This study assessed adherence to psychotropic and non-psychotropic medications in 88 patients with bipolar disorder. Adherence was defined as missing 20% or less of medications. Patients had high rates of medical comorbidities like hypertension, hyperlipidemia, obesity, and smoking. Adherence to psychotropic medications was worse than adherence to non-psychotropic medications, with over half missing foundational bipolar medications. Poor non-psychotropic adherence was related to greater psychiatric symptoms and hospitalizations. The results suggest mental health instability impacts one's ability to manage other medical treatments and that interventions should address adherence in a personalized way.

1. Non-adherence to psychotropic medication is
known to be a significant problem in the treatment
of bipolar disorder (BD). Individuals with serious
mental illness (SMI) including BD have a 50-90%
chance of
having one or more chronic medical illnesses, are
three times more likely to die a premature death
than the general population, and have a life
expectancy that is shortened by 10-30 years.
Approximately three-fourths of all deaths in
individuals with BD result from chronic medical
illnesses and more than two-thirds of such
individuals die of cardiovascular (CV) related
disorders. CV risk factors include hypertension,
diabetes, elevated lipids, smoking, alcohol,
obesity, inactivity, and metabolic syndrome, all of
which are more prevalent in BD than in the
general population.
Non-adherence in BD extends to all medication
types; however, the data are sparse with regard
to the relationship between medication taking
behavior for psychotropic and non-psychotropic
medication in the same individual in the BD
population. Few studies have looked at
adherence to non-psychotropic medications in
individuals known to be non-adherent to their
psychotropic medications.
Medication Adherence in Patients with Bipolar
Disorder and Medical Morbidities
Jennifer B. Levin1,2, PhD; Michelle E. Aebi1, BA; Curtis Tatsuoka1,2, PhD; Kristin Cassidy1, MA; Martha Sajatovic1,2, MD
1Case Western Reserve University School of Medicine, Department of Psychiatry
2Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center
To describe medical morbidities and
cardiovascular risk factors in individuals who are
non-adherent to psychotropic medication for BD
and also assesses the relationship between
adherence to psychotropic and non-psychotropic
medications in these individuals.
It was hypothesized that BD patients who are
on-adherent to psychotropic medication would
also be non-adherent to non-psychotropic
medication.
Non-adherence is defined as missing at least
20% of medication within the past week or month
as measured by the Tablets Routine
Questionnaire (TRQ).
Among poorly adherent patient with BD,
psychotropic adherence was worse than non-
psychotropic adherence. Poor adherence with
foundational BD medication ranged from 55-60%, while
non-psychotropic non-adherence ranged from 34-40%.
Non-psychotropic non-adherence was related to
number of psychiatric hospitalizations and psychiatric
symptoms. This suggests that mental health instability
impacts one’s ability to manage non-psychotropic
medication regimens.
Given high rates of hypertension, hyperlipidemia,
obesity, substance abuse and smoking, there is a need
to address poor adherence with medications that can
reduce CV risk and premature mortality.
Future research should include qualitative methods
to provide more detail on specific reasons that
individuals may take or choose not to take either their
psychotropic or non-psychotropic medications. In doing
so, interventions can be more personalized.
This descriptive study assessed the relationship
between non-adherence to psychotropic and non-
psychotropic medications in 88 BD patients who
are non-adherent to BD treatment.
Inclusion Criteria:
1. Age 18 or older
2. DSM-IV diagnosis of BD for at least a 2
year duration
3. Treatment with either a mood stabilizer or
an antipsychotic for at least six months
4. At least 20% non-adherent with current BD
medication as measured by the TRQ.
Measures:
TRQ, Charlson Comorbidity Index (CCI), Brief
Psychiatric Rating Scale (BPRS), Montgomery-
Asberg Depression Rating Scale (MADRS),
Young Mania Rating Scale (YMRS).
• The majority was female (73%), African-American
(65%), disabled (56%) with Type I BD (74%) and
moderate global psychopathology (BPRS Mean =
36.56 ± 8.39), depression (MADRS Mean = 20.88
± 8.94), and mania YMRS Mean = 8.97 ± 5.10).
Mean age was 46.16 ± 8.98 (range = 47).
• Mean age of bipolar onset was 19.84 ± 9.58 (range
= 45).
• With regard to CV risk, 43% had hypertension, 30%
had hyperlipidemia, and 60% were smokers with an
average of 9.77 ± 7.48 cigarettes smoked per day
among smokers.
• Average BMI was 33.81 ± 8.71 and 64% (45/70)
were obese.
• Among those with at least one chronic medical
condition (N=73), 48% had hypertension, 38% had
hyperlipidemia, 64% were smokers, 56% were
obese, 30% had diabetes, and 12% were abusing
alcohol.
• Twenty-five individuals (28%) were not prescribed
any non-psychotropic medications, and 11% were
taking ≥ 6 drugs.
• Of those prescribed non-psychotropics, 35 (56%)
were taking either antihypertensives, diabetes, or
cholesterol medications, or a combination thereof.
35 (56%) were taking antihypertensives.
• Fifteen (21%) individuals with at least one medical
condition were taking 0 non-psychotropic
medications and 9 (12%) were taking ≥ 6 drugs.
• Of those prescribed non-psychotropics (N=63),
57% indicated they had trouble taking them
regularly.
• The average TRQ for BD medications was 58%.
For those taking non-psychotropics, the average
TRQ was 37%.
• Wilcoxon signed rank tests found a significant
difference between patient adherence to
psychotropic and non-psychotropic medications for
past week TRQ (Z= -4.11, p<.001). Similar results
were found for past month TRQ (Z= -4.19, p<.001)
(see Table 1 for means).
• There were no significant correlations between the
number of medications prescribed and adherence
for either psychotropic or non-psychotropic
medications based on past week TRQ.
• There were significant correlations between
psychiatric hospitalizations and non-psychotropic
non-adherence for past week (rs = .276, df = 58, p=
.016) and past month (rs= .252, df= 57, p=.027).
BPRS sore was significantly correlated with non-
psychotropic non-adherence for past week (rs= .26,
df= 59, p=.022) and past month (rs=.234, df=60,
p=.034).
• None of the categorical variables (presence or
absence of CV variables) were significant when
analyzing non-adherence.
The projects described were supported by Award Number
R01MH093321 from the National Institute of Mental Health
and the Clinical and Translational Science Award UL1TR
000439. The content is solely the responsibility of the authors
and does not necessarily represent the official views of the
sponsors or the National Institutes of Health.
All correspondence for this poster should be
addressed to Jennifer.Levin@uhhospitals.org
Background Conclusions
Objectives
Results
Research Design
Tables
Acknowledgements