A brief motivational intervention for enhancing medication adherence for adolescents with bipolar disorder: A pilot randomized trial
Tina R Goldstein, Megan L Krantz, Rachael K Fersch-Podrat, Nina J Hotkowski, John Merranko, Loren Sobel, David Axelson, Boris Birmaher, Antoine Douaihy, Tina R Goldstein, Megan L Krantz, Rachael K Fersch-Podrat, Nina J Hotkowski, John Merranko, Loren Sobel, David Axelson, Boris Birmaher, Antoine Douaihy
Abstract
Background: Youth with bipolar disorder (BP) exhibit poor medication adherence, contributing to affective recurrence. Brief Motivational Interventions (BMIs) improve adherence among adolescents with chronic conditions.
Methods: In an open pilot series, we developed a 3-session BMI for BP adolescents targeting medication adherence and conducted a pilot randomized trial comparing Standard Care (SC) versus SC+BMI. Participants include 43 adolescents with BP prescribed psychotropic medications. We assessed medication adherence objectively via bluetooth-enabled electronic pillbox (MedTracker). A blinded evaluator assessed mood symptoms at intake, 3- and 6-months.
Results: The BMI was well-received. Average objective medication adherence increased with time in SC+BMI, but decreased in SC-Alone (p < 0.0001). Adolescents' baseline self-rated expectation of improvement with treatment moderated the effect of treatment on improvement in adherence over time (p = 0.003). Across groups, poor adherence predicted increased likelihood of depression and hypo/mania symptoms in the subsequent two weeks; medication adherence mediated the effect of the BMI on the likelihood of depressive symptoms (p = 0.007).
Limitations: Electronic pillbox use (across groups) may enhance adherence, resulting in overestimates compared with naturalistic conditions. This pilot randomized trial may have been underpowered to detect some group differences.
Conclusions: A BMI offers promise as a disseminable adjunctive intervention for improving medication adherence for adolescents with BP. Future studies with larger samples can establish efficacy. NCT03203720.
Keywords: Adolescent; Bipolar disorder; Brief intervention; Medication adherence.
Conflict of interest statement
Declaration of Competing Interest None.
Copyright © 2020. Published by Elsevier B.V.
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Source: PubMed