Clinical Factors Associated With Treatment Noncompliance in Euthymic Bipolar Patients
J Clin Psychiatry 2000;61(8):549-555
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Background: Noncompliance with medication is a
very common feature among bipolar patients. Rates of poor
compliance may reach 64% for bipolar disorders, and noncompliance
is the most frequent cause of recurrence. Knowledge of the
clinical factors associated with noncompliance would enhance
clinical management and the design of strategies to achieve a
better outcome for bipolar patients. Although most patients
withdraw from medication during maintenance treatment, compliance
studies in euthymic bipolar samples are scarce.
Method: Compliance treatment and its clinical
correlates were assessed at the end of 2-year follow-up in 200
patients meeting Research Diagnostic Criteria for bipolar I or
bipolar II disorder by means of compliance-focused interviews,
measurements of plasma concentrations of mood stabilizers, and 2
structured interviews: the Schedule for Affective Disorders and
Schizophrenia and the Structured Clinical Interview for DSM-III-R
Axis II disorders. Well-compliant patients and poorly compliant
patients were compared with respect to several clinical and
Results: The rate of mildly and poorly compliant
patients was close to 40%. Comorbidity with personality disorders
was strongly associated with poor compliance. Poorly compliant
patients had a higher number of previous hospitalizations, but
reported fewer previous episodes. The type of treatment was not
associated with compliance.
Conclusion: Clinical factors, especially
comorbidity with personality disorders, are more relevant for
treatment compliance than other issues such as the nature of
pharmacologic treatment. Compliant patients may have a better
outcome in terms of number of hospitalizations, but not necessarily with respect to the number of episodes. Bipolar
patients, especially those with personality disorders, should be
monitored for treatment compliance.