Tip 1 Bipolar Bozuklukta Tedavi Uyumunu Etkileyen Faktörler

Neşe Burcu Bal; Hüseyin Hamdi Özsan

doi:10.20515/otd.1295324

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Tip 1 Bipolar Bozuklukta Tedavi Uyumunu Etkileyen Faktörler

Year 2023, Volume: 45 Issue: 5, 696 - 708, 27.09.2023

Neşe Burcu Bal , Hüseyin Hamdi Özsan

https://doi.org/10.20515/otd.1295324

Abstract

Medikal tedaviye uyumsuzluk, bipolar bozukluk (BB) hastalarında zorlanmanın ve yeti yitiminin yaygın nedenlerinden birisidir. Bu çalışmada, remisyonda olan BB hastalarında tedavi uyum düzeylerinin belirlenmesi, tedaviye uyum üzerine etkili olabilecek faktörlerin çok yönlü olarak tespit edilmesi amaçlanmaktadır. Araştırmaya remisyonda BB tip 1 tanılı 50 hasta dahil edilmiş, sosyodemografik veri formu, Kısa Uluslararası Nöropsikiyatrik Görüşme (MINI Plus 5.0.0), Hamilton Depresyon Derecelendirme Ölçeği (HAM-D), Young Mani Derecelendirme Ölçeği (YMDÖ), Kısa İşlevsellik Değerlendirme Ölçeği (FAST), İçgörünün Üç Bileşenini Değerlendirme Ölçeği, UKU Yan Etki Değerlendirme Ölçeği, Algılanan Sosyal Destek Ölçeği (ASDÖ) ve Tıbbi Tedaviye Uyum Oranı Ölçeği (TTUOÖ) uygulanmıştır. Grupların karşılaştırılmasında; TTUOÖ toplam puanları, cinsiyete (p<0,05), çalışma durumuna (p<0,05), medeni duruma (p<0,05), yakınına göre tedavi uyumu (p<0,05) ve yaygın anksiyete bozukluğu (YAB) eşlik edip etmemesine göre (p<0,05) göre anlamlı fark saptanmıştır. TTUOÖ toplam puanı ile düzenli ilaç kullanım süresi (p<0.01) ve içgörü toplam puanı (p<0,01) arasında aynı yönlü, YMDÖ (p<0.01) ve UKU yan psikolojik yan etkiler altölçeği (UKU1) (p<0,01) ve tüm yan etkiler toplam puanı (UKU toplam) (p<0,05) arasında ters yönlü bir ilişki saptanmıştır. Yapılan Regresyon analizinde; çalışma durumu, eşlik eden YAB ve YMDÖ toplam puanlarının TTUOÖ toplam puanı üzerinde etkili faktörler olduğu bulunmuştur (R=0.64). Araştırmanın bulgularına göre; erkek, evli, düzenli bir işte çalışıyor olmak ve yüksek içgörü düzeyi tedavi uyumunu olumlu yönde etkilerken, yan etkiler ve eşik altı manik belirtiler tedavi uyumunu olumsuz yönde etkilemektedir. Bu sonuçlar doğrultusunda, BB hastalarının iş yaşamının ve sosyal hayatının desteklenmesi, hastalık ve tedavi konularında ayrıntılı bilgilendirilmesi amacıyla psikoeğitime ağırlık verilmesinin önemli olduğu sonuçlarına ulaşılabilmektedir

Keywords

bipolar bozukluk, tedavi uyumu, ilaç tedavisine uyum, eşik altı belirti

References

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Factors Affecting The Treatment Compliance in Bipolar Disorder Type I

