Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Dec 22, 2016; 6(4): 399-409
Published online Dec 22, 2016. doi: 10.5498/wjp.v6.i4.399
Treatment-adherence in bipolar disorder: A patient-centred approach
Subho Chakrabarti
Subho Chakrabarti, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
Author contributions: Chakrabarti S solely contributed to this paper.
Conflict-of-interest statement: No conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Subho Chakrabarti, MD, FAMS, FRCPsych, Professor, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh 160012, India.
Telephone: +91-172-2756808 Fax: +91-172-2744401
Received: August 17, 2016
Peer-review started: August 19, 2016
First decision: October 21, 2016
Revised: October 31, 2016
Accepted: November 21, 2016
Article in press: November 22, 2016
Published online: December 22, 2016

About half of the patients diagnosed with bipolar disorder (BD) become non-adherent during long-term treatment, a rate largely similar to other chronic illnesses and one that has remained unchanged over the years. Non-adherence in BD is a complex phenomenon determined by a multitude of influences. However, there is considerable uncertainty about the key determinants of non-adherence in BD. Initial research on non-adherence in BD mostly limited itself to examining demographic, clinical and medication-related factors impacting adherence. However, because of inconsistent results and failure of these studies to address the complexities of adherence behaviour, demographic and illness-related factors were alone unable to explain or predict non-adherence in BD. This prompted a shift to a more patient-centred approach of viewing non-adherence. The central element of this approach includes an emphasis on patients’ decisions regarding their own treatment based on their personal beliefs, life circumstances and their perceptions of benefits and disadvantages of treatment. Patients’ decision-making processes are influenced by the nature of their relationship with clinicians and the health-care system and by people in their immediate environment. The primacy of the patient’s perspective on non-adherence is in keeping with the current theoretical models and concordance-based approaches to adherence behaviour in BD. Research over the past two decades has further endorsed the critical role of patients’ attitudes and beliefs regarding medications, the importance of a collaborative treatment-alliance, the influence of the family, and the significance of other patient-related factors such as knowledge, stigma, patient satisfaction and access to treatment in determining non-adherence in BD. Though simply moving from an illness-centred to a patient-centred approach is unlikely to solve the problem of non-adherence in BD, such an approach is more likely to lead to a better understanding of non-adherence and more likely to yield effective solutions to tackle this common and distressing problem afflicting patients with BD.

Keywords: Non-adherence, Bipolar disorder, Attitudes, Health-beliefs, Treatment-alliance, Familial influences, Knowledge, Stigma

Core tip: Treatment non-adherence in bipolar disorder (BD) is a complex phenomenon determined by a multitude of influences, but its critical determinants are yet to be identified with certainty. Demographic and illness-related factors have not been able to explain or predict non-adherence in BD. On the other hand, patient-centred variables such as attitudes and beliefs regarding medications, treatment-alliance, family attitudes, knowledge, stigma and access to treatment may be the more seminal influences on medication-taking in BD. A move from an illness-centred to a patient-centred approach is more likely to lead to a better understanding and more effective solutions for non-adherence in BD.