Sylvia L G, Reilly-Harrington N A, Leon A C, Kansky C I, Calabrese J R, Bowden C L, Ketter T A, Friedman E S, Iosifescu D V, Thase M E, Ostacher M J, Keyes M, Rabideau D, Nierenberg A A
Massachusetts General Hospital, Boston, MA, USA.
Acta Psychiatr Scand. 2014 May;129(5):359-65. doi: 10.1111/acps.12202. Epub 2013 Oct 3.
Psychopharmacology remains the foundation of treatment for bipolar disorder, but medication adherence in this population is low (range 20-64%). We examined medication adherence in a multisite, comparative effectiveness study of lithium.
The Lithium Moderate Dose Use Study (LiTMUS) was a 6-month, six-site, randomized effectiveness trial of adjunctive moderate dose lithium therapy compared with optimized treatment in adult out-patients with bipolar I or II disorder (N=283). Medication adherence was measured at each study visit with the Tablet Routine Questionnaire.
We found that 4.50% of participants reported missing at least 30% of their medications in the past week at baseline and non-adherence remained low throughout the trial (<7%). Poor medication adherence was associated with more manic symptoms and side-effects as well as lower lithium serum levels at mid- and post-treatment, but not with poor quality of life, overall severity of illness, or depressive symptoms.
Participants in LiTMUS were highly adherent with taking their medications. The lack of association with possible predictors of adherence, such as depression and quality of life, could be explained by the limited variance or other factors as well as by not using an objective measure of adherence.
精神药理学仍然是双相情感障碍治疗的基础，但该人群的药物依从性较低（范围为20%-64%）。我们在一项关于锂盐的多中心、比较疗效研究中考察了药物依从性。
锂盐中等剂量使用研究（LiTMUS）是一项为期6个月、在六个地点开展的随机疗效试验，将辅助中等剂量锂盐治疗与针对I型或II型双相情感障碍成年门诊患者的优化治疗进行比较（N = 283）。在每次研究访视时，使用片剂常规问卷测量药物依从性。
我们发现，4.50%的参与者报告在基线时过去一周内至少漏服了30%的药物，并且在整个试验过程中不依从率仍然较低（<7%）。药物依从性差与更多的躁狂症状和副作用以及治疗中期和后期较低的锂血清水平相关，但与生活质量差、疾病总体严重程度或抑郁症状无关。
LiTMUS的参与者服药依从性很高。与依从性可能的预测因素（如抑郁和生活质量）缺乏关联，可能是由于方差有限或其他因素，以及未使用依从性的客观测量方法所致。
