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Promoting medication adherence among patients with bipolar disorder: a multicenter randomized controlled trial of a multifaceted intervention

Published online by Cambridge University Press:  27 April 2017

A. H. Pakpour ,
A. Modabbernia ,
C.-Y. Lin ,
M. Saffari ,
M. Ahmadzad Asl  and
T. L. Webb
A. H. Pakpour*
Affiliation:
Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
A. Modabbernia
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
C.-Y. Lin
Affiliation:
Department of Rehabilitation Sciences, Faculty of Health & Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
M. Saffari
Affiliation:
Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
M. Ahmadzad Asl
Affiliation:
Mental Health Research Center, School of Medicine, Department of Psychiatry, Iran University of Medical Sciences, Tehran, IR Iran
T. L. Webb
Affiliation:
Department of Psychology, The University of Sheffield, Sheffield, UK
*
*Address for correspondence: Dr A. H. Pakpour, Ph.D., Associate Professor, Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Shahid Bahounar BLV, Qazvin, 3419759811, Iran. (Email: [email protected])
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Abstract

Background

The present research aimed to investigate the efficacy of a multifaceted intervention that included motivational interviewing (MI) and psychoeducation in improving medication adherence (MA) among patients with bipolar disorder (BD).

Method

A multicenter, cluster randomized, observer-blind, controlled, parallel-group trial was conducted in ten academic centers in Iran. Patients with BD were randomly assigned to the experimental group (EXP; n = 136) or the usual care group (UC; n = 134). The EXP group received five sessions of MI and psychoeducation together with their family members. The primary outcome measure was changes in scores on the Medication Adherence Rating Scale from baseline to 6 months post-intervention. Other outcome measures included serum levels of mood stabilizers, clinical symptoms, quality of life, as well as measures of intention, beliefs about medicine, perceived behavioral control, automaticity, action and coping planning, and adverse reactions.

Results

Medication adherence improved over time in both groups, but patients in the EXP group improved more (baseline score: 6.03; score at the sixth month: 9.55) than patients in the UC group (baseline score: 6.17; score at the sixth month: 6.67). In addition, patients in the EXP group showed greater improvement than patients in the UC group in almost all secondary outcomes 6 months following the intervention.

Conclusions

Multifaceted interventions that include motivational-interviewing and psychoeducation can significantly improve MA and clinical and functional outcomes in patients with BD.

Trial Registration Number: The trial was registered with theClinicalTrials.gov database (NCT02241863) https://clinicaltrials.gov/ct2/show/NCT02241863

Keywords

Adherencebipolar disordermood stabilizermotivational interviewingpsychoeducation
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 14 , October 2017 , pp. 2528 - 2539
Copyright
Copyright © Cambridge University Press 2017 

