Customized Treatment Adherence Enhancement in Bipolar Disorder

描述（由申请人提供）：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局的严重损害、高自杀率和高经济成本相关。尽管近年来对患有BPD的个体的治疗迅速增加，但治疗不依从性仍然是一个显著的问题，其中近二分之一的个体不依从处方药物。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，一个非依从性BPD和频繁躁狂复发患者的护理成本等于13个依从性情绪稳定药物的患者。因此，BPD患者的治疗不依从性是一个至关重要的公共卫生问题。该提案解决了项目公告PA-03-111中提到的治疗依从性问题，特别是对精神疾病干预措施的依从性。提高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。此外，迫切需要在现实环境中实施的依从性增强干预措施，如社区精神卫生诊所（CMHC）。这个三阶段项目的目的是在接受CMHC治疗的BPD患者中开发、完善和试点测试一种定制的依从性增强干预措施，这些患者已知具有治疗不依从性的高风险。目前提出的研究将在三个独立的目标进行开发和研究：1。描述在CMHC接受治疗的依从性差的BPD患者不依从处方药物的个体原因。2.）的情况。开发一系列标准化、手动驱动的治疗组件，针对BPD患者的个体依从性风险漏洞和不依从性原因进行定制。3、）在BPD高危人群中进行量身定制的、以患者为中心的干预措施的试点测试。干预措施的目的是节省所需的资源，并很容易融入一个忙碌CMHC设置。如果获得资助，该探索性项目将获得所需的初步数据，作为在高风险BPD患者中进行更大规模的治疗依从性增强研究的先决条件。

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.