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Treatment Adherence and Illness Insight in Veterans With Bipolar Disorder

Copeland, Laurel A. PhD*†; Zeber, John E. PhD*†; Salloum, Ihsan M. MD‡; Pincus, Harold A. MD§∥; Fine, Michael J. MD, MSc¶#; Kilbourne, Amy M. PhD**††

Journal of Nervous & Mental Disease: January 2008 - Volume 196 - Issue 1 - pp 16-21
doi: 10.1097/NMD.0b013e318160ea00
Original Article

Insight into the perceived value of psychotherapy and pharmacological treatment may improve adherence to medication regimens among patients with bipolar disorder, because patients are more likely to take medication they believe will make them better. We conducted a cross-sectional survey of patients recruited into the Continuous Improvement for Veterans in Care—Mood Disorders (CIVIC-MD; July 2004–July 2006), assessing therapeutic insight and 2 measures of medication adherence: the Morisky scale of intrapersonal barriers and missing any doses the previous 4 days. Among 435 patients with bipolar disorder, 27% had poor adherence based on missed dose and 46% had poor adherence based on the Morisky. In multivariable models, greater insight into medication was negatively associated with both measures of poor adherence. Odds of poor adherence increased for women, African Americans, mania, and hazardous drinking. The association of mutable factors—hazardous drinking, manic symptoms, and insight—could represent an opportunity to improve adherence.

*South Texas Veterans Health Care System, VERDICT HSR&D, San Antonio, Texas; †Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas; ‡Department of Psychiatry and Behavioral Science, University of Miami Leonard M. Miller School of Medicine, Miami, Florida; §Department of Psychiatry, Columbia University, New York, New York; ∥New York-Presbyterian Hospital, New York, New York; ¶VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA; #Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; **VA Ann Arbor Healthcare System, Serious Mental Illness Treatment Research and Education Center, Ann Arbor, Michigan; and ††Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.

Supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development grant IIR 02-283 (to A. M. K.). Also supported by Serious Mental Illness Treatment Research and Evaluation Center, VA Ann Arbor Healthcare System in Ann Arbor, MI, the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (to M. J. F.), and the VERDICT Research Program at the South Texas Veterans Health Care System, San Antonio, TX. Supported by the Merit Review Entry Program MRP-05-145 from the VA Health Services Research and Development program (to L. A. C.). Also supported in-part by National Institute of Allergy and Infectious Diseases grant 5K24AI01769 (to M. J. F.).

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Send reprint requests to Laurel A. Copeland, PhD, South Texas Veterans Health Care System, VERDICT, 7400 Merton Minter (11c6), San Antonio, TX 78229-4404. E-mail: laurel.copeland@va.gov.

© 2008 Lippincott Williams & Wilkins, Inc.