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References

Aflakseir, A (2012). Role of illness and medication perceptions on adherence to medication in a group of Iranian patients with type 2 diabetes. Journal of Diabetes 4, 243–247.CrossRefGoogle Scholar
Bauer, MS, McBride, L, Williford, WO, Glick, H, Kinosian, B, Altshuler, L, Beresford, T, Kilbourne, AM, Sajatovic, M, Cooperative Studies Program 430 Study T (2006 a). Collaborative care for bipolar disorder. I. Intervention and implementation in a randomized effectiveness trial. Psychiatric Services 57, 927–936.CrossRefGoogle Scholar
Bauer, MS, McBride, L, Williford, WO, Glick, H, Kinosian, B, Altshuler, L, Beresford, T, Kilbourne, AM, Sajatovic, M, Cooperative Studies Program 430 Study T (2006 b). Collaborative care for bipolar disorder. II. Impact on clinical outcome, function, and costs. Psychiatric Services 57, 937–945.CrossRefGoogle ScholarPubMed
Berk, M, Berk, L, Castle, D (2004). A collaborative approach to the treatment alliance in bipolar disorder. Bipolar Disorders 6, 504–518.Google Scholar
Bermúdez-Ampudia, C, García-Alocén, A, Martínez-Cengotitabengoa, M, Alberich, S, González-Ortega, I, Resa, SB, González-Pinto, A (2016). Mixed-effects models: family burden and functionality in patients with bipolar disorder. European Psychiatry 33, S331.CrossRefGoogle Scholar
Bilderbeck, AC, Atkinson, LZ, McMahon, HC, Voysey, M, Simon, J, Price, J, Rendell, J, Hinds, C, Geddes, JR, Holmes, E, Miklowitz, DJ (2016). Psychoeducation and online mood tracking for patients with bipolar disorder: a randomised controlled trial. Journal of Affective Disorders 205, 245–251.Google Scholar
Cakir, S, Bensusan, R, Akca, ZK, Yazici, O (2009). Does a psychoeducational approach reach targeted patients with bipolar disorder? Journal of Affective Disorders 119, 190–193.Google Scholar
Culpepper, L (2014). The diagnosis and treatment of bipolar disorder: decision-making in primary care. Primary Care Companion for CNS Disorders 16, 3.Google Scholar
Daneshpour, M (1998). Muslim families and family therapy. Journal of Marital and Family Therapy 24, 355–368.Google Scholar
Dean, BB, Gerner, D, Gerner, RH (2004). A systematic review evaluating health-related quality of life, work impairment, and healthcare costs and utilization in bipolar disorder. Current medical Research and Opinion 20, 139–154.Google Scholar
Depp, CA, Lebowitz, BD, Patterson, TL, Lacro, JP, Jeste, DV (2007). Medication adherence skills training for middle-aged and elderly adults with bipolar disorder: development and pilot study. Bipolar Disorders 9, 636–645.CrossRefGoogle ScholarPubMed
Folco, EG, Lee, C-S, Dufu, K, Yamazaki, T, Reed, R (2012). The Proteins PDIP3 and ZC11A Associate with the Human TREX Complex in an ATP-Dependent Manner and Function in mRNA Export. PLoS ONE 7, e43804.Google Scholar
Forte, A, Baldessarini, RJ, Tondo, L, Vazquez, GH, Pompili, M, Girardi, P (2015). Long-term morbidity in bipolar-I, bipolar-II, and unipolar major depressive disorders. Journal of Affective Disorders 178, 71–78.CrossRefGoogle ScholarPubMed
Gardner, B, Abraham, C, Lally, P, de Bruijn, GJ (2012). Towards parsimony in habit measurement: testing the convergent and predictive validity of an automaticity subscale of the Self-Report Habit Index. International Journal of Behavioral Nutrition and Physical Activity 9, 102.Google Scholar
Geddes, JR, Miklowitz, DJ (2013). Treatment of bipolar disorder. Lancet 381, 1672–1682.Google Scholar
Hidalgo-Mazzei, D, Mateu, A, Reinares, M, Murru, A, del Mar Bonnín, C, Varo, C, Valentí, M, Undurraga, J, Strejilevich, S, Sánchez-Moreno, J, Vieta, E (2016). Psychoeducation in bipolar disorder with a SIMPLe smartphone application: feasibility, acceptability and satisfaction. Journal of Affective Disorders 200, 58–66.Google Scholar
Horne, R, Weinman, J, Hankins, M (1999). The beliefs about medicines questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychology and Health 14, 1–24.CrossRefGoogle Scholar
Hubbard, AA, McEvoy, PM, Smith, L, Kane, RT (2016). Brief group psychoeducation for caregivers of individuals with bipolar disorder: a randomized controlled trial. Journal of Affective Disorders 200, 31–36.Google Scholar
IsHak, WW, Brown, K, Aye, SS, Kahloon, M, Mobaraki, S, Hanna, R (2012). Health-related quality of life in bipolar disorder. Bipolar Disorders 14, 6–18.CrossRefGoogle ScholarPubMed
Javadpour, A, Hedayati, A, Dehbozorgi, GR, Azizi, A (2013). The impact of a simple individual psycho-education program on quality of life, rate of relapse and medication adherence in bipolar disorder patients. Asian Journal of Psychiatry 6, 208–213.Google Scholar
