Association between Adherence with an Atypical Antipsychotic and with Other Psychiatric Drugs in Patients with Bipolar Disorder

Longitudinal Digital Mood Charting in Bipolar Disorder: Experiences with ChronoRecord Over 20 Years

INTRODUCTION

Longitudinal study is an essential methodology for understanding disease trajectories, treatment effects, symptom changes, and long-term outcomes of affective disorders. Daily self-charting of mood and other illness-related variables is a commonly recommended intervention. With the widespread acceptance of home computers in the early 2000s, automated tools were developed for patient mood charting, such as ChronoRecord, a software validated by patients with bipolar disorder. The purpose of this study was to summarize the daily mood, sleep, and medication data collected with ChronoRecord, and highlight some of the key research findings. Lessons learned from implementing a computerized tool for patient self-reporting are also discussed.

METHODS

After a brief training session, ChronoRecord software for daily mood charting was installed on a home computer and used by 609 patients with affective disorders.

RESULTS

The mean age of the patients was 40.3±11.8 years, a mean age of onset was 22±11.2 years, and 71.4% were female. Patients were euthymic for 70.8% of days, 15.1% had mild depression, 6.6% had severe depression, 6.6% had hypomania, and 0.8% had mania. Among all mood groups, 22.4% took 1-2 medications, 37.2% took 3-4 medications, 25.7 took 5-6 medications, 11.6% took 7-8 medications, and 3.1% took >8 medications.

CONCLUSION

The daily mood charting tool is a useful tool for increasing patient involvement in their care, providing detailed patient data to the physician, and increasing understanding of the course of illness. Longitudinal data from patient mood charting was helpful in both clinical and research settings.

Comparison of potential psychiatric drug interactions in six drug interaction database programs: A replication study after 2 years of updates

OBJECTIVE

Drug interaction database programs are a fundamental clinical tool. In 2018, we compared the category of potential drug-drug interaction (DDI) provided by six drug interaction database programs for 100 drug interaction pairs including psychiatric drugs, and found the category often differed. This study replicated the comparison in 2020 after 2 years of updates to all six drug interaction database programs.

METHODS

The 100 drug pairs included 94 different drugs: 67 pairs with a psychiatric and non-psychiatric drug, and 33 pairs with two psychiatric drugs. The assigned category of potential DDI for the drug pairs was compared using percent agreement and Fleiss kappa statistic of interrater reliability.

RESULTS

Despite 67 updates involving 46 of the 100 drug pairs, differences remained. The overall percent agreement among the six drug interaction database programs for the category of potential DDI was 67%. The interrater agreement results did not change. The Fleiss kappa overall interrater agreement was fair. The kappa agreement for a drug pair with any severe category rating was substantial, and the kappa agreement for a drug pair with any major category rating was fair.

CONCLUSIONS

Physicians should be aware of the inconsistency among drug interaction database programs in the category of potential DDI for drug pairs including psychiatric drugs. Additionally, the category of potential DDI for a drug pair may change over time. This study highlights the importance of ongoing international efforts to standardize methods used to define and classify potential DDI.