European psychiatrists' survey findings suggest that over half of all patients with bipolar disorder (BD) on prescribed medication show compliance difficulties, with most unable to attribute their deteriorating condition to this behavior.
But partial or nonadherence to medication in BD patients has been associated with symptom exacerbation, neurocognitive decline, increased suicide risk, and generally poor patient outcomes.
"There remains a need for increased knowledge at the level of the clinician-patient interaction concerning the issue of partial and nonadherence, in order to reduce its impact and bring about improved clinical outcomes in the treatment of patients with BD," say Eduard Vieta (University of Barcelona, Spain) and co-authors in the Journal of Affective Disorders.
The 15-question survey, which was designed to ascertain 2448 psychiatrists' perceptions on the level and causes of nonadherence in eight European countries, revealed that 57% of their BD patients had medication compliance concerns.
Furthermore, one-fifth of psychiatrists estimated that most patients show, or have shown, a lack of awareness about their condition, with three in four psychiatrists reporting that most patients who deteriorated following medication discontinuation were unable to attribute this to noncompliance.
The researchers caution that the extent of noncompliance among BD patients may have been underestimated, given that the majority of psychiatrists favor explicitly asking patients about their medication compliance over potentially more accurate methods, such as monitoring drug plasma levels or use of adherence assessment scales.
An irregular daily routine, life circumstances, and feeling better were rated as the most important reasons for discontinuing medication. Additional consumption of alcohol and drugs was also reported as impacting medication adherence by 11% of psychiatrists.
Conversely, worsening symptoms and intolerable side effects were considered as important factors in noncompliance by only 6% and 4% of psychiatrists, respectively.
In total, 35% of psychiatrists reported that medication adherence could be potentially improved by ensuring friends, families, carers, and other healthcare professionals remind patients to take their medication as prescribed.
"While clinicians may be aware of the extent and impact of non-adherence in patients with BD, they may not be using the most appropriate and effective tools with which it can be assessed," conclude the researchers.
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