Psychosocial Treatments for Bipolar Disorder

2007 ◽  
pp. 309-322 ◽  
Author(s):  
David J. Miklowitz ◽  
W. Edward Craighead
Keyword(s):  
Bipolar Disorder ◽  
Medication Adherence ◽  
Treatment Period ◽  
Pharmacological Treatment ◽  
Psychosocial Interventions ◽  
Improve Medication Adherence ◽  
Coping With Stress ◽  
Adherence To Medication ◽  
Bipolar Patients

Whereas pharmacological interventions remain the primary treatment for bipolar disorder, adjunctive psychosocial interventions have the potential to increase adherence to medication regimens, decrease hospitalizations and relapses, improve quality of life, and enhance mechanisms for coping with stress. Controlled studies have established that individual, family, and group psychoeducation, designed to provide information to bipolar patients and their families about the disorder, its pharmacological treatment, and the treatments’ side effects, leads to lower rates of recurrence and greater adherence to pharmacological treatment among bipolar patients. Type 1 and 2 studies have evaluated cognitive behavioral therapy (CBT) as an ancillary treatment. These studies indicate that CBT is associated with better medication adherence and significantly fewer recurrences and/or rehospitalizations. One Type 1 study has evaluated the effectiveness of IPSRT (interpersonal and social rhythm therapy) for bipolar disorder. IPSRT demonstrated its greatest symptomatic effects during a maintenance treatment period, especially if bipolar patients had been successful in stabilizing their daily and nightly routines during an acute treatment period. Finally, four Type 1 studies in adult and pediatric patients have shown that marital/ family therapy may be effectively combined with pharmacotherapy to reduce recurrences and improve medication adherence and family functioning.

Psychosocial Treatments for Bipolar Disorder

2015 ◽  
Author(s):  
Anjana Muralidharan ◽  
David J. Miklowitz ◽  
W. Edward Craighead
Keyword(s):  
Bipolar Disorder ◽  
Behavioral Therapy ◽  
Psychosocial Interventions ◽  
Primary Treatment ◽  
Coping With Stress ◽  
Adherence To Medication ◽  
Hospitalization Rates ◽  
Long Term Follow Up ◽  
Family Based ◽  
Bipolar Patients

Pharmacological interventions remain the primary treatment for bipolar disorder. However, adjunctive psychosocial interventions have the potential to increase adherence to medication regimens, decrease hospitalizations and relapses, decrease severity of symptoms, improve quality of life, and enhance mechanisms for coping with stress. Group psychoeducation, designed to provide information to bipolar patients about the disorder and its treatment, leads to lower rates of recurrence and greater adherence to medication among remitted bipolar patients at both short- and long-term follow-up. Cognitive-behavioral therapy as an ancillary treatment has found mixed results but generally supportive evidence indicating that it is useful in preventing relapse to depression in remitted patients. Family-based intervention, such as Family-Focused Therapy (FFT), may be combined with pharmacotherapy to reduce recurrences and hospitalization rates in adult patients.

Bipolar Disorder: A National Health Concern

CNS Spectrums ◽  
2004 ◽  
Vol 9 (S12) ◽  
pp. 6-15 ◽  
Author(s):  
Roger S. McIntyre ◽  
Jakub Z. Konarski
Keyword(s):  
Bipolar Disorder ◽  
Diagnostic Delay ◽  
Bipolar Disorders ◽  
Psychosocial Interventions ◽  
Health Concern ◽  
The Public ◽  
Primary Health ◽  
Appropriate Treatment ◽  
Concomitant Medications ◽  
Bipolar Patients

AbstractBipolar disorders are prevalent, disabling, and costly diseases that often pursue an inexorable course. Underdetection, misdiagnosis, and diagnostic delay frequently and unnecessarily interfere with appropriate treatment of the disorder. Mortality studies in bipolar disorder underscore the relevance of both unnatural and natural causes of death, inviting the need for improved preventative and primary health care for bipolar patients. The treatment framework for bipolar disorder must recognize and anticipate the multidirnensionality and comorbidity of this illness. Pharmacotherapy is necessary, with multiple concomitant medications required for most patients, In addition, adjunctive psychosocial interventions offer enhanced compliance and may beneficially influence psychopathological and functional outcomes. This article emphasizes the public health concern of bipolr disorder, and provides tactics to enhance detection of cryptic bipolar states, underscore the clinical and pathophysiological relevance of comorbidity in bipolar disorder, and provide a framework for multimodality therapy for this condition.

