title: Predictors of adherence to psychopharmacological and psychosocial treatment in bipolar I or II disorders - an 18-month prospective study.
abstract: BACKGROUND
  Poor treatment adherence among patients with bipolar disorder (BD) is a common clinical problem. However, whether adherence is mostly determined by patient characteristics or attitudes, type of treatment or treatment side-effects remains poorly known.
  
  
  METHODS
  The Jorvi Bipolar Study (JoBS) is a naturalistic prospective 18-month study representing psychiatric in- and outpatients with DSM-IV BD I and II in three Finnish cities. During the 18-month follow-up we investigated the continuity of, attitudes towards and adherence to various types of psychopharmacological and psychosocial treatments among 168 psychiatric in- and outpatients with BD I or II.
  
  
  RESULTS
  One-quarter of the patients using mood stabilizers or atypical antipsychotics discontinued medication during at least one treatment phase of the follow-up autonomously, mostly during depression. When pharmacotherapy continued, adherence was compromised in one-third. Rates of non-adherence to mood stabilizers or antipsychotics did not differ, but the predictors did. One-quarter of the patients receiving psychosocial treatments were non-adherent to them.
  
  
  CONCLUSIONS
  Serum concentrations were not estimated.
  
  
  CONCLUSIONS
  More than one-half of BD patients either discontinue pharmacotherapy or use it irregularly. Autonomous discontinuation takes place mostly in depression. Although rates of non-adherence do not necessarily differ between mood-stabilizing medications, the predictors for nonadherence do. Moreover, adherence to one medication does not guarantee adherence to another, nor does adherence at one time-point ensure later adherence. Attitudes towards treatments affect adherence to medications as well as to psychosocial treatments and should be repeatedly monitored. Non-adherence to psychosocial treatment should be given more attention.
authors.affiliation: Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki, Finland; Psychiatric and substance abuse services, Helsinki City Department of Social Services and Health Care, Helsinki, Finland.
authors.forename: Petri
authors.initials: P
authors.lastname: Arvilommi
authors.affiliation: Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki, Finland; Psychiatric and substance abuse services, Helsinki City Department of Social Services and Health Care, Helsinki, Finland.
authors.forename: Kirsi
authors.initials: K
authors.lastname: Suominen
authors.affiliation: Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Outi
authors.initials: O
authors.lastname: Mantere
authors.affiliation: Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland; Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Sami
authors.initials: S
authors.lastname: Leppämäki
authors.affiliation: Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki, Finland; Psychiatric and substance abuse services, Helsinki City Department of Social Services and Health Care, Helsinki, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Valtonen
authors.affiliation: Department of Mental Health and Substance Use, National Institute of Health and Welfare, Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland; Department of Psychiatry, University of Helsinki, Finland. Electronic address: erkki.isometsa@hus.fi.
authors.forename: Erkki
authors.initials: E
authors.lastname: Isometsä
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D003863:Depression / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D011446:Prospective Studies; D011613:Psychotherapy
chemical_list: D014150:Antipsychotic Agents
keywords: Adherence; Bipolar disorder; Naturalistic study; Prospective study; Treatment