Treatment Adherence Enhancement in Bipolar Disorder
CAE RCT
1 other identifier
interventional
184
1 country
1
Brief Summary
Bipolar disorder (BD) 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. In spite of a proliferation of treatments for BD, nearly half of individuals with BD do not benefit from pharmacotherapy because of sub-optimal medication treatment adherence. Non-adherence with BD medication treatment dramatically worsens outcomes. Reasons for non-adherence among individuals with BD are multi-dimensional, and it has been suggested that adherence enhancement might work best if the intervention specifically addresses factors that are important and modifiable for a specific individual. In spite of the enormity of the problem, the literature on interventions to improve treatment adherence is surprisingly limited. There is an urgent need for interventions to enhance treatment adherence among BD patients that: 1) are at high risk for future treatment non-adherence; 2) may not have access to or interest in long-term, high-intensity, and specialized care; and 3) are flexible and patient-focused taking into account reasons for non-adherence for a specific individual. The proposed study is a first-ever RCT focused specifically on BD treatment adherence enhancement, and will test whether a customized adherence enhancement (CAE) psychosocial intervention improves adherence and mental health outcomes compared to broadly-directed, non-individualized education (EDU). The proposed project has the potential to greatly advance the care of BD patients who are at greatest risk for poor health outcomes, with findings expected to be generalizable across a variety of treatment settings. Hypothesis 1: CAE will be associated with greater improvement in treatment adherence compared to broadly-directed, non-individualized BD education (EDU). Hypothesis 2: CAE will be associated with improved BD symptoms compared to EDU.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Apr 2012
Longer than P75 for not_applicable
1 active site
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
February 24, 2012
CompletedFirst Posted
Study publicly available on registry
March 1, 2012
CompletedStudy Start
First participant enrolled
April 1, 2012
CompletedPrimary Completion
Last participant's last visit for primary outcome
July 1, 2017
CompletedStudy Completion
Last participant's last visit for all outcomes
August 1, 2017
CompletedDecember 14, 2018
December 1, 2018
5.3 years
February 24, 2012
December 13, 2018
Conditions
Outcome Measures
Primary Outcomes (3)
Change from baseline in the Tablet Routine Questionaire (TRQ) "past month" item at 24 weeks
The TRQ "past month" item is a subject report of the percentage of prescribed medications not taken within the past month.
Baseline and 24 weeks
Change from baseline in the Tablet Routine Questionaire (TRQ) "past week" item at 24 weeks
The TRQ "past week" item is a subject report of the percentage of prescribed medications not taken within the past week.
Baseline and 24 weeks
Change from baseline in treatment adherence as measured by special pill cap counter at 24 weeks
A special pill cap will record the time/date of bottle opening. The cap will be used for the medication that the patient takes the most frequently (in the case of multiple BD medications taken at same frequency, the medication that was started most recently will be selected). A dose will be counted as "taken" if the bottle is opened within two hours of the prescribed time. A percent of doses taken (treatment adherence) will be calculated by dividing the number of times the bottle is opened by the number of times it should have been opened as per the prescription.
Baseline and 24 weeks
Secondary Outcomes (10)
Change from baseline in Brief Psychiatry Symptom Scale (BPRS) at 24 weeks
baseline and 24 weeks
Change from baseline in Montgomery Asberg Depression Rating Scale (MADRS) at 24 weeks
baseline and 24 weeks
Change from baseline in Young Mania Rating Scale (YMRS) at 24 weeks
baseline and 24 weeks
Change from baseline in Clinical Global Impression, Bipolar Version (CGI-BP) at 24 weeks
baseline and 24 weeks
Change from baseline in Global Assessment of Functioning (GAF) at 24 weeks
baseline and 24 weeks
- +5 more secondary outcomes
Study Arms (2)
Customized Adherence Enhancement (CAE)
EXPERIMENTALThis arm will receive the CAE intervention.
broad non-individualized education (EDU)
ACTIVE COMPARATORThis arm will receive the EDU intervention.
Interventions
CAE consists of the application of a series of up to four psychosocial treatment modules based upon a baseline evaluation of adherence vulnerabilities/needs. The standardized modules (Psychoeducation, Modified Motivational Enhancement Therapy, Communication with Providers, Medication Routines), are assigned based upon pre-established criteria designed to fit the needs of the patient.
EDU will consist of 4 core in-person sessions using the patient work-book from the NIMH funded study, Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), and following the general educational format of the Collaborative Care "control" intervention in the STEP study. EDU addresses BD treatment broadly, including diagnosis and management, and the sessions will review the materials and allow time for questions as needed.
Eligibility Criteria
You may qualify if:
- Subjects must have type I or type II Bipolar Disorder (BD) as confirmed by the Structured Clinical Interview for DSM-IV Axis I Disorders Patient Version (SCID-P)
- Have had BD for at least two years duration
- Have received treatment with at least one evidence-based medication to stabilize mood for at least six months (lithium, anticonvulsant, or antipsychotic mood stabilizer)
- Either 20% or more non-adherent with current BD medication treatment (i.e. lithium, anticonvulsant, or antipsychotic mood stabilizer)
You may not qualify if:
- Unable or unwilling to participate in psychiatric interviews. This will include individuals, who may be too psychotic to participate in interviews/rating scales
- Unable or unwilling to give written, informed consent to study participation
- Individuals at high risk for suicide who can not be safely managed in their current treatment setting
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (1)
University Hospitals Case Medical Center
Cleveland, Ohio, 44106, United States
Related Publications (1)
Aftab A, Levin J, Aebi M, Bhat C, Sajatovic M. Associations of Comorbid Anxiety With Medication Adherence and Psychiatric Symptomatology in a Population of Nonadherent Bipolar Disorder Subjects. J Nerv Ment Dis. 2018 Apr;206(4):258-262. doi: 10.1097/NMD.0000000000000788.
PMID: 29351117DERIVED
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Martha Sajatovic, M.D.
University Hospitals Cleveland Medical Center
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- SINGLE
- Who Masked
- OUTCOMES ASSESSOR
- Purpose
- TREATMENT
- Intervention Model
- PARALLEL
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Professor of Psychiatry
Study Record Dates
First Submitted
February 24, 2012
First Posted
March 1, 2012
Study Start
April 1, 2012
Primary Completion
July 1, 2017
Study Completion
August 1, 2017
Last Updated
December 14, 2018
Record last verified: 2018-12