Determinants of adherence to treatment in bipolar disorder: A comprehensive review

Determinants of adherence to treatment in bipolar disorder: A comprehensive review

Author Leclerc, Emilie Autor UNIFESP Google Scholar
Mansur, Rodrigo B. Autor UNIFESP Google Scholar
Brietzke, Elisa Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract Objective: Comprehensively review studies evaluating factors associated with adherence to treatment in bipolar disorder (BD), as well as the results of interventions developed to enhance adherence in this population.Methods: the following search engines were consulted: PubMed, Scielo, LILACS and PsycINFO. the keywords used were Bipolar Disorder, Factor, Adherence, Nonadherence, Compliance and Intervention. in addition, references list of selected studies were consulted searching for relevant articles.Results: Adherence has been defined in various ways, with some considering adherence vs. nonadherence, and other including a partial adherence measure. in addition, methods to assess adherence differ for each study. Several factors were related to poor adherence, including patient-related factors (e.g. younger age, male gender, low level of education, alcohol and drugs comorbidity), disorder-related factors (e.g. younger age of onset, severity of BD, insight and lack of awareness of illness) and treatment-related factors (e.g. side effects of medications, effectiveness). To improve adherence, the main recommendations are to provide customized interventions focusing on the underlying causes of nonadherence, strong therapeutic alliance and different modalities based on psychoeducation.Conclusion: Our results indicate that nonadherence is a multicausal phenomenon and strategies to prevent and approaches them must include enhanced therapeutic alliance, flexible topics, early intervention, group setting, and psychoeducation.Limitations: Different definitions and measures of adherence in the literature currently moderate the generalization of the findings in this review. Further studies are necessary regarding factors of adherence in BD and interventions to improve it, especially on social factors like stigma and family. (C) 2013 Elsevier B.V. All rights reserved.
Keywords Bipolar disorder
Adherence
Psychoeducation
Risk factors
Intervention
Language English
Date 2013-07-01
Published in Journal of Affective Disorders. Amsterdam: Elsevier B.V., v. 149, n. 1-3, p. 247-252, 2013.
ISSN 0165-0327 (Sherpa/Romeo, impact factor)
Publisher Elsevier B.V.
Extent 247-252
Origin http://dx.doi.org/10.1016/j.jad.2013.01.036
Access rights Closed access
Type Review
Web of Science ID WOS:000320593000032
URI http://repositorio.unifesp.br/handle/11600/36488

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