Kallestad, H, Wullum, E, Scott, J, Stiles, TC, Morken, G (2016). The long-term outcomes of an effectiveness trial of group versus individual psychoeducation for bipolar disorders. Journal of Affective Disorders 15, 32–38.CrossRefGoogle Scholar
Krull, JL, MacKinnon, DP (1999). Multilevel mediation modeling in group-based intervention studies. Evaluation Review 23, 418–444.Google Scholar
Lacro, JP, Dunn, LB, Dolder, CR, Leckband, SG, Jeste, DV (2002). Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. Journal of Clinical Psychiatry 63, 892–909.CrossRefGoogle ScholarPubMed
Lingam, R, Scott, J (2002). Treatment non-adherence in affective disorders. Acta Psychiatrica Scandinavica 105, 164–172.Google Scholar
Lundahl, B, Moleni, T, Burke, BL, Butters, R, Tollefson, D, Butler, C, Rollnick, S (2013). Motivational interviewing in medical care settings: a systematic review and meta-analysis of randomized controlled trials. Patient Education and Counseling 93, 157–168.Google Scholar
MacDonald, L, Chapman, S, Syrett, M, Bowskill, R, Horne, R (2016). Improving medication adherence in bipolar disorder: a systematic review and meta-analysis of 30 years of intervention trials. Journal of Affective Disorders 194, 202–221.Google Scholar
McIntyre, RS, Mancini, DA, Srinivasan, J, McCann, S, Konarski, JZ, Kennedy, SH (2004). The antidepressant effects of risperidone and olanzapine in bipolar disorder. Canadian Journal of Clinical Pharmacology 11, e218–e226.Google Scholar
Merikangas, KR, Akiskal, HS, Angst, J, Greenberg, PE, Hirschfeld, RM, Petukhova, M, Kessler, RC (2007). Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Archives of General Psychiatry 64, 543–552.Google Scholar
Michalak, EE, Murray, G, Collaborative RTtSPIiBD (2010). Development of the QoL.BD: a disorder-specific scale to assess quality of life in bipolar disorder. Bipolar Disorders 12, 727–740.Google Scholar
Miller, WR, Rollnick, S (2012). Motivational Interviewing: Helping People Change. Guilford Press.Google Scholar
Montgomery, SA, Asberg, M (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382–389.CrossRefGoogle ScholarPubMed
O'Carroll, R, Whittaker, J, Hamilton, B, Johnston, M, Sudlow, C, Dennis, M (2011). Predictors of adherence to secondary preventive medication in stroke patients. Annals of Behavioral Medicine 41, 383–390.Google Scholar
Orbell, S, Verplanken, B (2010). The automatic component of habit in health behavior: habit as cue-contingent automaticity. Health Psychology 29, 374–383.Google Scholar
Pakpour, AH, Gellert, P, Asefzadeh, S, Updegraff, JA, Molloy, GJ, Sniehotta, FF (2014). Intention and planning predicting medication adherence following coronary artery bypass graft surgery. Journal of Psychosomatic Research 77, 287–295.Google Scholar
Pakpour, AH, Gholami, M, Esmaeili, R, Naghibi, SA, Updegraff, JA, Molloy, GJ, Dombrowski, SU (2015). A randomized controlled multimodal behavioral intervention trial for improving antiepileptic drug adherence. Epilepsy & Behavior 52, 133–142.Google Scholar
Rollnick, S, Miller, WR, Butler, CC, Aloia, MS (2008). Motivational Interviewing in Health Care: Helping Patients Change Behavior. The Guilford Press: New York.Google Scholar
Rouget, BW, Aubry, JM (2007). Efficacy of psychoeducational approaches on bipolar disorders: a review of the literature. Journal of Affective Disorders 98, 11–27.Google Scholar
Sachs, GS, Guille, C, McMurrich, SL (2002). A clinical monitoring form for mood disorders. Bipolar Disorders 4, 323–327.Google Scholar
Scott, J, Pope, M (2002 a). Nonadherence with mood stabilizers: prevalence and predictors. Journal of Clinical Psychiatry 63, 384–390.Google Scholar
Scott, J, Pope, M (2002 b). Self-reported adherence to treatment with mood stabilizers, plasma levels, and psychiatric hospitalization. Journal of Clinical Psychiatry 159, 1927–1929.Google Scholar
Spearing, MK, Post, RM, Leverich, GS, Brandt, D, Nolen, W (1997). Modification of the Clinical Global Impressions (CGI) Scale for use in bipolar illness (BP): the CGI-BP. Psychiatry Research 73, 159–171.Google Scholar
Tsai, MC, Strong, C, Lin, CY (2015). Effects of pubertal timing on deviant behaviors in Taiwan: a longitudinal analysis of 7th- to 12th-grade adolescents. Journal of Adolescence 42, 87–97.Google Scholar
Williams, AA, Wright, KS (2014). Engaging families through motivational interviewing. Pediatric Clinics of North America 61, 907–921.Google Scholar
Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA (1978). A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry 133, 429–435.Google Scholar
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