Medication compliance remains an area of concern for many patients and the
professionals involved in their care and it is also one which education has
sought to address. In a study carried out by Peet & Harvey (1991), 60
lithium clinic attendees were recruited to take part in a 6-week education
program about lithium. Patients were randomly assigned to an education or
a control group. Those in the education group showed substantial and significant
increases in their knowledge about lithium together with a more favorable
attitude towards lithium. However, work carried out some years earlier by
Frank et al. (1985) found that a 1-day education workshop for patients and
their families resulted in no cases of medication compliance.
Similar research in schizophrenia has shown that changes in attitude and knowledge
does not necessarily lead to improved compliance and may well require the formal
implementation of so called ‘compliance therapy’ (Kemp et al.,
Miklowitz & Goldstein (1990) evaluated behavioral family management with
a group of manic depressive patients recently hospitalized for an episode of
mania. They found that of the nine family treatment cases only one relapsed
(11 %) over a 9-month post-hospitalization period, compared to 14 out of 23
cases (61 %) from their naturalistic outcome study. Glick et al. (1994) carried
out a cross national study of 24 in-patients with severe affective illness.
Those patients who received individual and family psychoeducation demonstrated
better coping with the episode, and their overall outcome was better 12-18
months after discharge. Clarkin et al. (1990) in a large-scale randomized controlled
trial considered the outcome of 169 patients offered in-patient family intervention (IFI) 18 months after discharge. Of the 21 bipolar patients in this group,
12 were allocated IFI and nine to the control (usual inpatient treatment program).
The results demonstrated that bipolar patients showed significantly improved
social, family, work, leisure and role performance and improved family attitudes
towards treatment were identified.
Jacobs (1982) reports the use of cognitive therapy techniques to reduce post-manic
and post-depressive dysphoria. He reported that the application of cognitive
therapy was ‘successful’ in both groups. Cochran (1984) studied
the efficacy of a cognitive approach to medical non-compliance in out-patient
lithium-treated patients. She used a modified cognitive--behavioral intervention
(adapted from Beck et al., 1979) to challenge cognitions that impeded compliance.
The results demonstrated an immediate improvement post treatment in the intervention
group. This was maintained at a 6-month follow-up. Moreover, the intervention
group were significantly less likely to have major compliance problems, to
terminate lithium treatment against medical advice, or to be hospitalized.
There are a small number of uncontrolled studies of group therapy of various
persuasions. Shakir et al. (1979) and Volkmar (1981) offered a therapy group
to 15 bipolars who were also lithium responsive; many of these patients (10)
had a poor history of compliance. The group, which was organized on the lines
of that advocated by Yalom, ran for a number of years. Following a 2-year
attendance at the group Shakir and colleagues reported significant changes
in the patients’ level of functioning compared to the 2-years prior
to attending the group. They also noted that following a 51-week attendance
at the group, admission rates fell. Only three individuals were admitted
to hospital over the period of 2 years and the average time spent in hospital
fell to 3 weeks. Similar findings were reported from Kripke & Robinson
(1985). Palmer & Williams (1995) in an exploratory study evaluated CBT
in a group of Bipolars who were also receiving pharmacotherapy. The group
was run weekly over a period of 17 weeks. The results indicated that for
some, the intervention was successful in improving symptomatology and overall
social adjustment, although the improvement varied across individuals.
- George, Sandra; Towards an Integrated Treatment Approach for Manic Depression;
Journal of Mental Health; Apr98, Vol. 7 Issue 2, p145.
Reflection Exercise #2
The preceding section contained information
about psychosocial interventions for bipolar clients. Write
three case study examples regarding how you might use the content of this section
in your practice.
Online Continuing Education
According to Cochran, what is the most effective form of therapy for increasing
medication compliance in bipolar patients? Record the letter of the correct answer