Poor adherence to treatment associated with a high recurrence in a bipolar disorder outpatient sample

J Affect Disord. 2010 Dec;127(1-3):77-83. doi: 10.1016/j.jad.2010.05.021. Epub 2010 Jun 25.


Background: We analyzed the association of previous course-of-illness and other variables of clinical interest with a high frequency of both depressive or (hypo)manic episodes controlling for the effect of socio-demographic characteristics.

Methods: A total of 108 outpatients with a DSM-IV diagnosis of bipolar disorder (BD) were recruited. A retrospective and naturalistic study was conducted to examine the number of affective episodes and their relationship with socio-demographic, clinical and course-of-illness variables, including adherence to medication, type of medication used and the use of addictive substances. The episode frequency was estimated as the number of "major instances" of depression, hypomania and mania during the illness. To classify the patients into two groups (higher and lower-episode frequency), we used the statistical criterion of median split. Results were analyzed with logistic regression models to control for the effects of potential confounders.

Results: A high episode frequency (nine or more episodes) was associated with age (36-55years), delay in diagnosis, poor adherence to medication and current use of antipsychotic medication. In addition, a high frequency of manic episodes (four or more) was associated with female sex, age (>36years) and a manic onset of the illness, whereas a high frequency of depressive episodes (five or more) was associated with delay in diagnosis and poor adherence to medication.

Limitations: Cross-sectional study design.

Conclusions: Avoiding delay in diagnosis and enhancing treatment adherence might be important targets for reducing recurrences in BD.

MeSH terms

  • Adult
  • Age of Onset
  • Ambulatory Care*
  • Antimanic Agents / adverse effects
  • Antimanic Agents / therapeutic use*
  • Bipolar Disorder / diagnosis
  • Bipolar Disorder / drug therapy*
  • Bipolar Disorder / epidemiology
  • Bipolar Disorder / psychology*
  • Comorbidity
  • Cross-Sectional Studies
  • Delayed Diagnosis
  • Female
  • Humans
  • Male
  • Medication Adherence / psychology*
  • Middle Aged
  • Patient Admission / statistics & numerical data
  • Psychotropic Drugs / adverse effects
  • Psychotropic Drugs / therapeutic use*
  • Retrospective Studies
  • Risk Factors
  • Secondary Prevention
  • Spain
  • Statistics as Topic
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / psychology


  • Antimanic Agents
  • Psychotropic Drugs