scholarly journals Psychosocial interventions enhance HIV medication adherence: A systematic review and meta-analysis

2018 ◽  
Vol 25 (10-11) ◽  
pp. 1326-1340 ◽  
Author(s):  
Pascalle Spaan ◽  
Sanne van Luenen ◽  
Nadia Garnefski ◽  
Vivian Kraaij
Keyword(s):  
Medication Adherence ◽  
Meta Analysis ◽  
Psychosocial Interventions ◽  
Controlled Trials ◽  
People Living With Hiv ◽  
Medication Regimen ◽  
Improve Medication Adherence ◽  
Randomized Controlled ◽  
Living With Hiv ◽  
Positive Effect

About 40 per cent of people living with HIV do not sufficiently adhere to their medication regimen, which adversely affects their health. The current meta-analysis investigated the effect of psychosocial interventions on medication adherence in people living with HIV. Databases were systematically searched, resulting in 43 included randomized controlled trials. Study and intervention characteristics were investigated as moderators. The overall effect size indicates a small to moderate positive effect (Hedges’ g = 0.37) of psychosocial interventions on medication adherence in people living with HIV. No evidence for publication bias was found. This meta-analysis study concludes that various psychosocial interventions can improve medication adherence and thereby the health of people living with HIV.

scholarly journals Evaluation and improvement of adherence to medication

2021 ◽  
Vol 64 (2) ◽  
pp. 130-136
Author(s):  
Won Kyung Lee ◽  
Joongyub Lee
Keyword(s):  
Information Technology ◽  
Medication Adherence ◽  
Healthcare Providers ◽  
Poor Adherence ◽  
Improve Medication Adherence ◽  
Medical Expenses ◽  
Adherence To Medication ◽  
Innovative Methods ◽  
Increased Risk ◽  
All Diseases

Medication adherence refers to the extent to which a patient takes medication according to prescription. In many cases, adherence to medication is defined as the proportion of prescribed drugs taken as prescribed over a certain period. However, there is no satisfactory level of adherence that can be applied uniformly to all diseases and medications. Patients with poor adherence experience worsening of conditions, complications, and increased risk for death, which increases medical expenses. Therefore, to improve medication adherence, healthcare providers should try to identify poor adherence, adjust prescriptions to optimize treatment according to the patient’s lifestyle, and educate patients to help them understand the value of medical treatment and the effects of adherence. The most practical way to identify poor adherence during clinical visits is by asking patients about their medication adherence in a non-judgmental manner. Reducing the number of doses is more effective than reducing the number of tablets to increase compliance. It is necessary to adopt innovative methods based on information technology in our healthcare system because of the labor-intensive nature of educational intervention to improve adherence.

scholarly journals Factors Influencing the Number of Relapse in Patients with Bipolar I Disorder

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Omran Davarinejad ◽  
Tahereh Mohammadi Majd ◽  
Farzaneh Golmohammadi ◽  
Payam Mohamadi ◽  
Farnaz Radmehr ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bipolar Disorder ◽  
Poisson Regression ◽  
Rate Ratio ◽  
Disease Onset ◽  
Study Data ◽  
Type I ◽  
Birth Season ◽  
Adherence To Medication ◽  
Bipolar Patients

Background: Type I bipolar disorder is a chronic mental illness with a recurrent nature. Objectives: This study was done to identify risk factors for relapse in patients with type I bipolar disorder using Poisson regression. Methods: In this retrospective cohort study, data were collected from 331 bipolar type I patients admitted to the largest and the only psychiatric hospital in West of Iran, Kermanshah. Poisson regression was used to identify risk factors for the relapse numbers in STATA software. Results: One hundred sixty six of 331 patients (50.2%) were men. Mean and standard deviation of relapse rates in males and females were 2.93 ± 0.16 and 2.93 ± 0.15, respectively. In multivariate analysis, the results showed that with increasing age of disease onset (RR = 0.98, 95% CI :(0.97 -0.99)) and adherence to medication (RR = 0.86, 95% CI :(0.75-0.98)), the relapse rate ratio decreased, and being divorced or widowed (RR = 1.20,95% CI :( 1.01-1.45)), cigarette smoking (RR = 1.28, 95% CI: (1.52-1.09)), and birth season of winter (RR = 1.18, 95% CI: (1.00-1.41)) increased the rate ratio of relapse. Conclusions: The results of this study showed that the frequency of relapse was lower in bipolar patients younger at the time of disease onset, cigarette smokers, divorced or widowed patients, and patients with no treatment adherent. It is necessary to prevent or reduce the likelihood of relapse, especially in patients who do not have therapeutic adherence through educational and therapeutic measurements.

