title: Determinants of adherence to treatment in bipolar disorder: a comprehensive review.
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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Program for Recognition and Intervention in Individuals in At-Risk Mental States, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil. emilie.leclerc@gmail.com
authors.forename: Emilie
authors.initials: E
authors.lastname: Leclerc
authors.forename: Rodrigo B
authors.initials: RB
authors.lastname: Mansur
authors.forename: Elisa
authors.initials: E
authors.lastname: Brietzke
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000523:psychology*