Navarro Santiago, Rodríguez Fernando, Acosta Francisco J, García-Bello Miguel
Service of Psychiatry, University Hospital of Gran Canaria Dr. Negrín. Gran Canaria, The Canary Islands, Spain.
Mental Health Research Program of the Canary Islands. Service of Mental Health. General Direction of Healthcare Programs. Gran Canaria, The Canary Islands, Spain Research Network for Health Services for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)). Health Institute Carlos III. Spain.
Actas Esp Psiquiatr. 2016 Sep;44(5):157-65. Epub 2016 Sep 1.
Nonadherence is an important and highly prevalent issue in bipolar disorder, which may have serious consequences. Surprisingly, few studies have been carried out in patients with clinical stability to explore risk factors for nonadherence.
Adherence was assessed in 76 bipolar disorder patients with clinical stability using objective and subjective methods, both with a cross-sectional approach and a 3-year retrospective period. Possible associations between nonadherence and sociodemographic, clinical, treatment-related, psychopathological, psychological-subjective and result variables were also assessed.
36.8% of patients were nonadherent. These patients showed greater concerns about medicines, worse functionality, a greater number of episodes and depressive episodes, higher prevalence of psychiatric comorbidities, present and/or past substance use or abuse and a history of depressive episodes with psychotic symptoms. A multivariate analysis revealed that concern about medicines, present and/or past substance use or abuse and psychiatric comorbidities were independently associated with nonadherence.
Nonadherence is a frequent phenomenon in bipolar disorder, even in patients with clinical stability. Clinicians should assess patients’ beliefs and attitudes towards medicines and help them reevaluate those issues with a more realistic perspective. Clinicians should also take actions to prevent substance use or abuse. Identification of nonadherence risk profile in bipolar disorder patients in clinical stability, adds complementary information to the identified risk profile in acute phases of the disease.
治疗依从性差是双相情感障碍中一个重要且普遍存在的问题，可能会产生严重后果。令人惊讶的是，针对临床病情稳定的患者开展的探索治疗依从性差风险因素的研究很少。
采用客观和主观方法，通过横断面研究方法和3年回顾期，对76例临床病情稳定的双相情感障碍患者的治疗依从性进行评估。还评估了治疗依从性差与社会人口统计学、临床、治疗相关、精神病理学、心理主观及结果变量之间可能存在的关联。
36.8%的患者治疗依从性差。这些患者对药物更为担忧，功能较差，发作次数和抑郁发作次数更多，精神疾病共病的患病率更高，目前和/或过去有物质使用或滥用情况，以及有伴有精神病症状的抑郁发作史。多因素分析显示，对药物的担忧、目前和/或过去的物质使用或滥用以及精神疾病共病与治疗依从性差独立相关。
即使在临床病情稳定的患者中，治疗依从性差在双相情感障碍中也是一种常见现象。临床医生应评估患者对药物的信念和态度，并帮助他们以更现实的视角重新评估这些问题。临床医生还应采取行动预防物质使用或滥用。识别临床病情稳定的双相情感障碍患者的治疗依从性差风险特征，可为已识别的疾病急性期风险特征增添补充信息。
