The RAS-24: Development and validation of an adherence-to-medication scale for severe mental illness patients.

Introduction: Several studies have found that most patients with severe mental illness (SMI) and comorbid (physical) conditions are partially or wholly nonadherent to their medication regimens. Nonadherence to treatment is a serious concern, affecting the successful management of patients with SMIs. Psychiatric disorders tend to worsen and persist in nonadherent patients, worsening their overall health. The study described herein aimed to develop and validate a scale (the Ralat Adherence Scale) to measure nonadherence behaviors in a culturally sensitive way. Materials and Methods: Guided by a previous study that explored the primary reasons for nonadherence in Puerto Rican patients, we developed a pool of 147 items linked to the concept of adherence. Nine experts reviewed the meaning, content, clarity, and relevance of the individual items, and a content validity ratio was calculated for each one. Forty items remained in the scale's first version. This version was administered to 160 patients (21-60 years old). All the participants had a diagnosis of bipolar disorder, major depressive disorder, or schizoaffective disorder. The STROBE checklist was used as the reporting guideline. Results: The scale had very good internal consistency (Cronbach's alpha = 0.812). After a factor analysis, the scale was reduced to 24 items; the new scale had a Cronbach's alpha of 0.900. Conclusions: This adherence scale is a self-administered instrument with very good psychometric properties; it has yielded important information about nonadherence behaviors. The scale can help health professionals and researchers to assess patient adherence or nonadherence to a medication regimen.

Development of a Psychosocial Intervention to Promote Treatment Adherence in Patients with Bipolar Disorder at Risk of Cardiovascular Disease.

Nonadherence to treatment is a serious concern that affects the successful management of bipolar disorder (BD) patients. The aim of this study was to pilot test a psychosocial intervention (previously developed by this team) intended to increase adherence to medication and health behaviors targeting cardiovascular disease (CVD) risk factors in BD patients. An open, single-group design was used to assess the feasibility and acceptability of the intervention. The participants had BD, type I/II or unspecified, and CVD risk factors. Baseline demographic measures were taken. We also obtained preliminary effect sizes related to pre-post changes on measures of self-reported adherence to psychiatric medication, depressive and manic symptoms, and pharmacy records. At baseline, 29% of the participants reported recent adherence to psychiatric medications. A total of 71% of the participants completed the intervention. Pre-post improvements by medium and large effect sizes (Cohen's d = 0.52-0.92) were seen in medication adherence, attitudes toward medication, and mania symptoms. The participants reported high levels of satisfaction with the intervention. A culturally sensitive psychosocial intervention for Puerto Rican BD patients who are at risk of CVD was found to be feasible and acceptable. Improvements in the key outcomes were seen in this small, preliminary study. Further research is needed with a larger sample size.

Using the MMSE-2 to Measure Cognitive Deterioration in a Sample of Psychiatric Patients Living in Puerto Rico.

Patients with psychiatric disorders often have cognitive impairment. Several deficits have been recognized in patients with mood and/or psychotic disorders. We hypothesized that differences in the levels of deterioration exist between patients with bipolar disorder (BD), major depressive disorder (MDD), and schizoaffective disorder (SAD). The mini-mental state examination, version 2 (MMSE-2), was used with a sample of 160 psychiatric patients to measure cognitive impairment. The aims of this studyssss were as follows: (1) To characterize the differences in cognitive deterioration among patients diagnosed with BD, MDD, or SAD; (2) to explore item difficulty and cutoff points based on the educational level and other variables which are significant for our psychiatric population. Descriptive statistics were used for categorical variables. In addition, a Bonferroni post hoc test and an analysis of covariance (ANCOVA) for the continuous dependent variable were performed. Psychiatric diagnosis and years of education adjusted by several covariates proved to be significant. The 25th percentile were obtained to establish the cutoff points. Each item's difficulty was analyzed using means and chi-square tests. Cognitive deterioration was found in 51% of the patients with SAD, in 31% with BD, and in 18% with MDD.

THE MANAGEMENT OF CARDIOVASCULAR DISEASE RISK FACTORS IN BIPOLAR DISORDER PATIENTS IN PRIMARY HEALTHCARE SETTINGS.

Accumulating evidence supports the association between cardiovascular disease (CVD) risk factors and bipolar disorder (BD). CVD is the leading cause of morbidity and mortality in patients with bipolar disorder. However, there is a need to study the management of the risk factors in the primary healthcare context. This narrative review aims to appraise the different approaches of care that have been used in the management of these patients to address CVD risk factors in primary care. We reviewed articles from PubMed, Science Direct and other studies cited in the articles found. The keywords used for this review included "bipolar," "bipolar disorder," "cardiovascular" or "metabolic syndrome," "screening," "primary care," and "integrative" or "integrated care model" or "collaborative care model." This review includes studies published over a period of 48 months (January 2016 through December 2019). We identified 128 articles, removing two duplicates. From them, 115 articles are excluded based on the inclusion/exclusion criteria leaving eleven relevant articles. Upon full-text review, six studies were excluded. The final studies included are five. We used the study-quality assessment tools from the National Heart, Lung, and Blood Institute to assess the quality of the articles found. CVD risk factors in patients with BD and forms of other severe mental illness (SMI) are often underdetected. Primary healthcare providers need to identify these risk factors in the management of these patients to determine and recommend appropriate strategies.

La evidencia acumulada apoya la asociación entre los factores de riesgo de la enfermedad cardiovascular (ECV) y el desorden bipolar (DB). La ECV es la causa principal de morbilidad y mortalidad en pacientes con el DB. Sin embargo, existe la necesidad de estudiar el manejo de estos factores de riesgo en contextos de atención primaria. Esta revisión narrativa tiene como objetivo evaluar los diferentes enfoques de atención que se han utilizado en el manejo de estos pacientes para abordar los factores de riesgo de ECV en la atención primaria. Revisamos artículos de PubMed, Science Direct y otros estudios citados en los artículos encontrados. Las palabras claves utilizadas para esta revisión incluyeron "bipolar", "trastorno bipolar", "síndrome metabólico" o "cardiovascular", "detectión", "atención primaria" y "modelo de atención integrada" o "integrativo" o "modelo de atención colaborativa". