title: Symptom severity, self-reported adherence, and electronic pill monitoring in poorly adherent patients with bipolar disorder.
abstract: OBJECTIVE
  This analysis of screening and baseline data from an ongoing trial examined self-report versus automated adherence monitoring and assessed the relationship between bipolar disorder (BD) symptoms and adherence in 104 poorly adherent individuals.
  
  
  METHODS
  Adherence was measured with the Tablets Routine Questionnaire (TRQ) and the Medication Event Monitoring System (MEMS). Symptoms were measured with the Montgomery-Åsberg Depression Rating Scale (MADRS), the Young Mania Rating Scale (YMRS), and the Brief Psychiatric Rating Scale (BPRS).
  
  
  RESULTS
  The mean age of the sample was 46.3 years [standard deviation (SD) = 9.41 years], with 72% (n = 75) women and 71% (n = 74) African American subjects. Adherence improved from screening to baseline, with a mean missed drug proportion measured by TRQ of 61.43% (SD = 26.48%) versus a baseline mean of 46.61% (SD = 30.55%). The mean proportion of missed medication using MEMS at baseline was 66.43% (SD = 30.40%). The correlation between TRQ and MEMS was 0.47. The correlation between a single index drug and all BD medications was 0.95. Symptoms were generally positively correlated with TRQ (worse adherence = more severe symptoms), but in most instances was only at a trend level (p > 0.05), with the exception of the correlations between baseline TRQ and MADRS and BPRS, which were positive (r = 0.20 and r = 0.21, respectively) and significant (p ≤ 0.05).
  
  
  CONCLUSIONS
  In patients with BD, monitoring increased adherence by 15%. MEMS identified 20% more non-adherence than self-report. Using a standard procedure to identify a single index drug for adherence monitoring may be one way to assess global adherence in patients with BD receiving polypharmacy treatment. Greater BD symptom severity may be a clinical indicator to assess for adherence problems.
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA.|University Hospitals Case Medical Center, Neurological and Behavioral Outcomes Center, Cleveland, OH, USA.|Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA.|University Hospitals Case Medical Center, Neurological and Behavioral Outcomes Center, Cleveland, OH, USA.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Levin
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA.|University Hospitals Case Medical Center, Neurological and Behavioral Outcomes Center, Cleveland, OH, USA.
authors.forename: Johnny
authors.initials: J
authors.lastname: Sams
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, 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, USA.
authors.forename: Kouri
authors.initials: K
authors.lastname: Akagi
authors.affiliation: University Hospitals Case Medical Center, Neurological and Behavioral Outcomes Center, Cleveland, OH, 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, USA.
authors.forename: Luis F
authors.initials: LF
authors.lastname: Ramirez
authors.affiliation: Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.affiliation: University Hospitals Case Medical Center, Neurological and Behavioral Outcomes Center, Cleveland, OH, USA.|Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Curtis
authors.initials: C
authors.lastname: Tatsuoka
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology; D003205:Computing Methodologies; D016903:Drug Monitoring / Q000379:methods / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D013223:Statistics as Topic; D011795:Surveys and Questionnaires
keywords: adherence; bipolar disorder; compliance; depression; mania; mood stabilizer