scholarly journals Dosing patterns and medication adherence in bipolar disorder patients treated with lurasidone: a US retrospective claims database analysis

2016 ◽  
Vol 6 (6) ◽  
pp. 355-368 ◽  
Author(s):  
Martha Sajatovic ◽  
Daisy Ng-Mak ◽  
Caitlyn T. Solem ◽  
Fang-Ju Lin ◽  
Krithika Rajagopalan ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Substance Use ◽  
Medication Adherence ◽  
Real World ◽  
First Generation ◽  
Medication Possession Ratio ◽  
Patient Characteristics ◽  
Bipolar Patients ◽  
Dosing Patterns

Background: The aim of this study was to describe dosing patterns and medication adherence among bipolar patients who initiated lurasidone in a real-world setting. Methods: Adult bipolar patients who initiated lurasidone between 1 November 2010 and 31 December 2012 (index period) with 6-month pre- and post-index continuous enrollment were identified from the IMS RWD Adjudicated Claims US database. Patients were grouped by starting lurasidone daily dose: 20 mg (7.1%), 40 mg (62.2%), 60–80 mg (28.7%), and 120–160 mg (2.1%). Patient characteristics were compared across doses using Cochran–Armitage trend tests. Multivariable ordinal logistic regression assessed the association between initial lurasidone dose and patient characteristics. Medication adherence was measured using medication possession ratio (MPR). Results: Of 1114 adult bipolar patients (mean age 40.6 years, 70.6% female), 90% initiated lurasidone at 40 mg or 80 mg/day (mean 51.9 mg/day). Of these, 16.2% initiated lurasidone as monotherapy. Mean lurasidone maintenance dose was 55.2 mg/day and mean MPR was 0.53 [standard deviation (SD) = 0.34] over the 6-month follow up. Substance use, hyperglycemia, obesity, and prior antipsychotic use were associated with higher initial lurasidone doses ( p < 0.05). Odds of a 20 mg/day increase in initial lurasidone dose was 1.6-times higher for patients with substance use [95% confidence interval (CI): 1.16−2.24], 2.6-times higher with hyperglycemia problems (95% CI: 1.15−5.83), 1.7-times higher with obesity (95% CI: 1.05−2.60), and 1.3 (95% CI: 1.01−1.78) and 1.8-times higher (95% CI: 1.17−2.86) with prior use of second- and first-generation antipsychotics, respectively. Conclusions: This real-world analysis of bipolar patients indicated that 40 mg or 80 mg/day were the most common starting doses of lurasidone. A majority of patients used concomitant psychiatric medications (polypharmacy). Higher doses of lurasidone were prescribed to patients with comorbidities or prior antipsychotic use. Adherence to lurasidone was comparable to or better than antipsychotic adherence reported in bipolar disorder literature.

scholarly journals Patient participation in the development of a customized m-Health intervention to improve medication adherence in poorly adherent individuals with bipolar disorder (BD) and hypertension (HTN)

2018 ◽  
Vol 4 (1) ◽  
pp. 25 ◽  
Author(s):  
Carol Blixen ◽  
Martha Sajatovic ◽  
David J. Moore ◽  
Colin Depp ◽  
Clint Cushman ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Medication Adherence ◽  
Patient Engagement ◽  
Text Messaging ◽  
Health Intervention ◽  
Chronic Illnesses ◽  
Improve Medication Adherence ◽  
Antihypertensive Medications ◽  
Study Objective ◽  
Optimal Adherence

Objective: Individuals living with bipolar disorder (BD) have poorer management of chronic medical conditions such as hypertension (HTN), and worse treatment adherence than the general population. The study objective was to obtain information from patients with both BD and HTN that would inform the development of an m-Health intervention to improve medication adherence for poorly adherent individuals living with both these chronic illnesses.Methods: Focus group methodology was used to collect information from 13 participants on perceived barriers and facilitators to BD and HTN medication adherence, as well as feedback on the demonstration and use of a bidirectional text messaging system for medication reminders. Focus groups were audiotaped, transcribed verbatim, and analyzed using content analysis with an emphasis on dominant themes.Results: Forgetfulness was the most frequently mentioned barrier to taking antihypertensive medications, and decisions about taking them were often influenced by BD mood fluctuations and the burden of having to take “too many pills” for both chronic illnesses. Participants’ feedback about the use of a text-messaging system to help with medication adherence for BD and HTN was very positive, and their suggestions for modification were incorporated into a more customized system for testing in a Phase 2 trial.Conclusions: Our findings indicate that patient engagement in the development of an m-Health intervention has the potential to improve adherence with both BD and HTN medications in individuals with known sub-optimal adherence. Patient engagement in health care is essential if we are to optimize patient outcomes.

