Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, USA.
J Child Adolesc Psychopharmacol. 2024 Oct;34(8):353-358. doi: 10.1089/cap.2024.0011. Epub 2024 May 21.
Youth with bipolar spectrum disorders (BSD) are frequently prescribed second-generation antipsychotics (SGAs). Nonadherence to treatment often results in increased mood symptoms and diminished quality of life. We examined SGA adherence rates and adherence barriers among youth who have overweight/obesity and are diagnosed with BSD enrolled in a multisite pragmatic clinical trial. SGA adherence and adherence barriers at baseline via patient- and caregiver report was assessed. Adherence was defined as taking ≥70% of prescribed SGA doses in the past week. The weighted Kappa statistic was used to measure child-caregiver agreement about adherence rates, barriers, and caregiver assistance. Regression analyses were used to examine associations of caregiver assistance, age, sex, race, insurance status, dosing frequency, and number of concomitant medications with adherence. Barriers to adherence were analyzed separately for youth and their caregivers, using logistic regression to assess associations between informant-reported barriers and informant-reported adherence. Participants included 1485 patients and/or caregivers. At baseline, 88.6% of patients self-reported as adherent; 92.0% of caregivers reported their child was adherent. Concordance between patients and caregivers was moderate ( = 0.42). Approximately, 50% of the sample reported no adherence barriers. Frequently endorsed barriers included forgetting, side effects, being embarrassed to take medications, and preferring to do something else. Concordance between informants regarding adherence barriers was weak ( = 0.05-0.36). Patients and caregivers who did not endorse adherence barriers reported higher adherence than those who endorsed barriers. Male sex and having once daily dosing of medications were associated with lower adherence. One-week patient- and caregiver-reported adherence was high in this sample. Half of the sample reported adherence barriers. Most commonly endorsed barriers were forgetting, side effects, being embarrassed, and preferring to do something else. Caregivers and patients have unique perspectives regarding adherence barriers. Understanding and addressing treatment barriers in clinical practice may facilitate adherence.
患有双相情感障碍（BSD）的年轻人经常会被开第二代抗精神病药物（SGAs）。治疗不依从常常会导致情绪症状加重和生活质量下降。我们研究了超重/肥胖且患有 BSD 的年轻人在参加一项多地点实用临床试验时的 SGA 依从率和治疗依从障碍。通过患者和照护者报告评估了基线时的 SGA 依从率和治疗依从障碍。依从性定义为过去一周内服用了≥70%的规定 SGA 剂量。使用加权 Kappa 统计量来衡量儿童与照护者在依从率、障碍和照护者协助方面的一致性。回归分析用于检查照护者协助、年龄、性别、种族、保险状况、给药频率和伴随药物数量与依从性的关联。分别对年轻人及其照护者进行依从障碍分析，使用逻辑回归评估报告障碍与报告依从性之间的关联。参与者包括 1485 名患者和/或照护者。在基线时，88.6%的患者报告自己依从；92.0%的照护者报告他们的孩子依从。患者和照护者之间的一致性为中度（ = 0.42）。大约 50%的样本报告没有依从障碍。经常报告的障碍包括遗忘、副作用、因服药而尴尬和更愿意做其他事情。报告障碍的信息提供者之间的一致性较弱（ = 0.05-0.36）。未报告依从障碍的患者和照护者报告的依从性高于报告障碍的患者和照护者。男性和每日一次的药物剂量与较低的依从性相关。在该样本中，一周内患者和照护者报告的依从性较高。一半的样本报告了依从障碍。最常报告的障碍是遗忘、副作用、尴尬和更愿意做其他事情。照护者和患者对依从障碍有独特的看法。在临床实践中了解和解决治疗障碍可能有助于提高依从性。
