Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France; Fondation FondaMental, fondation de coopération scientifique, Créteil, France.
Fondation FondaMental, fondation de coopération scientifique, Créteil, France; Laboratoire de Psychologie EA 4139, Université de Bordeaux, Bordeaux, France; Service de Psychiatrie Adulte, Hôpital Charles-Perrens, Bordeaux, France.
J Affect Disord. 2021 Mar 1;282:812-819. doi: 10.1016/j.jad.2020.12.192. Epub 2020 Dec 31.
Bipolar disorder (BD) is a chronic and severe mental illness. It requires a non-discontinued pharmacological treatment to prevent mood recurrences but nonadherence to medication is frequent. To this date, medication adherence in BD has been mostly evaluated in cross-sectional studies and often considered as a stable trait. We aimed to study medication adherence using a prospective person-oriented approach.
1627 BD patients were followed on a 2 years period and assessed every 6 months. Medication adherence was evaluated at each visit with the Medication Adherence Rating Scale (MARS). A latent class mixed model (LCMM) was used to identify trajectory classes of adherence over time. Regression analyses and linear mixed model were used to search for predictors and covariables of the trajectories.
Three distinct and robust trajectories of medication adherence have been identified: one that starts poorly and keeps deteriorating (4.8%), one that starts poorly but improves (9%) and one that starts well and keeps improving (86.2%). A good tolerance to psychotropic medications, low depressive symptoms, the absence of comorbid eating disorders and anticonvulsant medication were associated to a better prognosis of adherence. Along the follow-up, the lower were the depressive symptoms, the better was the medication adherence (p < .001) LIMITATIONS: The use of a single measure of medication adherence although it is a validated instrument and a possible positive selection bias that might limit the generalization of our findings.
This study demonstrates that medication adherence in BD patients is a heterogeneous and potentially variable phenomenon.
双相情感障碍（BD）是一种慢性且严重的精神疾病。为了预防情绪复发，需要持续进行药物治疗，但患者经常不遵医嘱服药。迄今为止，BD 患者的药物依从性主要在横断面研究中进行评估，并且通常被认为是一种稳定的特征。我们旨在使用前瞻性的个体导向方法研究药物依从性。
1627 名 BD 患者在 2 年期间接受随访，并每 6 个月评估一次。每次就诊时使用药物依从性评定量表（MARS）评估药物依从性。使用潜在类别混合模型（LCMM）来识别随时间的依从性轨迹类别。回归分析和线性混合模型用于搜索轨迹的预测因子和协变量。
确定了三种不同且稳定的药物依从性轨迹：一种是依从性开始较差且不断恶化（4.8%），一种是依从性开始较差但有所改善（9%），一种是依从性开始良好且不断改善（86.2%）。对精神药物具有良好耐受性、低抑郁症状、无合并的饮食障碍和抗惊厥药物与更好的依从性预后相关。在随访过程中，抑郁症状越低，药物依从性越好（p<0.001）。
使用单一的药物依从性测量方法，尽管它是一种经过验证的工具，但可能存在积极的选择偏差，这可能限制了我们研究结果的推广。
这项研究表明，BD 患者的药物依从性是一种异质且潜在可变的现象。
