Customized Treatment Adherence Enhancement in Bipolar Disorder

描述(申请人提供)：双相情感障碍(BPD)是一种严重的慢性精神疾病，与生活质量和功能结果的严重损害、高自杀率和高昂的经济成本有关。尽管近年来针对BPD患者的治疗方法迅速增多，但不坚持治疗仍然是一个严重的问题，几乎每两个人中就有一个不坚持服用处方药。众所周知，在BPD患者不遵守处方药物治疗的情况下，个人、社会和经济成本会急剧增加。据报道，一名患有BPD并经常躁狂复发的非依从性患者的护理费用相当于13名坚持服用稳定情绪药物的患者的护理费用。因此，BPD患者的治疗不依从是一个至关重要的公共卫生问题。该提案涉及方案公告PA-03-111中提到的坚持治疗的问题，特别是坚持精神疾病的干预措施。改善依从性的干预措施的有效性将取决于解决这些可变因素的能力，特别是解决个人在治疗依从性方面的脆弱性的能力。此外，迫切需要能够在社区精神卫生诊所(CMHC)等现实世界环境中实施的遵从性增强干预措施。这个分三个阶段的项目的目的是开发、改进和试点在接受CMHC治疗的BPD患者中进行定制的依从性增强干预措施，这些患者已知存在治疗不依从性的高风险。目前拟议的研究将以三个不同的目标进行开发和调查：1)分析在CMHC接受治疗的BPD依从性差的患者中不遵守处方药物治疗的个体原因。2.)开发一系列标准化的、手动驱动的治疗组件，针对BPD患者的个体依从性风险脆弱性和不依从性原因量身定做。3)在BPD高危人群中试行使用量身定做的、以患者为中心的干预措施。该干预旨在节省所需的资源，并且可以轻松地集成到繁忙的CMHC设置中。这一探索性项目，如果得到资助，将获得作为在BPD高危患者中提高治疗依从性的更大规模研究的先决条件所需的初步数据。

DESCRIPTION (provided by applicant): Bipolar disorder (BPD) is a serious and chronic mental illness that is associated with substantial impairment in quality of life and functional outcomes, high rates of suicide and high financial costs. Despite the rapid proliferation of treatments for individuals with BPD in recent years, treatment non- adherence remains a significant problem, with nearly one in two individuals being non-adherent with prescribed medication. Personal, societal and financial costs are known to increase sharply in circumstances where individuals with BPD are non-adherent with prescribed medication treatments. It has been reported that costs of care for one non-adherent patient with BPD and frequent manic relapses are equal to that for 13 individuals who are adherent with mood stabilizing medication. Thus, treatment non-adherence among individuals with BPD is a matter of critical public health importance. This proposal addresses the issue of treatment adherence noted in Program Announcement PA-03-111, specifically adherence to interventions for mental illness. The effectiveness of interventions to improve adherence will hinge on ability to address those factors that are changeable, and specifically address vulnerabilities that an individual has with respect to treatment adherence. Additionally, there is an urgent need for adherence enhancement interventions that can be implemented in real-world settings such as a community mental health clinic (CMHC). The purpose of this three-stage project is to develop, refine, and pilot test a tailored adherence enhancement intervention among individuals with BPD who receive treatment in a CMHC, and who are known to be at high risk for treatment non-adherence. The currently proposed study will be developed and investigated in three separate aims: 1.) To characterize individual reasons for non-adherence with prescribed medications among poorly adherent patients with BPD who are receiving treatment at a CMHC. 2.) To develop a series of standardized, manual-driven treatment components tailored to individual adherence risk vulnerabilities and reasons for non-adherence among patients with BPD. 3,) To pilot test the use of a tailored, patient-focused intervention in a high risk population with BPD. The intervention is designed to be parsimonious with respect to resources required, and is easily integrated into a busy CMHC setting. This exploratory project, if funded, will obtain preliminary data needed as a pre-requisite to a larger -scale study on treatment adherence enhancement among high-risk patients with BPD.