title: Treatment adherence and illness insight in veterans with bipolar disorder.
abstract: Insight into the perceived value of psychotherapy and pharmacological treatment may improve adherence to medication regimens among patients with bipolar disorder, because patients are more likely to take medication they believe will make them better. We conducted a cross-sectional survey of patients recruited into the Continuous Improvement for Veterans in Care-Mood Disorders (CIVIC-MD; July 2004-July 2006), assessing therapeutic insight and 2 measures of medication adherence: the Morisky scale of intrapersonal barriers and missing any doses the previous 4 days. Among 435 patients with bipolar disorder, 27% had poor adherence based on missed dose and 46% had poor adherence based on the Morisky. In multivariable models, greater insight into medication was negatively associated with both measures of poor adherence. Odds of poor adherence increased for women, African Americans, mania, and hazardous drinking. The association of mutable factors-hazardous drinking, manic symptoms, and insight-could represent an opportunity to improve adherence.
authors.affiliation: South Texas Veterans Health Care System, VERDICT, 7400 Merton Minter (11c6), San Antonio, TX 78229-4404, USA. laurel.copeland@va.gov
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Copeland
authors.forename: John E
authors.initials: JE
authors.lastname: Zeber
authors.forename: Ihsan M
authors.initials: IM
authors.lastname: Salloum
authors.forename: Harold A
authors.initials: HA
authors.lastname: Pincus
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology / Q000523:psychology; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D018692:Antimanic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001364:Awareness / Q000187:drug effects; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D044383:Black People / Q000523:psychology; D003131:Combined Modality Therapy; D015897:Comorbidity; D003527:Cyclothymic Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D011379:Prognosis; D011613:Psychotherapy; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D012803:Sick Role; D012959:Socioeconomic Factors; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D044465:White People / Q000523:psychology; D001741:Black or African American
chemical_list: D000927:Anticonvulsants; D018692:Antimanic Agents