By: Dr. G.S. Shankar, School of Pharmacy

Medication non-adherence is a major problem in chronic psychiatric disorders (Mert et al., 2015). Although various psychiatric disorders follow a relapsing-remitting pattern, bipolar disorder (BD) has a higher frequency of relapse, and the relapse risk remains constant throughout a patient’s life (Jawad, 2018). Although some patients with BD have long periods of recovery, long term follow-up shows that on average, patients are symptomatic around 50% of the time (Judd et al., 2003). During much of this time, patients suffer from subsyndromal symptoms (Judd et al., 2003), but even low symptom levels are associated with impaired psychosocial functioning (Ruggero et al., 2007). Bipolar disorder is associated with a range of well-described types of cognitive dysfunction across clinical subgroups, including patients with euthymia (Lima et al., 2018), and there is evidence of progression of dysfunction over time (Samame et al., 2014). Deficits are present across all cognitive domains including memory (Bourne et al., 2013). Studies with euthymic (normal mood) BD outpatients have examined the relationship between cognition and medication adherence. One major study of 353 euthymic outpatients found a relationship between poor inhibitory control and reduced adherence (Correard et al., 2017). Medication non-adherent patients with BD have lower levels of insight compared with medication adherent patients (Jawad et al., 2018). Medication non-adherence is a common problem in BD and is strongly associated with decreased cognition, lack of insight, and poorer clinical outcomes, and it also increases the need and cost of mental health services.

Prophylactic medication, ideally supported by psychosocial intervention, is regarded as the basis of managing BD (Goodwin et al., 2016). The enhancement of medication adherence is a central point for therapy in many psychosocial interventions for BD (Depp, 2008). In a review of the effectiveness of psychotherapy for enhancing medication adherence in BD, seven of 11 clinical trials reviewed showed positive effects on medication adherence, with a greater effect found for multi-component interventions that focused on medication adherence (Sajatovic et al., 2004), and multi-component intervention is the foundation of this study.

There are several research publications that emphasize the effects of a brief psycho-educative cognitive behavioral group therapy (CBT) focusing on mindfulness on medication adherence to prevent relapse in patients with bipolar disorder. It is speculated that participation in a psycho-educational program based on ‘Brief Mindfulness Centered Cognitive Behavioral Therapy’ (BMCBT) can improve medication adherence.