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Levin JB, Moore DJ, Briggs F, Rahman M, Montoya J, Depp C, Einstadter D, Stange KC, Weise C, Maniglia T, Barigye R, Howard Griggs G, Adeniyi C, Yala J, Sajatovic M. Clinical correlates of medication adherence in individuals with bipolar disorder and comorbid hypertension. Int J Psychiatry Med 2024:912174241281984. [PMID: 39276142 DOI: 10.1177/00912174241281984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2024]
Abstract
OBJECTIVE Individuals with bipolar disorder (BD) have high rates of suboptimal medication adherence, medical illness, and premature mortality, largely from cardiovascular causes. This analysis examined the association between adherence to antihypertensive and BD medications and clinical symptoms in patients with BD and comorbid hypertension (HTN) from an ongoing trial to optimize adherence. METHOD Inclusion criteria were a BD diagnosis, treatment with antihypertensives, adherence challenges, and poorly controlled HTN. Adherence was measured via self-report using the Tablets Routine Questionnaire and using eCAP, an electronic pillcap which captures openings. Average systolic blood pressure (SBP) was calculated from 12 readings over 1 week. The Montgomery-Asberg Depression Rating Scale (MADRS) and the Brief Psychiatric Rating Scale (BPRS) assessed BD symptoms. RESULTS A total of 83 participants with BD and HTN were included. Adherence to BD and antihypertensive medications were positively correlated. eCAP openings showed more missed doses than self-reported antihypertensive adherence. BD medication adherence was positively correlated with BPRS at baseline; antihypertensive adherence was negatively correlated with SBP at screening. Antihypertensive adherence improved and SBP decreased between screening and baseline. CONCLUSIONS Adherence levels fluctuated over time and differed based on measurement method in people with comorbid BD and HTN. Self-reported BD adherence was positively related to global psychiatric symptoms and antihypertensive adherence was related to better SBP control. Monitoring both medication and blood pressure led to change in self-reported adherence. BD symptom severity may indicate poor adherence in patients with BD and should be considered in treatment planning.
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Affiliation(s)
- Jennifer B Levin
- Department of Psychiatry and Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, San Diego CA, USA
| | - Farren Briggs
- Department of Public Health Sciences, Division of Epidemiology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Mahboob Rahman
- Department of Internal Medicine, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Jessica Montoya
- Department of Psychiatry, University of California San Diego, San Diego CA, USA
| | - Colin Depp
- Department of Psychiatry, University of California San Diego, San Diego CA, USA
| | - Douglas Einstadter
- Departments of Medicine and Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kurt C Stange
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Celeste Weise
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Taylor Maniglia
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Richard Barigye
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Gracie Howard Griggs
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Clara Adeniyi
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Joy Yala
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Martha Sajatovic
- Department of Psychiatry and Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Simon E, Edwards AM, Sajatovic M, Jain N, Montoya JL, Levin JB. Systematic Literature Review of Text Messaging Interventions to Promote Medication Adherence Among People With Serious Mental Illness. Psychiatr Serv 2022; 73:1153-1164. [PMID: 35959534 PMCID: PMC9976730 DOI: 10.1176/appi.ps.202100634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mobile health tools are feasible options to encourage behavior change among patients with serious mental illness. Mobile health tools vary widely, both in platforms used and content delivered. This literature review assessed the use of text messaging interventions to promote medication adherence among patients with serious mental illness. METHODS A systematic literature review using PRISMA guidelines examined short message service (SMS) text messaging interventions promoting medication adherence to people with a serious mental illness diagnosis. Databases included PubMed, Cochrane, CINAHL, and PsycINFO. Data extraction included demographic information, participant diagnoses, intervention components, medication class, adherence measures, research design, and study outcomes. Study quality was also assessed. RESULTS Of 114 full-text articles screened, 10 articles were selected from nine unique interventions (N=937 people with serious mental illness). Study durations ranged from 30 days to 18 months, with frequency of SMS ranging from twice weekly to 12 times daily. Of the nine unique trials, most reported using an automated server to deliver SMS messages (N=7), two-way SMS capabilities (N=6), customized message content or timing (N=7), and additional components (e.g., provider contact, educational content, and monetary rewards) (N=7). Seven of the 10 articles reported statistically significant improvement in medication adherence and in at least one clinical outcome. CONCLUSIONS Evidence to date indicates that text messaging interventions are feasible and appear to improve medication adherence and clinical outcomes among patients with serious mental illness. Future research should assess implementation approaches and how to scale up efforts in nonresearch settings.
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Affiliation(s)
- Emily Simon
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland (Simon, Edwards, Sajatovic, Jain, Levin); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Levin); Department of Psychiatry, University of California, San Diego, San Diego (Montoya)
| | - Alyssa M Edwards
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland (Simon, Edwards, Sajatovic, Jain, Levin); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Levin); Department of Psychiatry, University of California, San Diego, San Diego (Montoya)
| | - Martha Sajatovic
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland (Simon, Edwards, Sajatovic, Jain, Levin); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Levin); Department of Psychiatry, University of California, San Diego, San Diego (Montoya)
| | - Nisha Jain
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland (Simon, Edwards, Sajatovic, Jain, Levin); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Levin); Department of Psychiatry, University of California, San Diego, San Diego (Montoya)
| | - Jessica L Montoya
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland (Simon, Edwards, Sajatovic, Jain, Levin); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Levin); Department of Psychiatry, University of California, San Diego, San Diego (Montoya)
| | - Jennifer B Levin
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland (Simon, Edwards, Sajatovic, Jain, Levin); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Levin); Department of Psychiatry, University of California, San Diego, San Diego (Montoya)
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