Cohen Bar, Sixsmith Andrew, Pollock Star Ariel, Haglili Ophir, O'Rourke Norm
Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
Science and Technology for Aging Research Institute, Simon Fraser University, Vancouver, BC, Canada.
JMIR Form Res. 2023 Feb 7;7:e44059. doi: 10.2196/44059.
Despite the efficacy of treatment and severity of symptoms, medication adherence by many with bipolar disorder (BD) is variable at best. This poses a significant challenge for BD care management.
For this study, we set out to identify psychosocial and psychiatric predictors of medication adherence with BD.
Using microtargeted social media advertising, we recruited an international sample of young and older adults with BD living in North America (Canada and the United States), Western Europe (eg, United Kingdom and Ireland), Australia and New Zealand (N=92). On average, participants were 55.35 (SD 9.65; range 22-73) years of age, had been diagnosed with BD 14.25 (SD 11.14; range 1-46) years ago, and were currently prescribed 2.40 (SD 1.28; range 0-6) psychotropic medications. Participants completed questionnaires online including the Morisky Medication Adherence Scale.
Medication adherence did not significantly differ across BD subtypes, country of residence, or prescription of lithium versus other mood stabilizers (eg, anticonvulsants). Path analyses indicate that alcohol misuse and subjective or perceived cognitive failures are direct predictors of medication adherence. BD symptoms, psychological well-being, and the number of comorbid psychiatric conditions emerged as indirect predictors of medication adherence via perceived cognitive failures.
Alcohol misuse did not predict perceived cognitive failures. Nor did age predict medication adherence or cognitive failures. This is noteworthy given the 51-year age range of participants. That is, persons in their 20s with BD reported similar levels of medication adherence and perceived cognitive failures as those in their 60s. This suggests that perceived cognitive loss is a facet of adult life with BD, in contrast to the assumption that accelerated cognitive aging with BD begins in midlife.
尽管双相情感障碍（BD）的治疗具有疗效且症状严重，但许多患者的药物依从性充其量也只是参差不齐。这给双相情感障碍的护理管理带来了重大挑战。
在本研究中，我们旨在确定双相情感障碍患者药物依从性的心理社会和精神预测因素。
通过有针对性的社交媒体广告，我们招募了居住在北美（加拿大和美国）、西欧（如英国和爱尔兰）、澳大利亚和新西兰的双相情感障碍患者的国际样本（N = 92）。参与者的平均年龄为55.35岁（标准差9.65；范围22 - 73岁），14.25年前（标准差11.14；范围1 - 46年）被诊断为双相情感障碍，目前正在服用2.40种（标准差1.28；范围0 - 6种）精神药物。参与者通过在线方式完成问卷，包括莫利斯基药物依从性量表。
双相情感障碍的亚型、居住国家或锂盐与其他情绪稳定剂（如抗惊厥药）的处方情况对药物依从性没有显著差异。路径分析表明，酒精滥用和主观或感知到的认知失误是药物依从性的直接预测因素。双相情感障碍症状、心理健康状况以及共病精神疾病的数量通过感知到的认知失误成为药物依从性的间接预测因素。
酒精滥用并不能预测感知到的认知失误。年龄也不能预测药物依从性或认知失误。鉴于参与者的年龄范围为51岁，这一点值得注意。也就是说，20多岁的双相情感障碍患者报告的药物依从性水平和感知到的认知失误与60多岁的患者相似。这表明，感知到的认知丧失是双相情感障碍成年生活的一个方面，这与双相情感障碍加速认知衰老始于中年的假设形成对比。
