title: Trajectories of medication attitudes and adherence behavior change in non-adherent bipolar patients.
abstract: OBJECTIVE
  While medication treatment is necessary for the successful management of bipolar disorder (BD), non-adherence rates are up to 60%. Although medication attitudes are believed to be relevant to adherence behavior, few studies have investigated the trajectories of adherence change. This study evaluated attitudinal correlates of adherence conversion in 86 poorly adherent individuals with BD.
  
  
  METHODS
  This secondary analysis pooled data from two uncontrolled prospective trials of customized adherence enhancement (CAE), a psychosocial intervention delivered over 4-6 weeks. Poor adherence was defined as missing at least 20% of prescribed BD medication based on the self-reported Tablets Routine Questionnaire (TRQ). The sample was dichotomized into converters who achieved good adherence (N=44) and non-converters who remained poorly adherent (N=21). Converters vs. non-converters were compared on adherence, attitudes, and symptoms at baseline, 6 weeks and 3 months.
  
  
  RESULTS
  At baseline, converters and non-converters were similar demographically and clinically, but converters were less non-adherent (32% doses missed) than non-converters (59% missed). At 6 weeks, converters had better attitudes than non-converters. At 3 months, converters maintained improvements, but group differences were less pronounced due to some improvement in non-converters. Converters had better adherence at 3 months and trajectories differed for the groups on attitudes. Symptoms gradually improved for both converters and non-converters.
  
  
  CONCLUSIONS
  Over two-thirds of poorly adherent BD patients who received CAE converted to good adherence. Improved medication attitudes may be a driver of improved adherence behavior and ultimately reduce BD symptoms.
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA; Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, OH, USA. Electronic address: Jennifer.levin@uhhospitals.org.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Levin
authors.affiliation: Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, OH, USA; Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
authors.forename: Curtis
authors.initials: C
authors.lastname: Tatsuoka
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Cassidy
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Aebi
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA; Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001521:Behavior Therapy; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy*; D002986:Clinical Trials as Topic; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D011446:Prospective Studies; D057566:Self Report
chemical_list: D014150:Antipsychotic Agents