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06-08-2013 | Mental health | Article

Temperament affects bipolar treatment adherence


Free abstract

medwireNews: Patients with bipolar II disorder and acute depression are more likely to be nonadherent to medication if they have a cyclothymic temperament, say Italian researchers.

They also found that these patients experienced high levels of subjective pain and showed a tendency toward a “therapeutic seeking pattern,” in that they scored higher than adherent patients for sensation-seeking and were more likely to have a lifetime addiction to over-the-counter painkillers.

“The connection between predominant cyclothymic temperament and ‘therapeutic sensation seeking’ may allow a better characterization of bipolar II disorder cases, eventually supporting a more conscious prescription of medications, with a special emphasis towards antidepressant drugs, as well as a preemptive integrative approach,” says the team, led by Michele Fornaro (University of Catania).

Of 220 acutely depressed bipolar II disorder outpatients assessed, 49 (22.3%) were nonadherent to treatment, based on scoring below 5 on both the 8-Item Medication Adherence Scale and the Clinician Rating Scale.

These patients scored significantly higher, indicating worse outcome, than their adherent peers on the cyclothymic temperament scale (13.9 vs 4.8), the Visual Analogue Scale for pain (VAS; 58.1 vs 32.1), and the Zuckerman’s Sensation-Seeking Scale-Form-V (SSS-V; 22.6 vs 11.3), and had a higher prevalence of lifetime abuse of over-the-counter painkillers or homeopathic medications (24.5 vs 1.2%).

These factors significantly and positively correlated with each other and together correctly classified 93.9% of the nonadherent patients.

“Higher sensation seeking scores may be interpreted as the need for immediate ‘compulsive’ relief from subjective intense painful experience (higher VAS score),” the researchers write in the Journal of Affective Disorders.

The study findings also suggested that the presence of current sub-threshold major mixed depressive episode in nonadherent patients correlated significantly with cyclothymic temperament score and the items included in the “therapeutic sensation seeking pattern.”

The investigators therefore suggest that “mixed features could underpin compulsive seeking of ‘immediate pain relief’, possibly resulting in misuse or self-administration of prescribed drugs as well as overt misconduct or addiction behaviors for ‘painkiller’-advertised pills available at low cost and without the need of a medical prescription.”

They conclude that given “the availability of a number of pharmacological agents having intense biological effects on mood,” their proposed “therapeutic sensation seeking” construct may help to characterize patients’ relationships with their medications.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Lucy Piper, Senior medwireNews Reporter

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