TORONTO— Compliance with antipsychotic treatment is low among patients with bipolar disorder, according to data presented at the 159th Annual Meeting of the American Psychiatric Association. "Fifty-eight percent of patients with bipolar illness were fully compliant, 20% were partially compliant, and 22% were noncompliant with their antipsychotic medication," reported Meera Narasimhan, MD, an Associate Professor in the Department of Neuropsychiatry and Behavioral Science at the University of South Carolina in Columbia.

Dr. Narasimhan and her colleagues performed a retrospective study of 2,400 patients with psychiatric disorders from the South Carolina Medicaid Database. A total of 1,057 patients with bipolar disorder (average age, 42; 77% female) were identified. Noncompliance with treatment was defined as six or more months without treatment; partial compliance, as one to five months without treatment; and full compliance, as less than one month without treatment. Substance abuse and use of mood stabilizers and antidepressants were also assessed.

Antipsychotic treatment—consisting of risperidone, olanzapine, clozapine, quetiapine, ziprasidone, or typical antipsychotics—was assessed for a period of two years. Risperidone had the highest rate of full compliance (35%). No significant differences were found between compliance with risperidone and compliance with any other antipsychotic drug studied, except for olanzapine; rates of full compliance, partial compliance, and noncompliance were 35%, 17%, and 22%, respectively, in patients taking risperidone, compared with 19%, 55%, and 47%, respectively, for patients taking olanzapine.

Compliance with antipsychotic treatment was particularly low among younger patients, the investigators pointed out. Compliance was more likely if the patients were started on a mood stabilizer or an atypical antipsychotic at the time of bipolar disorder diagnosis. A mood stabilizer, an antipsychotic, or an antidepressant was not prescribed for a large percentage of patients with bipolar disorder. Approximately 80% of patients were not taking an antipsychotic, about 75% were not taking an antidepressant, and nearly 70% were not taking a mood stabilizer.

Doctor visits were strongly correlated to improved Medication Possession Ratio (MPR > 50%), thereby emphasizing that therapeutic contact and alliance play a major role in medication compliance. The role of substance abuse and rates of relapse and rehospitalization is being analyzed.

The investigators concluded that "prospective trials with large sample size are warranted to assess compliance issues in bipolar disorder."

—Tim Begany

Suggested Reading
Colom F, Vieta E, Tacchi MJ, et al. Identifying and improving non-adherence in bipolar disorders. Bipolar Disord. 2005;7(suppl 5):24-31.
Fleck DE, Keck PE Jr, Corey KB, Strakowski SM. Factors associated with medication adherence in African American and white patients with bipolar disorder. J Clin Psychiatry. 2005;66:646-652.
Gianfrancesco FD, Rajagopalan K, Sajatovic M, Wang RH. Treatment adherence among patients with bipolar or manic disorder taking atypical and typical antipsychotics. J Clin Psychiatry. 2006;67:222-232.

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