Sajatovic, Department of Psychiatry and Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Levin, Department of Psychiatry and Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Psychopharmacol Bull. 2023 Aug 11;53(3):8-21.
While medication non-adherence is common in bipolar disorder (BD), few studies have specifically assessed non-adherent BD adolescents and young adults (AYAs). This analysis, using screening and baseline data from an ongoing randomized controlled trial, examined the relationship between BD symptoms and adherence in poorly adherent AYAs.
AYAs ages 13-21 had sub-optimal adherence defined as missing ⩾ 20% of prescribed BD medication. Mean sample (N = 36) age was 19.1 years (SD = 2.0), 66.7 % (N = 24) female, 25.0 % (n = 9) non-white. Adherence was measured via: 1) self-reported Tablets Routine Questionnaire (TRQ) and 2) electronic monitoring (SimpleMed pillbox). Symptoms were measured with the Hamilton Depression Rating Scale (HAM-D), the Young Mania Rating Scale (YMRS), and the Clinical Global Impression Scale (CGI).
Mean percentage of missed BD medications using TRQ was 34.9 (SD = 28.9) at screening and 30.6 (SD = 33.0) at baseline. Mean percentage of missed medication using SimpleMed at baseline was 42.1 (SD = 37.0). The correlation between TRQ and SimpleMed was r = 0.36 (p = 0. 13). Neither CGI nor age were correlated with adherence. Neither TRQ nor SimpleMed were significantly related to HAM-D. YMRS was positively associated with worse adherence for TRQ (r = 0.36, p = 0.03), but not significantly associated with SimpleMed. Adherence did not differ by other demographic attributes.
Adherence levels varied widely in AYA with BD. Adherence monitoring increased adherence by approximately 4.5%, and use of electronic pill monitoring identified a greater proportion of missed medication vs. self-report. BD symptoms may not consistently identify AYA with adherence challenges.
尽管在双相情感障碍（BD）中经常出现药物不依从的情况，但很少有研究专门评估不依从的 BD 青少年和年轻人（AYA）。本分析使用正在进行的随机对照试验的筛查和基线数据，研究了 BD 症状与依从性不良的 AYA 之间的关系。
年龄在 13-21 岁之间的 AYA 被定义为不依从，即错过 ⩾ 20%的规定 BD 药物。平均样本（N=36）年龄为 19.1 岁（SD=2.0），66.7%（N=24）为女性，25.0%（n=9）为非白人。依从性通过以下方式测量：1）自我报告的 Tablets Routine Questionnaire（TRQ）和 2）电子监测（SimpleMed 药盒）。症状采用 Hamilton 抑郁评定量表（HAM-D）、Young 躁狂评定量表（YMRS）和临床总体印象量表（CGI）进行测量。
使用 TRQ 在筛查时的平均错过 BD 药物百分比为 34.9%（SD=28.9），在基线时为 30.6%（SD=33.0）。基线时使用 SimpleMed 错过药物的平均百分比为 42.1%（SD=37.0）。TRQ 和 SimpleMed 之间的相关性为 r=0.36（p=0.13）。CGI 和年龄均与依从性无关。TRQ 和 SimpleMed 均与 HAM-D 无显著相关性。YMRS 与 TRQ 的较差依从性呈正相关（r=0.36，p=0.03），但与 SimpleMed 无显著相关性。依从性与其他人口统计学特征无差异。
BD 的 AYA 中，依从水平差异很大。依从性监测使依从性提高了约 4.5%，并且电子药丸监测比自我报告发现更多漏服药物的情况。BD 症状可能无法始终识别出有依从性挑战的 AYA。