Year 2023, Volume: 45 Issue: 5, 696 - 708, 27.09.2023

Neşe Burcu Bal , Hüseyin Hamdi Özsan

https://doi.org/10.20515/otd.1295324

Abstract

Non-adherence to medical treatment is one of the common causes of difficulties and disability in bipolar disorder (BD) patients. In this study it is aimed to determine the level of treatment compliance and the factors that may affect the treatment compliance in many aspects. 50 patients followed up with BD type I in remission and they were evaluated with sociodemographic data form, The Mini International Neuropsychiatric Interview (MINI Plus 5.0.0), Hamilton Depression Scale (HAM-D), Young Mania Rating Scale (YMRS), Functioning Assessment Short Test (FAST), Schedule for Assesing the Three Components of Insight, UKU Side Effect Rating Scale, The Multidimensional Scale of Perceived Social Support (MSPSS) and Medication Adherence Rating Scale (MARS). The total score of treatment compliance differed statistically among patients depending on the gender (p<0,05), employment status (p<0,05), marital status (p<0,05), treatment compliance according to a relative (p<0,05) and presence of generalized anxiety disorder (GAD) (p<0,05). The total score of MARS is statistically related with the duration of regular medication use (p<0.01) and total score of insight scale (p<0.01). On the other hand, it has statistically significant inverse relationships with YMRS total score, Psychological Side Effects Subscale of UKU (UKU1) (p<0,01) and total UKU score (UKU total) (p<0,05). In the regression analysis, employment status, accompanying GAD and YMRS total scores were found to be effective factors on the MARS total score (R=0.64). In BD, being male and married, working in a regular job, having high insight affect treatment compliance positively, side effects and presence of subthreshold manic symptoms affect treatment compliance adversely. According to these results it can be inferred that supporting the working and social life of patients with BD, focusing on psychoeducation to inform patients about the disorder and treatment issues are important.

Keywords

bipolar disorder, treatment compliance, medication adherence, subthreshold symptoms

