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14-02-2012 | Mental health | Article

Medication non-adherence common in patients with SAD, bipolar type


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MedWire News: Non-adherence to pharmacologic treatment is common in patients with schizoaffective disorder (SAD), and is associated with an increased frequency of non-affective psychotic episodes, research shows.

Lead researcher Eduard Vieta (University of Barcelona, Spain) and team explain: "SAD presents as an intermediate form of psychotic disorder between schizophrenia and bipolar disorder, and may account for up to one-quarter of admissions to acute units."

They say that previous studies have observed high rates of non-adherence to treatment in patients with schizophrenia or bipolar disorder, but less is known about adherence rates in patients with SAD.

The team therefore assessed data from a 10-year follow-up study of 76 patients (52.6% women), aged a mean of 47.7 years, who met DSM-IV-TR criteria for a diagnosis of SAD, bipolar type.

Treatment adherence was assessed at the end of the study period by means of a combination of adherence-focused half-structured patient interviews, interviews with family members, and blood tests for serum levels of mood stabilizers. Non-adherence was assumed when at least one of these assessments indicated inadequate adherence, while adherence was assumed when all three assessments indicated adequate adherence.

According to these criteria, 58.8% (n=44) of patients were classified as adherent and 41.2% (n=32) as non-adherent, the researchers report in Acta Psychiatrica Scandinavica.

There were no significant differences between adherent and non-adherent patients regarding mean age, gender, age at illness onset, age at first hospitalization, number of total hospitalizations, current employment status, or average duration of illness.

Furthermore, the presence of stressful life events, family psychiatric history, and symptom features, such as a history of catatonia, atypical symptoms, and suicide ideation or attempts, did not differentiate adherent from non-adherent patients.

However, adherent patients were significantly more likely to have had an affective episode at illness onset than non-adherent patients, at 87.8% versus 64.3%, while non-adherent patients had a significantly greater median number of non-affective (purely psychotic) episodes than adherent patients, at two versus one.

Vieta and team conclude: "Rates of non-adherence in SAD are high."

They add: "Even when properly treated, SAD is a disabling and severe disorder with high risk for recurrences, [indicating] that psychosocial interventions, such as psycho-education, or treatments specifically aimed at enhancing adherence and possibly insight, should be implemented in all patients with SAD, bipolar type."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Mark Cowen

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