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Promoting medication adherence among patients with bipolar disorder: a multicenter randomized controlled trial of a multifaceted intervention

Published online by Cambridge University Press:  27 April 2017

A. H. Pakpour ,
A. Modabbernia ,
C.-Y. Lin ,
M. Saffari ,
M. Ahmadzad Asl  and
T. L. Webb
A. H. Pakpour*
Affiliation:
Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
A. Modabbernia
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
C.-Y. Lin
Affiliation:
Department of Rehabilitation Sciences, Faculty of Health & Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
M. Saffari
Affiliation:
Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
M. Ahmadzad Asl
Affiliation:
Mental Health Research Center, School of Medicine, Department of Psychiatry, Iran University of Medical Sciences, Tehran, IR Iran
T. L. Webb
Affiliation:
Department of Psychology, The University of Sheffield, Sheffield, UK
*
*Address for correspondence: Dr A. H. Pakpour, Ph.D., Associate Professor, Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Shahid Bahounar BLV, Qazvin, 3419759811, Iran. (Email: Pakpour_Amir@yahoo.com)
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Abstract

Background

The present research aimed to investigate the efficacy of a multifaceted intervention that included motivational interviewing (MI) and psychoeducation in improving medication adherence (MA) among patients with bipolar disorder (BD).

Method

A multicenter, cluster randomized, observer-blind, controlled, parallel-group trial was conducted in ten academic centers in Iran. Patients with BD were randomly assigned to the experimental group (EXP; n = 136) or the usual care group (UC; n = 134). The EXP group received five sessions of MI and psychoeducation together with their family members. The primary outcome measure was changes in scores on the Medication Adherence Rating Scale from baseline to 6 months post-intervention. Other outcome measures included serum levels of mood stabilizers, clinical symptoms, quality of life, as well as measures of intention, beliefs about medicine, perceived behavioral control, automaticity, action and coping planning, and adverse reactions.

Results

Medication adherence improved over time in both groups, but patients in the EXP group improved more (baseline score: 6.03; score at the sixth month: 9.55) than patients in the UC group (baseline score: 6.17; score at the sixth month: 6.67). In addition, patients in the EXP group showed greater improvement than patients in the UC group in almost all secondary outcomes 6 months following the intervention.

Conclusions

Multifaceted interventions that include motivational-interviewing and psychoeducation can significantly improve MA and clinical and functional outcomes in patients with BD.

Trial Registration Number: The trial was registered with theClinicalTrials.gov database (NCT02241863) https://clinicaltrials.gov/ct2/show/NCT02241863

Keywords

Adherencebipolar disordermood stabilizermotivational interviewingpsychoeducation
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 14 , October 2017 , pp. 2528 - 2539
Copyright
Copyright © Cambridge University Press 2017 

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