Treatment adherence in bipolar I and schizoaffective disorder, bipolar type

Background: Poor adherence rates in Bipolar Disorder type I (BDI) and Schizoaffective Disorder, bipolar
type (SAD) may be high This study was aimed at comparing the clinical correlates of adherence to
treatment and the course of illness in BDI and SAD patients.
Methods: 75 SAD and 150 BDI DSM-IV outpatients were included. Adherence was assessed on the basis
of patients’ and care-givers’ reports and serum levels, when available. Socio-demographic, clinical and
treatment variables were collected and compared between diagnostic subsamples and then between
goodly and poorly adherent patients. Multiple logistic regressions were performed, controlling for
diagnostic subsample differences, to identify correlates of adherence in BDI and SAD groups.
Results: Poor adherence was highly prevalent both in BDI (32%) and in SAD patients (44%), with no
significant differences between diagnostic categories. Presence of psychotic symptoms (p¼0.029), higher
number of manic relapses (po0.001), comorbidity with personality disorders (p¼0.002), and lithium
therapy (p¼0.003) were associated with poor adherence to treatment. Diagnostic subgroup analyses
showed different predictive models, with the BDI poorly adherent subsample being more likely to
include comorbid personality and manic recurrences and the SAD poorly adherent subsample being less
clinically predictable.
Limitations: The cross-sectional nature of the study limits de capacity to ascertain the direction of the
relationship between certain variables.
Conclusions: Rates of poor adherence to oral treatments are similar in SAD and BDI. BDI patients with
comorbid personality and substance use disorders are likely to be poorly adherent. Treatment adherence
may be more difficult to predict in SAD patients.