Department of Child and Adolescent Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
J Child Adolesc Psychopharmacol. 2021 Mar;31(2):86-94. doi: 10.1089/cap.2020.0098. Epub 2021 Jan 18.
Pediatric bipolar disorder is a severe disabling condition affecting 1%-3% of youth worldwide. Both acute and maintenance treatment with medications are mainstays of treatment. It is well established in adult literature that adherence to medications improves outcomes and many adult studies have examined factors impacting adherence. This systematic review set out to identify the current state of research examining adherence to medications and characteristics influencing adherence in pediatric bipolar disorder. We performed a systematic literature review in the Medline, PsycINFO, CINAHL, EMBASE, Wiley Clinical Trials, and Cochrane databases. New research regarding characteristics and measurement of adherence to psychotropic medication for bipolar disorder (I, II, or not otherwise specified) in patients ≤18 years old were included for review. Exclusion criteria included no bipolar diagnosis, inclusion of patients >18 years old, no pharmacologic treatment, and lack of adherence measurements. Initial search generated 439 articles after duplicate removal. One hundred thirty-three full-text articles were reviewed, 16 underwent additional review and 6 were selected for final inclusion. The majority of articles were excluded for patients >18 years old. Included articles were extremely heterogeneous for multiple measures, including methodology, determination of adherence, adherence rates, and characteristics influencing adherence. Of medications evaluated, 6/6 studies included mood stabilizers, 4/6 antidepressants, 3/6 antipsychotics, and 2/6 psychostimulants. Three out of six articles included patients <12 years old. Some significant factors affecting adherence included polypharmacy, comorbid psychiatric diagnoses, socioeconomic status, sex, family history and functioning, side effects, race, stability of bipolar diagnosis, and number of follow-up visits attended. Pediatric-specific information on medication adherence in bipolar disorder is very limited. Information on patient characteristics that may influence adherence rates is critical to target interventions to improve adherence. No articles reported on interventions to improve adherence. Given the different psychosocial situations of pediatric patients versus adults, it is likely that targets for improving adherence differ in pediatric patients.
儿科双相情感障碍是一种严重的致残疾病，影响全球 1%-3%的青少年。药物的急性和维持治疗是治疗的主要方法。成人文献中已经充分证实，药物治疗的依从性可以改善预后，许多成人研究都检查了影响依从性的因素。本系统综述旨在确定目前研究儿科双相情感障碍药物依从性及其影响因素的现状。我们在 Medline、PsycINFO、CINAHL、EMBASE、Wiley 临床试验和 Cochrane 数据库中进行了系统文献综述。纳入了新的研究，这些研究涉及 18 岁以下患者双相情感障碍（I、II 或未特指）的精神药物依从性的特征和测量。排除标准包括无双相诊断、纳入 18 岁以上患者、无药物治疗和缺乏依从性测量。初始搜索在去除重复项后生成了 439 篇文章。133 篇全文文章进行了审查，16 篇进行了额外审查，6 篇被选中进行最终纳入。大多数文章因患者年龄>18 岁而被排除。纳入的文章在多种措施上非常多样化，包括方法学、依从性的确定、依从率以及影响依从性的特征。在评估的药物中，6/6 项研究包括心境稳定剂，4/6 项研究包括抗抑郁药，3/6 项研究包括抗精神病药，2/6 项研究包括精神兴奋剂。6 篇文章中有 3 篇包括<12 岁的患者。一些影响依从性的重要因素包括联合用药、共病精神诊断、社会经济地位、性别、家庭功能和作用、副作用、种族、双相诊断的稳定性和随访次数。儿科双相情感障碍药物依从性的具体信息非常有限。关于可能影响依从率的患者特征的信息对于针对提高依从性的干预措施至关重要。没有文章报告过改善依从性的干预措施。鉴于儿科患者与成人的不同社会心理情况，提高依从性的目标在儿科患者中可能有所不同。
