Department of Psychiatry Department of Neurology and Neurological Outcomes Center, Case Western Reserve University, Cleveland, OH 44106, USA.
Bipolar Disord. 2012 May;14(3):291-300. doi: 10.1111/j.1399-5618.2012.01010.x.
There are few psychosocial interventions specifically focused on improved treatment adherence in people with bipolar disorder (BD). Customized adherence enhancement (CAE) is a needs-based, manualized approach intended to improve medication adherence in individuals with BD. This was a six-month prospective trial of a CAE among 43 medication non-adherent individuals with BD who were receiving treatment in a community mental health clinic (CMHC).
CAE was flexibly administered in modules applied as indicated by an initial adherence vulnerabilities screening. Screening identified reasons for non-adherence and modules were then administered using pre-set criteria. CAE effects were evaluated at six-week, three-month, and six-month follow-up. The six-month follow-up was our primary time point of interest. The primary outcome was change from baseline in adherence using the Tablets Routine Questionnaire (TRQ) and pill counts. Secondary outcomes included change from baseline in BD symptoms [Hamilton Depression Rating Scale (HAM-D), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS)].
Subjects completed 86% of scheduled sessions, with only two individuals (5%) not participating in any sessions. The number of dropouts at six months was 12 (28%). Mean baseline non-adherence by TRQ was 48% [standard error (SE) 4.8%] missed tablets within the previous week and 51% (4.1%) missed tablets within the previous month. At six-month follow-up, mean TRQ non-adherence improved to 25% (6.8%) missed tablets for the previous week (p = 0.002) and 21% (5.5%) for the previous month (p < 0.001). Symptoms improved, with a change in the baseline mean (SE) BPRS of 43.6 (1.8) versus an endpoint of 36.1 (2.3) (p = 0.001), and baseline mean (SE) HAM-D of 17.8 (1.1) versus an endpoint of 15.3 (1.6) (p = 0.044).
CAE was associated with improvements in adherence, symptoms, and functional status. Controlled trials are needed to confirm these preliminary findings.
针对双相情感障碍（BD）患者提高治疗依从性，目前仅有少数心理社会干预措施。个性化依从增强（CAE）是一种基于需求的、规范化的方法，旨在提高 BD 患者的药物依从性。这是一项为期六个月的前瞻性试验，在社区心理健康诊所（CMHC）接受治疗的 43 名药物不依从的 BD 患者中进行了 CAE。
CAE 采用灵活的模块管理方式，根据初始依从性脆弱性筛查的结果进行应用。筛查确定了不依从的原因，然后根据预设标准进行模块管理。在 6 周、3 个月和 6 个月的随访时评估 CAE 效果。6 个月的随访是我们主要关注的时间点。主要结果是使用片剂常规问卷（TRQ）和药丸计数来评估依从性从基线的变化。次要结果包括 BD 症状从基线的变化[汉密尔顿抑郁评定量表（HAM-D）、杨氏躁狂评定量表（YMRS）和简明精神病评定量表（BPRS）]。
被试者完成了计划就诊的 86%，只有 2 人（5%）未参加任何就诊。6 个月时的失访人数为 12 人（28%）。TRQ 基线非依从性平均值为 48%[标准误差（SE）为 4.8%]，即过去一周内漏服的药片为 48%，过去一个月内漏服的药片为 51%。在 6 个月的随访中，TRQ 非依从性平均值改善为过去一周内漏服的药片为 25%（6.8%）（p = 0.002），过去一个月内漏服的药片为 21%（5.5%）（p < 0.001）。症状得到改善，基线平均值（SE）简明精神病评定量表（BPRS）为 43.6（1.8），终点值为 36.1（2.3）（p = 0.001），基线平均值（SE）汉密尔顿抑郁评定量表（HAM-D）为 17.8（1.1），终点值为 15.3（1.6）（p = 0.044）。
CAE 与依从性、症状和功能状态的改善相关。需要对照试验来证实这些初步发现。
