Unit 2 - Drug adherence

Summary

Improving treatment adherence must be one of the main objectives of any psychological intervention in bipolar disorders, since the problem of poor adherence is certainly the cornerstone of the poor evolution of many of our patients. The problem is severe if we consider that practically all bipolar patients seriously think at least once in their life of abandoning treatment, and it is not risky to affirm that more than half the patients stop taking the prescribed treatment without indication from their psychiatrists, even including during periods of euthymia. On the other hand, treatment withdrawal is the most common cause of relapse among bipolar patients and in fact, the risk of hospitalization is four times higher among the patients who do not duly comply with their maintenance treatment. Mortality, especially by suicide, is also higher in untreated patients. These considerations, along with the high rates of poor adherence recorded in bipolar populations, force us to make a great effort to improve our patients’ adherence to treatment. This effort makes it appropriate for us to dedicate up to seven sessions to this topic in our program.

As we can see in Chart 1, when speaking of poor adherence we are not only referring to the patient who does not take his medication. Broadly, we can affirm that by poor adherence we understand that inability of the patient to follow some or all of the instructions given by his psychiatrist and psychologist, including drug prescription and the facilitation of health-promoting behavior or habits.