Keck P E, McElroy S L, Strakowski S M, Stanton S P, Kizer D L, Balistreri T M, Bennett J A, Tugrul K C, West S A
Biological Psychiatry Program, Department of Psychiatry, University of Cincinnati College of Medicine, Ohio, USA.
J Clin Psychiatry. 1996 Jul;57(7):292-7.
Studies of noncompliance with pharmacotherapy in bipolar disorder have primarily involved outpatients receiving lithium. There are limited data to date regarding the rates of noncompliance in patients with bipolar disorder and schizoaffective disorder hospitalized for recurrent mania. Similarly, the influence of race, illness phenomenology, and comorbid psychiatric and medical disorders and the treatment with antipsychotics, antidepressants, and mood-stabilizing agents other than lithium on noncompliance in this population have not been systematically examined.
Patients hospitalized for acute mania (N = 101) were evaluated by the Structured Clinical Interview for DSM-III-R to establish diagnosis and comorbidity and the Young Mania Rating Scale and Hamilton Rating Scale for Depression to assess severity of manic and depressive symptoms, respectively. Compliance was assessed by responses to a clinician-administered questionnaire administered to the patient, treaters, and significant others and by admission plasma concentrations of mood-stabilizing agents.
Sixty-five patients (64%) were noncompliant with their pharmacologic regimen in the month prior to admission as defined by criteria for full compliance and partial or total noncompliance. Noncompliance was significantly associated with greater severity of mania upon admission (p = .02) and treatment with combinations of mood stabilizers (p = .01).
Noncompliance with pharmacotherapy was present in the majority of patients admitted for acute mania and was associated with greater severity of mania upon admission and treatment with combinations of mood stabilizers.
双相情感障碍药物治疗不依从性的研究主要涉及接受锂盐治疗的门诊患者。目前关于双相情感障碍和分裂情感性障碍患者因反复躁狂发作而住院的不依从率的数据有限。同样，种族、疾病现象学、共病的精神和躯体疾病以及除锂盐外的抗精神病药、抗抑郁药和心境稳定剂治疗对该人群不依从性的影响尚未得到系统研究。
对因急性躁狂发作住院的患者（N = 101）采用《精神障碍诊断与统计手册第三版修订本》（DSM - III - R）的结构化临床访谈来确定诊断和共病情况，并用青年躁狂评定量表和汉密尔顿抑郁评定量表分别评估躁狂和抑郁症状的严重程度。通过对患者、治疗者和重要他人进行的临床医生问卷回答以及入院时心境稳定剂的血浆浓度来评估依从性。
根据完全依从和部分或完全不依从的标准，65名患者（64%）在入院前一个月未遵医嘱服药。不依从与入院时更严重的躁狂症状（p = 0.02）以及使用多种心境稳定剂联合治疗（p = 0.01）显著相关。
大多数因急性躁狂发作入院的患者存在药物治疗不依从的情况，且与入院时更严重的躁狂症状以及使用多种心境稳定剂联合治疗有关。
