Trajectories of adherence to mood stabilizers in patients with bipolar disorder.

BACKGROUND: Nonadherence with mood stabilizers is a major problem that negatively impacts the course of bipolar disorder. Medication adherence is a complex individual behavior, and adherence rates often change over time. This study asked if distinct classes of adherence trajectories with mood stabilizers over time could be found, and if so, which patient characteristics were associated with the classes. METHODS: This analysis was based on 12 weeks of daily self-reported data from 273 patients with bipolar 1 or II disorder using ChronoRecord computer software. All patients were taking at least one mood stabilizer. The latent class mixed model was used to detect trajectories of adherence based on 12 weekly calculated adherence datapoints per patient. RESULTS: Two distinct trajectory classes were found: an adherent class (210 patients; 77%) and a less adherent class (63 patients; 23%). The characteristics associated with the less adherent class were: more time not euthymic (p < 0.001) and female gender (p = 0.016). No other demographic associations were found. CONCLUSION: In a sample of motivated patients who complete daily mood charting, about one quarter were in the less adherent class. Even patients who actively participate in their care, such as by daily mood charting, may be nonadherent. Demographic characteristics may not be useful in assessing individual adherence. Future research on longitudinal adherence patterns in bipolar disorder is needed.

Regularity in daily mood stabilizer dosage taken by patients with bipolar disorder.

OBJECTIVE: The aim of this study was to investigate regularity in the daily mood stabilizer dosage taken by patients with bipolar disorder, and identify factors associated with irregularity. METHODS: Self-reported daily mood and medication data were available from 206 patients who took the same mood stabilizer for ≥100 days. Approximate entropy (ApEn) was used to measure serial regularity in daily mood stabilizer dosage. Generalized estimating equations (GEE) were used to estimate if demographic or clinical variables were associated with ApEn. RESULTS: There was a wide range of regularity in the daily mood stabilizer dosage. The mean percent of days of missing doses was 13.6%. The number of psychotropic medications (p=0.007), pill burden (p=0.004) and percent of days with depressed mood (p=0.013) were associated with more irregularity, while the percent of days euthymic (p=0.014) was associated with less irregularity. The percent of days missing doses was not associated with the number of medications, pill burden or mood ratings. DISCUSSION: Patients may have irregularity in daily dosage in spite of a low percent of days missing doses. Psychotropic medication regimen complexity and depression are associated with increased dosage irregularity. Research is needed on how irregularity in daily dosage impacts the continuity of drug action of mood stabilizers.

Comparison of pre-episode and pre-remission states using mood ratings from patients with bipolar disorder.

Daily self-reported mood ratings from patients with bipolar disorder were analyzed to see if the 60 days before an episode of hypomania or depression (pre-episode state) could be distinguished from the 60 days before a month of euthymia (pre-remission state), and if a pre-hypomanic state could be distinguished from a pre-depressed state. Data were available from 98 outpatients with bipolar disorder, who returned about one year of daily data, and received treatment as usual. The approximate entropy (ApEn), mean mood and mood variability (standard deviation) were determined for 53 pre-hypomanic states, 42 pre-depressive states, and 65 pre-remission states.There was greater serial irregularity (ApEn) and greater variability in mood in the pre-episode than the pre-remission state. There was greater serial irregularity (ApEn) but no difference in variability in mood in the pre-hypomanic state when compared to the pre-depressed state. ApEn can distinguish between the pre-episode, pre-remission, pre-hypomanic and pre-depressive states. Using daily mood ratings, pre-episode changes were detected before the episode onset. Further investigation to relate the pre-episode and pre-remission states to other clinical and biological data is indicated.

Prospective 12-month course of bipolar disorder in out-patients with and without comorbid anxiety disorders.

BACKGROUND: The impact of anxiety disorders has not been well delineated in prospective studies of bipolar disorder. AIMS: To examine the association between anxiety and course of bipolar disorder, as defined by mood episodes, quality of life and role functioning. METHOD: A thousand thousand out-patients with bipolar disorder were followed prospectively for 1 year. RESULTS: A current comorbid anxiety disorder (present in 31.9% of participants) was associated with fewer days well, a lower likelihood of timely recovery from depression, risk of earlier relapse, lower quality of life and diminished role function over I year of prospective study. The negative impact was greater with multiple anxiety disorders. CONCLUSIONS: Anxiety disorders, including those present during relative euthymia, predicted a poorer bipolar course. The detrimental effects of anxiety were not simply a feature of mood state. Treatment studies targeting anxiety disorders will help to clarify the nature of the impact of anxiety on bipolar course.

A comparison of the restraint and seclusion experiences of patients with schizophrenia or other psychotic disorders.

OBJECTIVE: The purpose of this study was to understand how restrained and secluded patients felt about these interventions, and to compare the perceptions of the two groups. METHODS: Subjects were 25 restrained, and 25 secluded inpatients. A questionnaire was developed to explore patients' feelings and perceptions of the two interventions. Comparisons were made on the clinical data and the answers from both groups. RESULTS: Restrained and secluded patients seemed to view some aspects of their experience differently. Few (40%) of the secluded group reported finding positive aspects, compared to even fewer (20%) of restrained. Most patients in both groups felt negatively about staff involved, and disagreed with staff on the reported intensity of their documented threatening behavior. The interventions seemed to have only a brief modifying effect on patients' behavior following these interventions and did not seem to modify future behavior. CONCLUSIONS: Despite their differences, many patients in both groups reported negative feelings about the interventions and the staff involved. Both groups seemed not to perceive the procedural staff interactions as communication. Our study population seemed to be a subgroup of the admitted patient population who were repeatedly requiring seclusion or restraint. Screening this patient population during the admission process, and planning preventive and alternative interventions could decrease the need for restraint and seclusion.

The etiology of panic disorder: a review of current research.

During the last decade, there has been extensive research toward understanding the etiology and developing a treatment approach for panic disorder. This is a review and summary of issues related to proposed current biological mechanisms in an attempt to define the etiology of panic disorder. It also emphasizes the need for further studies.

The effect of intensive case management on hospitalization of patients with schizophrenia.

OBJECTIVE: The study aim was to determine if a community-based psychiatric rehabilitation program with intensive case management was more effective than traditional outpatient services in reducing hospitalization of chronic schizophrenic patients. METHODS: One hundred twelve schizophrenic patients enrolled in the intensive case management program were matched by age, number of previous hospitalizations, and days spent in the hospital with 112 schizophrenic patients who received medication services and minimal case management. The two groups were compared on the amount of services used and the number of hospitalizations and hospital days over a 24-month study period. RESULTS: Patients in the intensive case management program had been enrolled for a mean of 10.96 months, with a range from one to 24 months. They used significantly more mental health services during the study period compared with the patients in the control group. However, no significant differences were found between the two groups in number of hospitalizations and hospital days. Both groups showed an increase in the number of hospitalizations over the study period. CONCLUSIONS: A community-based psychiatric rehabilitation program with intensive case management was no more effective than medication services and minimal case management in reducing hospitalization among chronic schizophrenic patients.