title: Factors associated with pharmacologic noncompliance in patients with mania.
abstract: BACKGROUND
  Studies of noncompliance with pharmacotherapy in bipolar disorder have primarily involved outpatients receiving lithium. There are limited data to date regarding the rates of noncompliance in patients with bipolar disorder and schizoaffective disorder hospitalized for recurrent mania. Similarly, the influence of race, illness phenomenology, and comorbid psychiatric and medical disorders and the treatment with antipsychotics, antidepressants, and mood-stabilizing agents other than lithium on noncompliance in this population have not been systematically examined.
  
  
  METHODS
  Patients hospitalized for acute mania (N = 101) were evaluated by the Structured Clinical Interview for DSM-III-R to establish diagnosis and comorbidity and the Young Mania Rating Scale and Hamilton Rating Scale for Depression to assess severity of manic and depressive symptoms, respectively. Compliance was assessed by responses to a clinician-administered questionnaire administered to the patient, treaters, and significant others and by admission plasma concentrations of mood-stabilizing agents.
  
  
  RESULTS
  Sixty-five patients (64%) were noncompliant with their pharmacologic regimen in the month prior to admission as defined by criteria for full compliance and partial or total noncompliance. Noncompliance was significantly associated with greater severity of mania upon admission (p = .02) and treatment with combinations of mood stabilizers (p = .01).
  
  
  CONCLUSIONS
  Noncompliance with pharmacotherapy was present in the majority of patients admitted for acute mania and was associated with greater severity of mania upon admission and treatment with combinations of mood stabilizers.
authors.affiliation: Biological Psychiatry Program, Department of Psychiatry, University of Cincinnati College of Medicine, Ohio, USA.
authors.forename: P E
authors.initials: PE
authors.lastname: Keck
authors.forename: S L
authors.initials: SL
authors.lastname: McElroy
authors.forename: S M
authors.initials: SM
authors.lastname: Strakowski
authors.forename: S P
authors.initials: SP
authors.lastname: Stanton
authors.forename: D L
authors.initials: DL
authors.lastname: Kizer
authors.forename: T M
authors.initials: TM
authors.lastname: Balistreri
authors.forename: J A
authors.initials: JA
authors.lastname: Bennett
authors.forename: K C
authors.initials: KC
authors.lastname: Tugrul
authors.forename: S A
authors.initials: SA
authors.lastname: West
mesh_terms: D000208:Acute Disease; D000328:Adult; D017668:Age of Onset; D000553:Ambulatory Care; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005163:Factor Analysis, Statistical; D005260:Female; D006760:Hospitalization; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D010349:Patient Compliance; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D012720:Severity of Illness Index; D016312:Treatment Refusal
chemical_list: D014151:Anti-Anxiety Agents; D014150:Antipsychotic Agents; D008094:Lithium