References

1. APA. Amerikan Psikiatri Birliği, Ruhsal Bozuklukların Tanısal ve Sayımsal Elkitabı, Beşinci Baskı (DSM-5), Tanı Ölçütleri Başvuru Elkitabı’ndan Çev. Köroğlu E, Hekimler Yayın Birliği, Ankara. 2013. 91–112 p.
2. Soykan A. İki uçlu bozuklukta tedavi uyumunu arttırma stratejileri. J Mood Disord. 2013;3(5).
3. Savas HA, Unal A, Virit O. Treatment adherence in bipolar disorder. Psychiatry Behav Sci. 2011;1(3):95.
4. Levin JB, Krivenko A, Howland M, Schlachet R, Sajatovic M. Medication adherence in patients with bipolar disorder: a comprehensive review. CNS Drugs. 2016;30:819–35.
5. Colom F, Vieta E, Martinez-Aran A, Reinares M, Benabarre A, Gasto C. Clinical factors associated with treatment noncompliance in euthymic bipolar patients. J Clin Psychiatry. 2000;61(8):549–55.
6. Busby KK, Sajatovic M. Patient, treatment, and systems‐level factors in bipolar disorder nonadherence: a summary of the literature. CNS Neurosci Ther. 2010;16(5):308–15.
7. Smilowitz S, Aftab A, Aebi M, Levin J, Tatsuoka C, Sajatovic M. Age-related differences in medication adherence, symptoms, and stigma in poorly adherent adults with bipolar disorder. J Geriatr Psychiatry Neurol. 2020;33(5):250–5.
8. Uygun E, Kucukgoncu S. Treatment Adherence in Patients with Bipolar Disorder and Beliefs Related to Non-Adherence. Psychiatry Behav Sci. 2020;10(4):192.
9. Scott J. Predicting medication non-adherence in severe affective disorders. Acta Neuropsychiatr. 2000;12(3):128–30.
10. Lingam R, Scott J. Treatment non‐adherence in affective disorders. Acta Psychiatr Scand. 2002;105(3):164–72.
11. Manhas RS, Manhas GS, Manhas A, Sharma R, Thappa JR, Akhter R. Prevalence of non-adherence to treatment among patients of bipolar affective disorder. J Med Sci Clin Res. 2019;7(6):623–8.
12. Gutiérrez-Rojas L, Jurado D, Martínez-Ortega JM, Gurpegui M. Poor adherence to treatment associated with a high recurrence in a bipolar disorder outpatient sample. J Affect Disord. 2010;127(1–3):77–83.
13. Hong J, Reed C, Novick D, Haro JM, Aguado J. Clinical and economic consequences of medication non-adherence in the treatment of patients with a manic/mixed episode of bipolar disorder: results from the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) study. Psychiatry Res. 2011;190(1):110–4.
14. Müller-Oerlinghausen B. Arguments for the specificity of the antisuicidal effect of lithium. Eur Arch Psychiatry Clin Neurosci. 2001;251:72–5.
15. Tang C, Hsieh MH, Hung S, Lee IH, Lin Y, Yang YK. One‐year post‐hospital medical costs and relapse rates of bipolar disorder patients in Taiwan: a population‐based study. Bipolar Disord. 2010;12(8):859–65.
16. Scott J, Pope M. Self-reported adherence to treatment with mood stabilizers, plasma levels, and psychiatric hospitalization. Am J Psychiatry. 2002;159(11):1927–9.
17. Johnson RE, McFarland BH. Lithium use and discontinuation in a health maintenance organization. Am J Psychiatry. 1996;
18. Belzeaux R, Correard N, Boyer L, Etain B, Loftus J, Bellivier F, et al. Depressive residual symptoms are associated with lower adherence to medication in bipolar patients without substance use disorder: results from the FACE-BD cohort. J Affect Disord. 2013;151(3):1009–15.
19. Sylvia LG, Reilly‐Harrington NA, Leon AC, Kansky CI, Calabrese JR, Bowden CL, et al. Medication adherence in a comparative effectiveness trial for bipolar disorder. Acta Psychiatr Scand. 2014;129(5):359–65.
20. Sajatovic M, Ignacio R V, West JA, Cassidy KA, Safavi R, Kilbourne AM, et al. Predictors of nonadherence among individuals with bipolar disorder receiving treatment in a community mental health clinic. Compr Psychiatry. 2009;50(2):100–7.
21. Perlis RH, Ostacher MJ, Miklowitz DJ, Hay A, Nierenberg AA, Thase ME, et al. Clinical features associated with poor pharmacologic adherence in bipolar disorder: results from the STEP-BD study. J Clin Psychiatry. 2010;71(3):2763.
22. Karadağ H, Kokurcan A, Güriz SO, Atmar M, Örsel S. Assessing the treatment adherence and clinical correlates of low adherence among bipolar disorder outpatients: A cross-sectional study. Psychiatry Clin Psychopharmacol. 2019;29(4):558–64.
23. Jones SH, Sellwood W, McGovern J. Psychological therapies for bipolar disorder: the role of model‐driven approaches to therapy integration. Bipolar Disord. 2005;7(1):22–32.
24. Sofuoglu S, Turan T. Antipsikotik ilaç tedavisinde uyum problemleri: Bunlarin ekstrapiramidal yan etkilerle iliskisi1/Problems of comliance with antipsychotic drugs: In relation to their extrapyramidal side effects. Anadolu Psikiyatr Derg. 2000;1(2):100.
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Details

Primary Language	Turkish
Subjects	Psychiatry
Journal Section	ORİJİNAL MAKALE
Authors	Neşe Burcu Bal 0000-0002-6445-9393 Hüseyin Hamdi Özsan This is me 0009-0000-9582-7999
Publication Date	September 27, 2023
Published in Issue	Year 2023 Volume: 45 Issue: 5

Cite

Vancouver	Bal NB, Özsan HH. Tip 1 Bipolar Bozuklukta Tedavi Uyumunu Etkileyen Faktörler. Osmangazi Tıp Dergisi. 2023;45(5):696-708.

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