成人双相情感障碍患者对口服精神药物的依从性差：精神科医生的影响可能比其他严重精神疾病更大。

Poor Adherence to Oral Psychiatric Medication in Adults with Bipolar Disorder: The Psychiatrist May have More Influence than in Other Severe Mental Illnesses.

机构信息

Department of Internal Medicine, Dermatology and Psychiatry and Instituto Universitario de Neurociencia (IUNE), School of Medicine, University of La Laguna, Canary Islands, Spain.

Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA.

出版信息

Neuropsychopharmacol Hung. 2021 Dec 1;23(4):347-362.

PMID:34971399

Abstract

Objective: Medication adherence in bipolar disorder (BD) may be influenced by 6 selfreported dimensions: 1) high/low psychological reactance, 2) high/low internal healthlocus of control (HLOC), 3) high/low doctor HLOC, 4) pharmacophobia, 5) pharmacophilia, and 6) skepticism about a specific medication. This study in Spain, Argentina, and Venezuela included 142 outpatients with BD prescribed 320 psychiatric medications and 1230 other psychiatric outpatients prescribed 2134 medications. Methods: Logistic regression models included adherence for each psychiatric medication, measured by the Sidorkiewicz Adherence Tool as the dependent variable. The models provided adjusted odds ratios (ORs) of dichotomous independent variables: clinical variables and 6 self-reported dimensions. Results: ORs significant in both groups were: 1) high doctor HLOC (OR=1.87 in BD, OR=1.25 in other patients), 2) high psychological reactance (respectively OR=0.572, OR=0.798), 3) pharmacophobia (respectively OR=0.361, OR=0.614), and 4) skepticism about a specific medication (respectively OR=0.300, OR=0.556). Two ORs were only significant in BD patients: medication duration > 1 year (OR=0.449), and extreme polypharmacy (OR=2.49). The study included 104 BD patients prescribed 122 mood stabilizers and 136 other patients prescribed 140 mood stabilizers. Two ORs were significant for mood stabilizer adherence only in BD patients: high doctor HLOC and skepticism (respective ORs=2.38, OR=0.390). The study included 87 BD patients prescribed 97 antipsychotics and 417 other patients prescribed 458 antipsychotics. Four ORs were significant for antipsychotic adherence only in the BD group. Conclusions: Future studies of adherence to all/specific medications should explore the specific city/commonality of these dimensions, particularly doctor HLOC, in BD versus other psychiatric patients. (Neuropsychopharmacol Hung 2021; 23(4): 347-362).

摘要

目的

双相情感障碍（BD）患者的药物依从性可能受到 6 种自我报告维度的影响：1）高/低心理反应性，2）高/低内在健康控制源（HLOC），3）高/低医生 HLOC，4）药物恐惧症，5）药物癖，6）对特定药物的怀疑。这项在西班牙、阿根廷和委内瑞拉进行的研究纳入了 142 名服用 320 种精神科药物的 BD 门诊患者和 1230 名服用 2134 种精神科药物的其他门诊患者。方法：逻辑回归模型将 Sidorkiewicz 依从性工具测量的每种精神科药物的依从性作为因变量。模型提供了二项独立变量的调整比值比（OR）：临床变量和 6 种自我报告维度。结果：两组中均有统计学意义的 OR 是：1）高医生 HLOC（BD 中的 OR=1.87，其他患者中的 OR=1.25），2）高心理反应性（分别为 OR=0.572，OR=0.798），3）药物恐惧症（分别为 OR=0.361，OR=0.614）和 4）对特定药物的怀疑（分别为 OR=0.300，OR=0.556）。只有在 BD 患者中，两个 OR 具有统计学意义：药物治疗持续时间>1 年（OR=0.449）和极端多药治疗（OR=2.49）。该研究纳入了 104 名服用 122 种情绪稳定剂的 BD 患者和 136 名服用 140 种情绪稳定剂的其他患者。只有在 BD 患者中，两个 OR 对情绪稳定剂的依从性具有统计学意义：高医生 HLOC 和怀疑（分别为 OR=2.38，OR=0.390）。该研究纳入了 87 名服用 97 种抗精神病药物的 BD 患者和 417 名服用 458 种抗精神病药物的其他患者。只有在 BD 组中，四个 OR 对抗精神病药物的依从性具有统计学意义。结论：未来对所有/特定药物依从性的研究应探讨这些维度在 BD 与其他精神科患者中的具体/共同性，特别是医生 HLOC。（神经精神药理学匈牙利杂志 2021；23（4）：347-362）。