Patients' reports of the factors influencing medication adherence in bipolar disorder - an integrative review of the literature.

BACKGROUND: As with other long-term conditions patients with bipolar disorder are rarely totally adherent or non-adherent. Rates of non-adherence have not changed since the first introduction of psychotropic medications in the 1950s despite vast numbers of new compounds being marketed. Non-adherence with medication in bipolar disorder is associated with affective relapse and consequently poor quality of life. The reasons that patients are non-adherent with medication are not well understood by clinicians who often assume it is related to the illness itself.

OBJECTIVES: To identify patients' perceptions of medication adherence in bipolar disorder.

DESIGN: An integrated review of the literature published between 1999 and 2010.

DATA SOURCES: Ovid (Medline, CINAHL, Embase, PsycINFO) and manual searching.

REVIEW METHODS: An integrative review of the literature was conducted which included: (a) problem formation, (b) literature search and initial screening, (c) gathering data from studies, (d) evaluating study quality, (e) data analysis and integration, (f) data interpretation, and (g) presentation of the findings.

RESULTS: Thirteen articles met criteria for inclusion in the review. These articles identified how patients reported their perceptions on medication and were integrated into four categories: illness factors, personal attitudes and beliefs, medication factors and environmental factors.

CONCLUSIONS: These findings suggest a need to address adherence from the full range of influencing factors (patient, illness, medication and environmental). Clinicians need to utilise a collaborative approach to working together with patients in order to identify the meaning that patients attribute to the symptoms, diagnosis, prognosis and medication. Understanding patients' perceptions and accepting these may facilitate greater medication adherence and the consequent improved clinical outcomes for patients with bipolar disorder.