title: Compliance as a stable function in the treatment course of bipolar disorder in patients stabilized on olanzapine: results from a 24-month observational study.
abstract: Compliance is a key factor in the maintenance treatment of bipolar disorder. This noninterventional study was conducted to explore factors associated with higher levels of compliance in bipolar patients, all treated in routine clinical settings. Bipolar outpatients (Clinical Global Impression of Severity score ≤3) who had been stabilized with olanzapine mono- or combination therapy for ≥4 weeks were enrolled in the study. Compliance to medication was assessed at baseline and after 3, 6, 9, 12, 18, and 24 months by a physician-rated, 4-point categorical scale using the following classification: noncompliant (patients being compliant to treatment schedule less than 20% of the time) and low (20% to 59% of the time), moderate (60% to 79% of the time), and high (≥80% of the time) levels of compliance. Both baseline and post-baseline factors were used in a generalized estimating equations (GEE) model to predict the likelihood of high compliance. Of 891 eligible patients, 657 patients completed the 24-month observation period. High levels of compliance (≥80%) were observed in 67% of patients at baseline, increasing to 80% in study completers. High compliance at baseline was identified as a strong predictor of compliance during study participation (odds ratio (OR) = 6.9, 95% confidence interval (CI) = 5.0 to 9.5, p < 0.001). Factors associated with high compliance during the study (GEE model) included greater life satisfaction (p = 0.002), better insight into illness (p < 0.001), less work impairment (p = 0.007), and fewer days of inpatient care (p = 0.002). Compliance ratings varied by country (p < 0.001) and duration of post-baseline treatment (p = 0.014). In conclusion, a number of clinical, functional, and social factors were identified as predictors of compliance in patients with bipolar disorder. As compliance is crucial for the long-term management of these patients, more attention should be directed towards compliance itself and factors associated with compliance levels in everyday treatment settings.
authors.affiliation: Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kutzelnigg
authors.affiliation: Psychosoziale Dienste in Wien (PSD), Mariahilfer Strasse 77-79, 1060 Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Kopeinig
authors.affiliation: Chang Gung Memorial Hospital, Keelung, Chang Gung University School of Medicine, No.200 Lane 208, Ji-Jin 1st Road, Anle District, Keelung City, 204 Taoyuan, Taiwan.
authors.forename: Chih-Ken
authors.initials: CK
authors.lastname: Chen
authors.affiliation: Réthy Pál Kórház-Rendelőintézet, Békéscsaba, Hungary.
authors.forename: Agnes
authors.initials: A
authors.lastname: Fábián
authors.affiliation: Hosp. Angeles Metropolitano, 59-600 Roma Sur, 06760 Mexico City, Mexico.
authors.forename: María Gloria
authors.initials: MG
authors.lastname: Pujol-Luna
authors.affiliation: Kangbuk Samsung Hospital, 110-746, Seoul, South Korea.
authors.forename: Young-Chul
authors.initials: YC
authors.lastname: Shin
authors.affiliation: Eli Lilly, Madách u. 13-14. (VII. emelet), 1075 Budapest, Hungary.
authors.forename: Tamás
authors.initials: T
authors.lastname: Treuer
authors.affiliation: Eli Lilly, Kölblgasse 8-10, 1030 Vienna, Austria.
authors.forename: Yulia
authors.initials: Y
authors.lastname: D'yachkova
authors.affiliation: Eli Lilly, Kölblgasse 8-10, 1030 Vienna, Austria.
authors.forename: Claudia
authors.initials: C
authors.lastname: Deix
authors.affiliation: Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Kasper
authors.affiliation: Eli Lilly, Kölblgasse 8-10, 1030 Vienna, Austria.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Doby
keywords: Bipolar disorder; Compliance; Drug attitude; Long-term treatment; Olanzapine; Quality of life