Long-term injectable drugs and counseling improve adherence and symptoms in patients with bipolar disorder

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Researchers found that medication adherence improved in people with bipolar disorder through the use of long-term injectable medications combined with psychosocial intervention.

Research results from University Hospitals (UH) Cleveland Medical Center and Case Western Reserve University (CWRU) School of Medicine appear in the September 16, 2021 issue of the journal. The primary care companion for CNS disorders.

“Poor medication grip is widespread in people with bipolar disorder and is often associated with negative outcomes, ”said senior author Martha Sajatovic, MD, director of the Neurological and Behavioral Outcomes Center, CWRU School of Medicine and UH Cleveland Medical Center. “A growing body of literature focuses on clinical approaches to remedy poor adhesion that can lead to substantial improvements in outcomes for this group of people.”

Bipolar disorder is a mental health problem that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

The study recruited 30 people with bipolar disorder who had problems with adhesion. More than 20 percent of them said they missed their bipolar medication in the previous week or month at the initial screening.

For the study, participants were given the long-acting injectable (LAI) antipsychotic drug aripiprazole, approved by the U.S. Food and Drug Administration (FDA) for the treatment of bipolar disorder.

“However, despite the adherence benefits of long-acting injectable drugs, simply switching to these drugs may not be enough to maintain long-term behavior change,” said Dr Sajatovic. “Our pilot test combined LAI with a brief behavioral approach called Personalized Grip Enhancement (CAE). Together we called them CAE-L to assess the effects on adherence, bipolar disorder symptoms and functional status, ”she said.

The CAE was provided by a social worker following a detailed program and delivered during the same clinical visit when the patients came to collect their medication. Barriers to adherence, Dr Sajatovic said, could be made up of several things, including a lack of drug education; communication problems with suppliers; strategies for improving medication routines and substance abuse problems.

CAE is a brief and practical intervention program designed to tackle an individual’s specific barriers to membership. Each module could be combined with other modules as determined by a prior assessment. For this study, the EAC was performed in seven sessions (an initial baseline session, followed by one session each month for the six months of the study).

The drug was also administered once a month for six months. Participants also continued other maintenance treatments such as mood stabilizing drugs (lithium, valproate, or lamotrigine) or prescribed antidepressants and hypnotics for at least one month prior to enrollment.

“Overall, our results suggest that a personalized intervention to overcome barriers to adherence combined with IAT can dramatically improve outcomes in high-risk people with bipolar disorder,” said Dr. Sajatovic.

By the end of six months, self-reported adherence behaviors improved. Adhesion remained stable and bipolar symptoms improved.

CAE-L was associated with excellent adherence to LAI (100% of people received the injection within a week of scheduled time), compared to initial screening where people missed an average of 50.1% of medications orals prescribed during the previous week and 40.6% of drugs during the last month.

The proportion of medications missed in the week between screening and 24 weeks improved significantly from 50.1% to 16.9%, and last month from 40.6% to 19.2 %.

From baseline to week 24, there were significant decreases in bipolar disorder symptoms and overall psychopathology. Function was significantly improved from baseline to week 24. Participants also found the CAE intervention to be highly acceptable.

Limitations of the study include the small sample size, the lack of a control group for comparison, and all patients from one hospital site. An additional limitation is that adherence was based on self-report, which has the potential to underestimate missed medications. Twenty-one completed the trial out of the initial 30 that began (nine participants dropped out of the study prematurely for various reasons).

In addition to Dr. Sajatovic, MD, other authors are Jennifer B. Levin, Ph.D .; Luis F. Ramirez, MD; Kristin A. Cassidy, MA; Nora McNamara, MD; Edna Fuentes-Casiano, MSSA, LSW; Deionte Appling, BA, all with CWRU and UH; Farren BS Briggs, Ph.D., with CWRU, and Betsy Wilson, MPH, who was with CWRU and UH at the time of the study.


Why bipolar patients don’t take their medications


More information:
Martha Sajatovic et al, Long-Acting Injectable Antipsychotic Drugs and Personalized Adhesion Improvement in Patients with Bipolar Disorder with Poor Adhesion, The primary care companion for CNS disorders (2021). DOI: 10.4088 / PCC.20m02888

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Long-term injectable drugs and counseling improve adherence and symptoms in patients with bipolar disorder (2021, September 16)
retrieved September 16, 2021
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