Brief Motivational Intervention to Improve Medication Adherence for Adolescents w

描述(申请人提供)：青春期是严重和持续性精神障碍的发病高峰期。青春期主要精神障碍的治疗指南表明，药物治疗是有效治疗的关键因素。不幸的是，青春期是服药依从性差的一个特别脆弱的窗口，而且对这一人群中与服药依从性差相关的时间进程和具体因素知之甚少。鉴于慢性精神疾病青年服药依从性差的后果是深远的，包括住院、严重的功能障碍甚至自杀，迫切需要针对这一群体的服药依从性的干预措施。动机访谈(MI)是一种以证据为基础的方法，侧重于增强变革的动力。这一模式为改善患有精神障碍的青少年的用药依从性带来了巨大的希望，因为它对发育敏感，患者和提供者可以接受，并且很容易在临床环境中传播。研究表明，使用MI方法的简短动机干预(BMI)可以改善患有各种慢性疾病的青年的治疗依从性。尽管BMI被广泛应用于青少年的物质使用行为，但BMI仍未被用于改善患有严重精神障碍的青少年的用药依从性。患有双相情感障碍(BP)的青少年是制定BMI以坚持服药的理想人群，因为患有BP的青少年是所有精神疾病人群中最不依附的。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障碍的青少年提供干预信息。这项拟议的研究的目的是进行为期6个月的自然主义调查(n=50)，以了解该人群服药依从性差的时间、轨迹以及特定的人口学和临床因素。然后，我们将开发和研究BMI的可行性，以改善在西方精神病学研究所和诊所的儿童和青少年双相情感障碍服务专科诊所开始治疗的青少年的用药依从性。样本的选择将以最初的自然主义研究结果为依据。结果将在6个月内每月评估一次。参与者将包括50名患有BP的青少年。考虑到评估青少年服药依从性的选择范围，我们还将探索客观和主观方法在这一人群中的可行性和相对可靠性。这项治疗发展研究的数据将为这项干预的全面对照试验提供信息。这种方法与NIMH战略计划直接一致，在该战略计划中，开发和测试创新干预措施以降低风险并积极改变精神疾病的发展轨迹，是基于关于强健和可延展的风险因素的研究结果。这一领域的研究具有重大的公共卫生意义，因为它有可能降低成本，扰乱不良结果的循环，并将这些严重疾病的长期衰弱影响降至最低。

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.