Depressive residual symptoms are associated with lower adherence to medication in bipolar patients without substance use disorder: results from the FACE-BD cohort.
BACKGROUND
Poor adherence to medication is frequent in Bipolar Disorder (BD). It is associated with illness severity and increases total medical cost. Several factors are associated with poor adherence but previous studies included heterogeneous cohorts of patients with and without current mood episode, with and without SUD.


METHODS
We conducted a cross-sectional study, based on the Fondamental Advanced Centers of Expertise in Bipolar Disorders. 382 patients diagnosed with BD (type I, II or NOS) according to DSM-IV, with partial or complete remission and without comorbid SUD, were included. All patients had a large standardized clinical evaluation with structured interview and self reports. Side effects were evaluated with Patient Rated Inventory of Side Effects (PRISE). Adherence behavior was measured by a self reported scale, Medication Adherence Rating Scale (MARS). Univariate analyses and linear regression models were undertaken to determine factors associated with adherence.


RESULTS
Residual depressive symptoms (β=-0.155, p=0.004), and side effects (β=-0.142, p=0.008) were the main factors associated with adherence behavior in linear regression model. We found no association with residual manic symptoms, age at assessment, marital status, number of past mood episodes as well as past psychotic symptoms.


CONCLUSIONS
We used no other assessment than self-rating scale for adherence behavior evaluation. We had no information concerning treatment regimen and patient/family knowledge about BD.


CONCLUSIONS
Adherence behavior in bipolar patients appears to be mainly influenced by the presence of residual depressive symptoms in patients without SUD. Improvement in diagnosis and pharmacotherapy of residual depressive symptoms has to be kept in mind to face low adherence to medication.
Pôle de psychiatrie, Hôpital Sainte Marguerite, Assistance Publique Hôpitaux de Marseille, France; Aix-Marseille Université, CNRS, CRN2M UMR 7286, 13344 cedex 15, Marseille, France; Fondation FondaMental, Créteil, France. Electronic address: raoul.belzeaux@ap-hm.fr.
Raoul
R
Belzeaux
Nadia
N
Correard
Laurent
L
Boyer
Bruno
B
Etain
Joséphine
J
Loftus
Frank
F
Bellivier
Thierry
T
Bougerol
Philippe
P
Courtet
Sébastien
S
Gard
Jean-Pierre
JP
Kahn
Christine
C
Passerieux
Marion
M
Leboyer
Chantal
C
Henry
Jean-Michel
JM
Azorin
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D019966:Substance-Related Disorders / Q000523:psychology*; D016896:Treatment Outcome; D016903:Drug Monitoring
D014150:Antipsychotic Agents
Adherence; Bipolar disorder; Residual symptoms; Side effects