FACTORS ASSOCIATED WITH PHARMACOLOGICAL NONCOMPLIANCE IN PATIENTS WITH MANIA

Background: Studies of noncompliance with pharmacotherapy in bipolar d isorder have primarily involved outpatients receiving lithium. There a re limited data to date regarding the rates of noncompliance in patien ts with bipolar disorder and schizoaffective disorder hospitalized for recurrent mania, Similarly, theinfluence of race, illness phenomenolo gy, and comorbid psychiatric and medical disorders and the treatment w ith antipsychotics, antidepressants, and mood-stabilizing agents other than lithium on noncompliance in this population have not been system atically examined. Method: Patients hospitalized for acute mania (N = 101) were evaluated by the Structured Clinical Interview for DSM-III-R to establish diagnosis and comorbidity and the Young Mania Rating Sca le and Hamilton Rating Scale for Depression to assess severity of mani c and depressive symptoms, respectively. Compliance was assessed by re sponses to a clinician-administered questionnaire administered to the patient, treaters, and significant others and by admission plasma conc entrations of mood-stabilizing agents. Results: Sixty-five patients (6 4%) were noncompliant with their pharmacologic regimen in the month pr ior to admission as defined by criteria for full compliance and partia l or total noncompliance. Noncompliance was significantly associated w ith greater severity of mania upon admission (p = .02) and treatment w ith combinations of mood stabilizers (p = .01). Conclusion: Noncomplia nce with pharmacotherapy was present in the majority of patients admit ted for acute mania and was associated with greater severity of mania upon admission and treatment with combinations of mood stabilizers.