Brief Motivational Intervention to Improve Adherence for Bipolar Adolescents

描述（由申请人提供）：青春期是严重和持续性精神疾病的发病高峰期。青春期主要精神疾病的治疗指南表明药物治疗是有效治疗的关键因素。不幸的是，青春期是一个特别脆弱的窗口，药物依从性差，并鲜为人知的时间进程和具体因素与药物依从性差，在这一人群。鉴于患有慢性精神疾病的青年人药物依从性差的后果是深远的，包括住院治疗，严重的功能障碍，甚至自杀，迫切需要针对这一人群药物依从性的干预措施。动机访谈（MI）是一种基于证据的方法，专注于增强变革的动机。这种模式对改善青少年精神疾病患者的药物依从性有很大的希望，因为它对发育敏感，患者和提供者都能接受，并且易于在临床环境中传播。研究表明，利用MI方法的简短动机干预（BMI）可改善患有各种慢性疾病的青年的治疗依从性。虽然BMI被广泛应用于青少年物质使用行为，但尚未对改善严重精神障碍青少年的药物依从性进行检查。双相情感障碍（BP）青少年是一个理想的人群，与他们一起制定药物依从性的BMI，因为BP青少年是任何精神病人群中依从性最低的。为这一具有挑战性的人群制定BMI的经验将直接为患有一系列慢性精神疾病的青年提供干预。拟定研究的目的是对该人群中与药物依从性差相关的时间、轨迹以及特定人口统计学和临床因素进行为期6个月的自然调查（n=50）。然后，我们将开发和研究BMI的可行性，以提高青少年在西部精神病研究所和诊所的儿童和青少年双相服务专业诊所开始治疗的药物依从性。样本选择将根据最初自然主义研究的结果进行。将在6个月内每月评估结果。参与者将包括50名患有BP的青少年。鉴于评估青少年药物依从性的选择范围，我们还将探讨客观和主观方法在这一人群中的可行性和相对可靠性。这项治疗开发研究的数据将为这项干预措施的全面对照试验提供信息。这一方法与NIMH战略计划直接雅阁，在该战略计划中，关于强大和可塑性风险因素的研究结果为开发和测试创新干预措施以减少风险和积极改变精神疾病的轨迹提供了信息。这一领域的研究具有重要的公共卫生意义，因为它有可能降低成本，打破不良结果的循环，并最大限度地减少这些严重疾病的长期衰弱影响。

DESCRIPTION (provided by applicant): Adolescence is the peak period of onset for serious and persistent psychiatric disorders. Treatment guidelines for the management of major psychiatric disorders in adolescence indicate pharmacotherapy is a critical element of effective treatment. Unfortunately, adolescence is a particularly vulnerable window for poor medication adherence, and little is known about the timecourse and specific factors associated with poor medication adherence in this population. Given that the consequences of poor medication adherence among youth with chronic mental illness are far-reaching, and include hospitalization, profound functional impairment and even suicide, there is a desperate need for interventions targeting medication adherence in this population. Motivational Interviewing (MI) is an evidence-based approach focused on enhancing motivation for change. This model holds great promise for improving medication adherence in adolescents with psychiatric disorders because it is developmentally sensitive, acceptable to patients and providers, and readily disseminable across clinical settings. Research demonstrates that brief motivational interventions (BMIs) utilizing a MI approach result in improved treatment adherence among youth with a variety of chronic medical conditions. Although widely applied for adolescent substance use behaviors, BMIs have yet to be examined for improving medication adherence in youth with severe psychiatric disorders. Adolescents with bipolar disorder (BP) are an ideal population with whom to develop a BMI for medication adherence because adolescents with BP are among the least adherent of any psychiatric population. Experience developing a BMI for this challenging population will directly inform intervention for youth with a range of chronic psychiatric disorders. The purpose of the proposed study is to conduct a 6-month naturalistic investigation (n=50) of the timing, trajectories, and specific demographic and clinical factors associated with poor medication adherence in this population. We will then develop and examine the feasibility of a BMI to improve medication adherence for adolescents initiating treatment at the Child and Adolescent Bipolar Services specialty clinic at Western Psychiatric Institute and Clinic. Sample selection will be informed by findings from the initial naturalistic study. Outcomes will be assessed monthly over 6 months. Participants will include 50 adolescents with BP. Given the range of options for assessing medication adherence in youth, we will also explore the feasibility and relative reliability of objective and subjective methods in this population. Data from this treatment development study will inform a full-scale controlled trial of this intervention. This approach is in direct accord with the NIMH Strategic Plan in which the development and testing of innovative interventions to reduce risk and positively alter trajectories of mental illness are informed by research findings regarding robust and malleable risk factors. Research in this area is of great public health importance, as it has the potential to lessen costs, disrupt the cycle of poor outcomes, and minimize the long-term debilitating effects of these serious disorders.