Six-month outcomes of customized adherence enhancement (CAE) therapy in bipolar disorder

Bipolar Disorders, 05/04/2012

Customized adherence enhancement was associated with improvements in adherence, symptoms, and functional status.

Methods

  • CAE was flexibly administered in modules applied as indicated by an initial adherence vulnerabilities screening.
  • Screening identified reasons for non-adherence and modules were then administered using pre-set criteria.
  • CAE effects were evaluated at six-week, three-month, and six-month follow-up.
  • The six-month follow-up was the authors' primary time point of interest.
  • The primary outcome was change from baseline in adherence using the Tablets Routine Questionnaire (TRQ) and pill counts.
  • Secondary outcomes included change from baseline in BD symptoms [Hamilton Depression Rating Scale (HAM-D), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS)].

Results

  • Subjects completed 86% of scheduled sessions, with only two individuals (5%) not participating in any sessions.
  • The number of dropouts at six months was 12 (28%).
  • Mean baseline non-adherence by TRQ was 48% [standard error (SE) 4.8%] missed tablets within the previous week and 51% (4.1%) missed tablets within the previous month. At six-month follow-up, mean TRQ non-adherence improved to 25% (6.8%) missed tablets for the previous week (p = 0.002) and 21% (5.5%) for the previous month (p < 0.001).
  • Symptoms improved, with a change in the baseline mean (SE) BPRS of 43.6 (1.8) versus an endpoint of 36.1 (2.3) (p = 0.001), and baseline mean (SE) HAM-D of 17.8 (1.1) versus an endpoint of 15.3 (1.6) (p = 0.044).

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