Chauhan Nidhi, Chakrabarti Subho, Grover Sandeep
Department of Psychiatry, Postgraduate Institution of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India.
J Neurosci Rural Pract. 2021 Sep 28;13(1):12-22. doi: 10.1055/s-0041-1736155. eCollection 2022 Jan.
Unlike schizophrenia, comparisons of different methods of estimating inadequate adherence in bipolar disorder (BD) are scarce. This study compared four methods of identifying inadequate adherence among outpatients with BD. Two self-reports, the Morisky Medication Adherence Questionnaire (MAQ) and the Drug Attitude Inventory (DAI-10), clinician ratings employing the Compliance Rating Scale (CRS), mood-stabilizer levels, and clinic-based pill counts were compared at intake in 106 outpatients with BD and after 6 months of follow-up ( = 75). Rates of nonadherence were determined for each method. The ability to detect inadequate adherence was based on sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (LR positive and LR negative). Correlation coefficients and Cohen's kappa values were used to determine the agreement between measures. Correlation coefficients were also used to evaluate the determinants of inadequate adherence The MAQ and the DAI-10 (cut-off score of two) yielded higher rates of nonadherence (35-47%) than the other methods. They were better at detecting adherence (specificity, 34-42%; PPV, 40-44%; and LR negative, 0.70-0.96) than other measures and had moderate ability to identify nonadherence compared with them (sensitivity, 63-73%; NPV, 54-70%; and LR positive, 1.02-1.16). They were associated with several established predictors of nonadherence. The MAQ and DAI-10 scores and the MAQ and CRS scores were modestly correlated. Multivariate analysis showed that 20% of the variance in the DAI-10 scores was explained by the MAQ scores. Despite their low yield, serum levels had a high sensitivity (88%) and higher accuracy (55%) in identifying inadequate adherence. CRS ratings and pill counts had high sensitivity but low specificity to detect inadequate adherence. Self-reports appeared to be the most efficient method of ascertaining inadequate adherence among outpatients with BD. However, since none of the measures were adequate by themselves, a combination of different measures is more likely to maximize the chances of identifying inadequate adherence among these patients.
与精神分裂症不同，关于双相情感障碍（BD）中评估依从性不足的不同方法的比较很少见。本研究比较了在BD门诊患者中识别依从性不足的四种方法。 在106例BD门诊患者入组时以及随访6个月后（n = 75），比较了两种自我报告方法，即Morisky药物依从性问卷（MAQ）和药物态度量表（DAI-10），采用依从性评定量表（CRS）的临床医生评分、心境稳定剂水平以及基于诊所的药丸计数。 确定了每种方法的不依从率。检测依从性不足的能力基于敏感性、特异性、阳性和阴性预测值（PPV和NPV）以及阳性和阴性似然比（LR阳性和LR阴性）。相关系数和科恩kappa值用于确定测量之间的一致性。相关系数还用于评估依从性不足的决定因素。 MAQ和DAI-10（临界分数为2）产生的不依从率（35%-47%）高于其他方法。它们在检测依从性方面（特异性为34%-42%；PPV为40%-44%；LR阴性为0.70-0.96）比其他测量方法更好，并且与其他方法相比，识别不依从的能力中等（敏感性为63%-73%；NPV为54%-70%；LR阳性为1.02-1.16）。它们与几种已确定的不依从预测因素相关。MAQ和DAI-10评分以及MAQ和CRS评分之间存在适度相关性。多变量分析表明，DAI-10评分中20%的方差可由MAQ评分解释。尽管血清水平的检出率较低，但在识别依从性不足方面具有较高的敏感性（88%）和较高的准确性（55%）。CRS评分和药丸计数检测依从性不足的敏感性高但特异性低。 自我报告似乎是确定BD门诊患者依从性不足的最有效方法。然而，由于没有一种测量方法本身是足够的，不同测量方法的组合更有可能最大限度地提高识别这些患者依从性不足的机会。
