Medication adherence skills training for middle-aged and elderly adults with bipolar disorder: development and pilot study.
OBJECTIVE
To present the rationale, development, and pilot study of a medication adherence skills training (MAST-BD) intervention for older adults with bipolar disorder (BPD). We developed a 12-week manualized group intervention that combined educational, motivational, medication management skills and symptom management training adapted for older adults.


METHODS
Among 21 older outpatients with BPD (mean age = 60 years; SD = 6), the feasibility and acceptability of MAST-BD were assessed in a quasi-experimental clinical trial. We also obtained preliminary effect sizes associated with pre-post change on measures of self-reported adherence to psychiatric medications, performance-based medication management ability, attitudes toward medication, depressive and manic symptoms, and health-related quality of life.


RESULTS
At baseline, 55% of participants reported recent non-adherence to psychiatric medications and were, on average, suffering from moderately severe depressive symptoms and minimal symptoms of mania. A total of 76% of participants completed the intervention, and 86% of sessions were attended by completers. Participants reported high levels of satisfaction with the intervention and manual. Pre-post improvement by small to medium effect sizes (Cohen's d = 0.30-0.57) was seen in medication adherence, medication management ability, depressive symptoms, and selected indices of health-related quality of life.


CONCLUSIONS
Notwithstanding the limitations of this small preliminary study, the results are encouraging in that the MAST-BD intervention was feasible, acceptable to patients, and associated with improvement in key outcomes. Suggestions for further development of medication adherence interventions for this neglected group of patients are discussed.
Depp
Colin A
CA
Department of Psychiatry, University of California, San Diego, CA 92161, USA. cedpp@ucsd.edu
Lebowitz
Barry D
BD
Patterson
Thomas L
TL
Lacro
Jonathan P
JP
Jeste
Dilip V
DV
D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D012565:Schizophrenic Psychology; D011795:Surveys and Questionnaires