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Antipsychotic nonadherence may be more common in bipolar disorder, MDD than schizophrenia

SAN DIEGO — Nonadherence to antipsychotic medication and substance misuse may be more common among individuals with major depressive disorder or bipolar disorder than among those with schizophrenia, according to data presented at U.S. Psychiatric and Mental Health Congress.

“Patients with serious mental illnesses often require maintenance treatment with antipsychotic medication to prevent symptom relapse,” Robert A. Millet, Jr., MD, of Duke University Medical Center, and colleagues wrote in their poster. “Up to 60% of patients with serious mental illness are not adherent with their prescribed antipsychotic medication regimen within up to a 3-year period.”

To determine potential nonadherence among patients prescribed antipsychotic agents and to identify use of nonprescribed medications or illicit substances, Millet and colleagues analyzed urine samples from 34,744 patients prescribed an antipsychotic. Of these, 3,609 were diagnosed with schizophrenia, major depressive disorder (MDD) or bipolar disorder. The mean age of the patients was 43.9 years.

Schizophrenia (43%) and bipolar disorder (38%) were the most common psychiatric diagnoses among study participants.

The most commonly prescribed medications included risperidone (18.2%) among patients with schizophrenia, aripiprazole (31.3%) among patients with MDD and quetiapine (26.9%) among patients with bipolar disorder.

Potential nonadherence to antipsychotic prescriptions, indicated by negative urine drug monitoring results, was significantly more common among patients with bipolar disorder or MDD than those with schizophrenia.

Patients with bipolar disorder or MDD were also more likely to have illicit substances or medications, including opioids, in their samples.

“Urine drug monitoring is useful in identifying psychiatric patients who would benefit from interventions aimed at increasing adherence and/or reducing substance abuse, thereby enhancing treatment outcomes,” the researchers concluded. – by Amanda Oldt

Reference:

Millet RA, et al. Adherence to treatment with antipsychotic medications among patients with schizophrenia, major depressive disorder, or bipolar disorder. Presented at: U.S. Psychiatric and Mental Health Congress; Sept. 10-13, 2015; San Diego.

Disclosure: The study was funded by Ingenuity Health, a service of Ameritox, Ltd. Millet reports being a consultant for Ameritox. Please see the study for a full list of disclosures.