Using Preventive Medicine to Combat Non-Adherence in Bipolar Disorder

As Christoph Correll, MD, professor of psychiatry at Hofstra Northwell School of Medicine, New York, said at Psych Congress 2022, non-adherence is an issue in all medicine. Keeping up with regular medications can be difficult for anybody but is made especially challenging in people with illnesses like bipolar disorder. So, to combat non-adherence in patients, Dr Correll suggests practicing preventive psychiatry and long-acting injectables (LAIs) to "reduce the touchpoints of ambivalence."  

Be sure to reserve your spot now for Psych Congress 2023 and join us in Nashville, Tennessee, next September! For more news and insights from this year's conference, visit the newsroom.

Christoph Correll, MD, is a professor of psychiatry at Hofstra Northwell School of Medicine, New York, and medical director of the Recognition and Prevention program at the Zucker Hillside Hospital, New York. Dr Correll completed his medical studies at both the Free University of Berlin in Germany and at the Dundee University Medical School in Scotland. Dr Correll is board-certified in general psychiatry, having completed his residency at The Zucker Hillside Hospital in New York City.

Dr Correll’s research and clinical work focus on the identification, characterization, and psychopharmacological management of adults with severe psychiatric disorders. His areas of expertise range from the prodrome and first episode to the refractory illness phase of patients with severe mood and psychotic disorders. His research further focuses on psychotropic medication efficacy, effectiveness, and adverse effects as well as on physical health in the mentally ill.

Read the Transcript:
 

Non-adherence is a common problem in all of medicine. I would even add in all of life. You and I have been non-compliant with things we should do: diet, exercise. Think of the 31st of December, all your great ideas for the next year. How compliant are we really with that? Your loved ones asking you to do certain things. It's not easy to follow through and do it every day.

And it's even harder with medication and whoever in the audience and the viewers is are taking medications. You know that at the end of the month you sometimes ask, "Who has put these medications in my pill box? I took it every day. Why are there extra medications?' It's hard. And it's even harder when you have a mental illness, maybe cognitive impairment. You're not as structured, you don't have support and you might not have the illness insight, "Should I really take this?"

You're ambivalent and you might want to take substances on your own. And you are told never mix the two. And then you get into the pattern of, "Oh, let me skip the medication." And you don't get a relapse right away. Rather, you might feel a little relieved, less side effects. And then you have this pseudo security, "Oh, I didn't need that. The doctor was wrong. I don't have the illness."

So non-adherence is very common in any long-term illness, be it diabetes, hypertension, or bipolar disorder and schizophrenia. So we need to be cognizant of it and assume that it will happen during the illness course. And if we assume that, and if we know that relapses are bad for the brain and bad for people's lives, bad for their self-stigma and stigma from outside, then we might want to do preventive medicine, preventive psychiatry.

Not wait for the relapse, not wait for the non-adherence, but rather preemptively, offer long-acting injectables. Get them into place, after you've found the right medication and dose that's available as an LAI. And then give that to patients, making it easier. Not having to think every day, "Did I take it or not?" Not having to be reminded, "Oh, I'm sick. I must take this." Making it easier and reducing the touch points of ambivalence. "Should I, should I not?" Moving that from every day to every 2 weeks, every 4 weeks, every 8 or even 12 weeks. And now we even have treatments, at least in schizophrenia that can be given every 6 months.