Role of Medication Beliefs on Medication Adherence in Hypertensive Middle Eastern Refugees and Migrants in Australia

2020 ◽  
Author(s):  
Wejdan Shahin ◽  
Gerard A. Kennedy ◽  
Wendell Cockshaw ◽  
Ieva Stupans
Keyword(s):  
Medication Adherence ◽  
Middle Eastern ◽  
Multiple Mediation ◽  
Improve Medication Adherence ◽  
Medication Beliefs ◽  
Migration Status ◽  
Adherence To Medication ◽  
Modifiable Factors ◽  
The Relationship

Abstract BackgroundAdherence to medication is essential in some patients for achieving treatment control in hypertension. Medication beliefs is one of the personal modifiable factors that has been recognised to influence medication adherence in different populations. However, there is no published research to confirm the relationship between medication beliefs and medication adherence in Middle Eastern refugees and migrants in Australia. These two different groups may develop different beliefs about their medications that lead to different medication taking behaviours. Understanding the possible differences in beliefs may have a significant impact on enhancing medication adherence in these groups.Design320 Middle Eastern refugees and migrants with hypertension were approached via various social groups in Australia and asked to complete Arabic versions of the Beliefs about Medicine Questionnaire (BMQ) and the Medication Adherence Questionnaire. BMQ scores (necessity and concerns scales) were classified as "accepting", "indifferent", "ambivalent" or "skeptical". Multiple mediation modelling was applied to examine the role of necessity and concerns scales as mediators between migration status and medication adherence.ResultsThere were significant associations between medication adherence and medication beliefs scores (necessity and concerns scales) (p = 0.0001). Necessity, and concern were mediators in the relationship between migration status and medication adherence. Significant differences were found between refugees and migrants for medication adherence and medication beliefs. Refugees were likely to have less necessity, and more concern beliefs than migrants. They were also less likely to adhere to medications. Almost 30% of refugees could be classified as skeptical and 40% as ambivalent. In contrast, 50% of migrants had accepting beliefs, and around 35% held ambivalent beliefs. Refugees and migrants with “accepting” beliefs reported the highest adherence to medication and those holding “skeptical” beliefs reported the lowest adherence.ConclusionMedication beliefs are potentially modifiable and are reasonable targets for clinical interventions designed to improve medication adherence. Understanding these beliefs and the likely differences between refugees and migrants is crucial to provide specific and targeted advice to each group independently in order to improve medication adherence and overall health.

Treatments for Pediatric Bipolar Disorder

2015 ◽  
Author(s):  
Pablo H. Goldberg ◽  
Prerna Martin ◽  
Carolina Biernacki ◽  
Moira A. Rynn
Keyword(s):  
Bipolar Disorder ◽  
Mood Stabilizer ◽  
Psychosocial Interventions ◽  
Mood Stabilizers ◽  
Pediatric Bipolar Disorder ◽  
Careful Monitoring ◽  
The Past ◽  
Second Generation Antipsychotics ◽  
Evidence Based Treatments

The past two decades have seen significant advances in the development of evidence-based treatments for pediatric bipolar disorder. Practice guidelines recommend pharmacotherapy with mood stabilizers or second-generation antipsychotics (SGAs) as the first-line treatment. Lithium, risperidone, aripiprazole, quetiapine, and olanzapine are approved by the U.S. Food & Drug Administration for treating bipolar disorder in children and adolescents. The pharmacological literature suggests that SGAs are faster and more effective than mood stabilizers in treating acute manic or mixed episodes, but they have significant side effects and require careful monitoring. While mild to moderate bipolar disorder can be treated with monotherapy, combination pharmacotherapy with an SGA and a mood stabilizer is recommended for youth with severe bipolar disorder. A growing body of literature also suggests the efficacy of psychosocial interventions, with family psychoeducation and skills building as adjunct treatments to pharmacotherapy. More type 1 studies of pharmacotherapy and psychosocial treatments are needed.

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