title: Why do persons with bipolar disorder stop their medication?
abstract: OBJECTIVE
  Non-adherence to maintenance medication regimens is a major problem, limiting outcomes for many persons with bipolar disorder. The aim of this paper is to determine the most relevant aspects of adherence attitudes in a sample of bipolar patients selected for problems with adherence behavior.
  
  
  METHODS
  Among a larger sample of bipolar disorder patients participating in a prospective follow-up study (N = 140), a subsample of patients were selected for non-adherent behavior defined as missing ≥ 30% of medication during the past month (n = 27; 19.3%). Adherence attitudes were assessed with the Rating of Medication Influences scale (ROMI), a self-reported attitudinal measure assessing reasons for and against adherence. Multiple logistic regression models for non-adherence vs. adherence were estimated with each of the 19 ROMI items in the model, while controlling for sex, age, ethnicity, education, duration of illness, and substance abuse.
  
  
  RESULTS
  Mean score of ROMI items corresponding to reasons for treatment adherence was greater among adherent participants, whereas the mean score of ROMI items corresponding to reasons for treatment non-adherence was greater among nonadherent participants. The ROMI item identifying that the individual believes that medications are unnecessary had the strongest influence for non-adherence (p < 0.0001). This was followed by ROMI items corresponding to no perceived daily benefit (p = 0.0008), perceived change in appearance (p = 0.0057), and perceived interference with life goals (p = 0.0033). The ROMI item identifying fear of relapse was the strongest predictor for adherence (p = 0.0017).
  
  
  CONCLUSIONS
  Non-adherent patients with bipolar disorder differ from adherent patients with bipolar disorder on reasons for adherence and non-adherence. Utilization of tools that evaluate medication treatment attitudes, such as the ROMI or similar measures, may assist clinicians in the selection of interventions that are most likely to modify future treatment adherence.
authors.affiliation: Case Western Reserve University, School of Medicine, Cleveland, OH, USA.
authors.forename: Kavi K
authors.initials: KK
authors.lastname: Devulapalli
authors.forename: Rosalinda V
authors.initials: RV
authors.lastname: Ignacio
authors.forename: Peter
authors.initials: P
authors.lastname: Weiden
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Cassidy
authors.forename: Tiffany D
authors.initials: TD
authors.lastname: Williams
authors.forename: Roknedin
authors.initials: R
authors.lastname: Safavi
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D016017:Odds Ratio; D010465:Perception; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D057566:Self Report; D014481:United States
chemical_list: D014150:Antipsychotic Agents