fear of relapse was the strongest predictor for adherence (p = 0.0017).
Non-adherent patients with bipolar disorder differ from adherent patients with bipolar disorder on reasons for adherence and non-adherence. Utilization of tools that evaluate medication treatment attitudes, such as the ROMI or similar measures, may assist clinicians in the selection of interventions that are most likely to modify future treatment adherence.
不坚持维持药物治疗方案是一个主要问题，限制了许多双相情感障碍患者的治疗效果。本文旨在确定因依从行为存在问题而被挑选出的双相情感障碍患者样本中，依从态度最相关的方面。
在参与一项前瞻性随访研究的较大样本双相情感障碍患者（N = 140）中，挑选出一个患者子样本，其不依从行为定义为在过去一个月内漏服≥30%的药物（n = 27；19.3%）。使用药物影响评分量表（ROMI）评估依从态度，这是一种自我报告的态度测量方法，用于评估支持和反对依从的原因。在模型中纳入19个ROMI项目中的每一个，同时控制性别、年龄、种族、教育程度、病程和药物滥用情况，估计不依从与依从的多重逻辑回归模型。
在依从的参与者中，与坚持治疗原因相对应的ROMI项目平均得分更高，而在不依从的参与者中，与不坚持治疗原因相对应的ROMI项目平均得分更高。表明个人认为药物不必要的ROMI项目对不依从的影响最强（p < 0.0001）。其次是与未察觉到每日益处（p = 0.0008）、察觉到外貌变化（p = 0.0057）以及察觉到对生活目标的干扰（p = 0.0033）相对应的ROMI项目。表明害怕复发的ROMI项目是依从的最强预测因素（p = 0.0017）。
双相情感障碍不依从患者与依从患者在依从和不依从原因方面存在差异。使用评估药物治疗态度的工具，如ROMI或类似测量方法，可能有助于临床医生选择最有可能改善未来治疗依从性的干预措施。
