Customized Adherence Enhancement for Individuals With Bipolar Disorder Receiving Antipsychotic Therapy

Objective: A three-month prospective trial of a psychosocial intervention-customized adherence enhancement (CAE)-was conducted with 43 medication-nonadherent individuals with bipolar disorder. Methods: CAE modules were administered as indicated by a screen that identifies reasons for nonadherence. The primary outcome was change in adherence to mood-stabilizing medications as measured by the Tablet Routines Questionnaire and pill counts. Secondary outcomes included change in symptoms, measured by the Hamilton Rating Scale for Depression (HAM-D), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS). Results: Participants completed 76% of sessions. Dropout at three months was 13 (30%). Adherence improved from a baseline mean +/- SD of 34%+/- 27% of tablets missed in the past month to only 10%+/- 15% (p<.001). BPRS, HAM-D, and YMRS scores all indicated significant improvement at three-month follow-up (p<.05). Conclusions: Although conclusions must be tempered by the uncontrolled design, CAE appeared to be well accepted and was associated with improvements in adherence, symptoms, and functioning.