The case of Mrs KA has brought up few interesting points for discussion. The discussion will be centred on the theme of poor compliance in bipolar disorder and its management. Obviously Mrs KA had issue of non-adherence to treatment as showed by her relapses episodes which were precipitated by non compliance to her medications.
Bipolar Disorder is challenging to treat even with motivated patients and choosing the best treatment for each patient is complicated. It is important to learn how to connect with our patients, increase our insight into their concerns, and work collaboratively to find a treatment that they can follow to ensure compliance. Though adherence is not a guarantee of good outcome, but medication remains the backbone of treatment for most people with bipolar disorder. Often people do not take their medication as prescribed, they may either take a lower dose than prescribed or cease one or all medications entirely. People with bipolar disorder routinely self-medicate and may change their medications without their doctor’s knowledge. Studies had found that there are a number of possible reasons for this.
Treatment non-adherence among patients with chronic illness is high, and bipolar disorder is no exception. Approximately 21% to 50% of patients with BD do not adhere to their recommended treatment regimen (1), which adds to the burden of illness and worsens prognosis. Studies have indicated that the consequences of non-adherence in bipolar disorder include greater propensity to relapse, higher hospitalization rates, and greater health care costs (2,3,4).
Studies had showed that there are multiple and interacting risk factors for medication non-adherence. Although all Bipolar Disorder patients share the same diagnosis, the factors that ultimately result in their medication adherence are as variable as the individuals themselves. Patients’ age, sex, culture, symptom severity, worldview, socioeconomic status, opinion of mental illness, and self-image influence their individual decisions on adhering to a prescribed medication regimen. Conceptually, these can be divided into patient-related, medication-related, and provider-related risk factors (5).
Among patient characteristics that appear to be risk factors for non-adherence, the strongest support appears to be for comorbid substance use, younger age, lower education level, and cognitive impairment (6). It was found that a good support system may also contribute to treatment adherence. In a study of 107 children and adolescents with Bipolar Disorder, non-adherent patients were more likely to experience family dysfunction and have a parental history of psychiatric hospitalization (7). Additionally, attitudinal factors, particularly the denial of the need for medications/severity of the illness appear to account for a substantial proportion of variance in adherence (7). Study had showed that factors for non adherence in younger age group are more likely due to lack...