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30-04-2013 | Mental health | Article

Therapeutic alliance influences bipolar disorder medication adherence


Free abstract

medwireNews: Patients with bipolar disorder are more likely to adhere to their medication if they have a positive perception of their relationship with their psychiatrist, study findings show.

A range of positive factors in the Helping Alliance Questionnaire were significantly associated with medication adherence in the 3337 patients with bipolar disorder who participated in the 6-year study. These were being dependent on the psychiatrist, having a good relationship with them, respecting their views, and having meaningful exchanges with them. Also, patients were more likely to be adherent if they felt their psychiatrist understood them and had similar ideas to them about their problems.

The presence of these factors at baseline reduced the likelihood for nonadherence during follow up by about 15-20%, independently of factors such as mood, rapid cycling, suicide attempts, and alcohol abuse.

Lead study author Louisa Sylvia (Massachusetts General Hospital and Harvard Medical School, USA) and team highlight that, in contrast to previous studies, patients' perception of their psychiatrists' knowledge did not influence medication adherence, and neither did their motivation to solve their problems.

However, the researchers stress that they relied on self-report of patients' medication adherence, ascertained as adherence during the week prior to each visit, which occurred every 3 months during the first year of the study and every 6 months thereafter.

The patients also completed the Care Satisfaction Questionnaire at each visit, which highlighted some other factors associated with medication adherence. Patients were more likely to be adherent if they believed they had been helped by their treatment, and also if they felt staff at the psychiatrist's practice treated them with courtesy and respect and if they did not have to wait more than 15 minutes for their appointment.

"This study underscores the importance of the patient's perceived relationship with his/her provider, and with the provider's office staff, in influencing his/her adherence," say Sylvia et al.

They add: "Providers may elect to prioritize these aspects of the therapeutic alliance and clinical practice when treating individuals with bipolar disorder."

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

By Eleanor McDermid, Senior medwireNews Reporter

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