Factors affecting treatment compliance in patients with bipolar I disorder during prophylaxis: a study from Turkey Saime Esra Col, M.D. a , Ali Caykoylu, M.D. b , Gorkem Karakas Ugurlu, M.D. b, ⁎, Mustafa Ugurlu, M.D. b a Deparment of Psychiatry, Igdır State Hospital, Igdır, Turkey b Department of Psychiatry, Yıldırım Beyazıt University Faculty of Medicine, Ankara Ataturk Training and Research Hospital, Ankara, Turkey abstract article info Article history: Received 20 March 2013 Revised 20 November 2013 Accepted 20 November 2013 Keywords: Medication Compliance Dipolar disorder Objectives: Treatment noncompliance is one of the most frequent causes of relapse and recurrence in patients with bipolar I disorder. Treatment compliance among patients with bipolar disorder is affected by individual patients’ features, the disease itself, doctor-patient relationships and patients’ socio-economic and cultural characteristics. This study aimed to determine the factors affecting treatment compliance during the treatment of bipolar disorder and contribute to current clinical strategies. Methods: Data were collected from 78 volunteers with bipolar I disorder in remission; all volunteers were being treated solely with mood stabilisers. Sociodemographic and clinical data were gathered through a semi- structured interview designed by researchers. The Hamilton Depression Rating Scale and the Young Mania Rating Scale were both administered to assess remission of bipolar I disorder, and a self-report scale, the Medication Adherence Rating Scale, was administered to assess medication adherence. Results: Treatment compliant patients reported that they had received adequate social support and had been sufficiently informed by their physicians about the illness and treatment. Treatment compliant individuals with higher rates of hospitalisations and the results indicate that the number of depressive episodes adversely affects treatment compliance. There was not a statistically significant difference in treatment compliance based on duration of illness, euthymia, time, total number of episodes, age of onset, predominant polarity, drug doses, number of daily medications, frequency of daily medications, or type of mood stabiliser used. Conclusions: These results indicate that there are differences between compliant and non-compliant bipolar I disorder patients in terms of adequate social support, information provided by the physician about the illness and treatment, number of depressive episodes and number of hospitalisations. © 2014 Elsevier Inc. All rights reserved. 1. Introduction Clinicians agree that treatment compliance is difficult to attain and poses an obstacle to good clinical outcomes among individuals with severe mental disorders [1]. Treatment compliance could be defined as the patient’s acceptance of the essential health and treatment proposals and conformity with them; this definition includes a number of behaviours, such as accessing treatment, accepting medication, understanding follow-up advice and remem- bering to take medication. This definition, which cannot be limited to describing the usage of prescribed medications, also describes the entire set of proposals made by the clinician, including in behavioural aspects [2–5]. The term “treatment compliance” is more compre- hensive than “medication adherence,” a term referring only to prescribed medications. Psychopharmacology has significant importance in the treatment of bipolar I disorder (BPD), both in the acute and maintenance therapy periods. Immediately after an acute episode, many patients require long-term prophylaxis to prevent recurrence. Despite new psycho- pharmacological developments, treatment outcomes still depend upon treatment compliance. Treatment noncompliance is one of the most frequent causes of relapse and recurrence in BPD patients and is linked to adverse outcomes, such as increased polyclinical applica- tions, rehospitalisation, poor community adjustment [6] and suicide [2,7–10]. These outcomes are also indicators of increased health care utilisation and cost of health services [11]. The potential benefits of pharmacological treatment, including recovery, relapse prevention and reduced mortality, decrease greatly with noncompliance [2,3]. The reported noncompliance rates for long-term prophylactic pharmacotherapy for BPD range from 20% to 66%; the mean prevalence is noted to be 41% [2–4]. Thus far, the factors affecting treatment compliance among patients with BPD have not been determined. Many variables related to the patient (socioeconomic characteristics, perceptions, beliefs), clinician (the relationship between physician and patient), treatment (efficacy, side effects, drug dose, number of pills, number of General Hospital Psychiatry 36 (2014) 208–213 ⁎ Correspondence author. Bilkent/Ankara, Turkey. Tel.: +90 0312 291 25 25/3765; fax: +90 03122912705. E-mail addresses: sesrac@hotmail.com (S.E. Col), acaykoylu@hotmail.com (A. Caykoylu), dr_gorkem@yahoo.com (G. Karakas Ugurlu), dr_ugurlu@yahoo.com (M. Ugurlu). 0163-8343/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.genhosppsych.2013.11.006 Contents lists available at ScienceDirect General Hospital Psychiatry journal homepage: http://www.ghpjournal.com