Bipolar disorder (BPD) is a serious and chronic mental illness that is associated with substantial impairment in quality of life and functional outcomes, high rates of suicide and high financial costs. Despite the rapid proliferation of treatments for individuals with BPD in recent years, treatment non- adherence remains a significant problem, with nearly one in two individuals being non-adherent with prescribed medication. Personal, societal and financial costs are known to increase sharply in circumstances where individuals with BPD are non-adherent with prescribed medication treatments. It has been reported that costs of care for one non-adherent patient with BPD and frequent manic relapses are equal to that for 13 individuals who are adherent with mood stabilizing medication. Thus, treatment non-adherence among individuals with BPD is a matter of critical public health importance. This proposal addresses the issue of treatment adherence noted in Program Announcement PA-03-111, specifically adherence to interventions for mental illness. The effectiveness of interventions to improve adherence will hinge on ability to address those factors that are changeable, and specifically address vulnerabilities that an individual has with respect to treatment adherence. Additionally, there is an urgent need for adherence enhancement interventions that can be implemented in real-world settings such as a community mental health clinic (CMHC). The purpose of this three-stage project is to develop, refine, and pilot test a tailored adherence enhancement intervention among individuals with BPD who receive treatment in a CMHC, and who are known to be at high risk for treatment non-adherence. The currently proposed study will be developed and investigated in three separate aims: 1.) To characterize individual reasons for non-adherence with prescribed medications among poorly adherent patients with BPD who are receiving treatment at a CMHC. 2.) To develop a series of standardized, manual-driven treatment components tailored to individual adherence risk vulnerabilities and reasons for non-adherence among patients with BPD. 3,) To pilot test the use of a tailored, patient-focused intervention in a high risk population with BPD. The intervention is designed to be parsimonious with respect to resources required, and is easily integrated into a busy CMHC setting. This exploratory project, if funded, will obtain preliminary data needed as a pre-requisite to a larger -scale study on treatment adherence enhancement among high-risk patients with BPD.
