Clinical Factors Associated With Treatment Noncompliance in Euthymic Bipolar Patients

Background: Noncompliance with medication is avery common feature among bipolar patients. Rates of poorcompliance may reach 64% for bipolar disorders, and noncomplianceis the most frequent cause of recurrence. Knowledge of theclinical factors associated with noncompliance would enhanceclinical management and the design of strategies to achieve abetter outcome for bipolar patients. Although most patientswithdraw from medication during maintenance treatment, compliancestudies in euthymic bipolar samples are scarce.

Method: Compliance treatment and its clinicalcorrelates were assessed at the end of 2-year follow-up in 200patients meeting Research Diagnostic Criteria for bipolar I orbipolar II disorder by means of compliance-focused interviews,measurements of plasma concentrations of mood stabilizers, and 2structured interviews: the Schedule for Affective Disorders andSchizophrenia and the Structured Clinical Interview for DSM-III-RAxis II disorders. Well-compliant patients and poorly compliantpatients were compared with respect to several clinical andtreatment variables.

Results: The rate of mildly and poorly compliantpatients was close to 40%. Comorbidity with personality disorderswas strongly associated with poor compliance. Poorly compliantpatients had a higher number of previous hospitalizations, butreported fewer previous episodes. The type of treatment was notassociated with compliance.

Conclusion: Clinical factors, especiallycomorbidity with personality disorders, are more relevant fortreatment compliance than other issues such as the nature ofpharmacologic treatment. Compliant patients may have a betteroutcome in terms of number of hospitalizations, but not necessarily with respect to the number of episodes. Bipolarpatients, especially those with personality disorders, should bemonitored for treatment compliance.