title: Predictors of psychotropic medication adherence among HIV+ individuals living with bipolar disorder.
abstract: OBJECTIVE
  HIV infection and bipolar disorder are highly comorbid and associated with frontostriatal disruption, emotional dysregulation, and neurocognitive impairment. Psychiatric and cognitive factors have been linked to antiretroviral nonadherence; however, predictors of psychotropic adherence among HIV+ individuals with psychiatric comorbidities have not been explored. We evaluated predictors of psychotropic adherence among individuals with HIV infection and bipolar disorder.
  
  
  METHODS
  Psychiatric medication adherence of 50 participants with HIV infection and bipolar disorder was tracked for 30 days using Medication Event Monitoring Systems. Participants completed neurocognitive, neuromedical, and psychiatric batteries.
  
  
  RESULTS
  Mean psychotropic adherence rate was 78%; 56% of participants achieved ≥90% adherence. Younger age and onset of depressive symptoms, more severe current depressive symptoms, number of previous psychiatric hospitalizations and suicide attempts, poorer neurocognition, and more negative attitudes and self-beliefs toward medications univariably predicted worse psychotropic adherence (p's < .10). A multivariable model demonstrated a combination of current depressive symptoms and more negative attitudes toward medications significantly predicting poorer adherence (R(2 )= 0.27, p < 0.003). Secondary analyses revealed an interaction between neurocognition and mood, such that individuals with HIV infection and bipolar disorder who had greater executive dysfunction and depressive symptoms evidenced the poorest psychotropic adherence (p < 0.001).
  
  
  CONCLUSIONS
  Both psychiatric and neurocognitive factors contribute to poorer psychotropic adherence among HIV+ individuals with serious mental illness. Adherence interventions aimed at remediating these factors may be especially fruitful.
authors.affiliation: SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
authors.forename: Kaitlin B
authors.initials: KB
authors.lastname: Casaletto
authors.affiliation: Department of Psychology, University of Chicago, Chicago, IL, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Kwan
authors.affiliation: SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Montoya
authors.affiliation: SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Obermeit
authors.affiliation: Department of Psychiatry, University of San Diego, CA, USA.
authors.forename: Ben
authors.initials: B
authors.lastname: Gouaux
authors.affiliation: Department of Psychiatry, University of San Diego, CA, USA.
authors.forename: Amelia
authors.initials: A
authors.lastname: Poquette
authors.affiliation: Department of Psychiatry, University of San Diego, CA, USA.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Heaton
authors.affiliation: Department of Psychiatry, University of San Diego, CA, USA VA San Diego Healthcare System, San Diego, CA, USA.
authors.forename: J Hampton
authors.initials: JH
authors.lastname: Atkinson
authors.affiliation: Department of Psychiatry, University of San Diego, CA, USA djmoore@ucsd.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Moore
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011619:Psychotropic Drugs / Q000627:therapeutic use*
chemical_list: D011619:Psychotropic Drugs
keywords: Comorbidity; attitude; cognition; depression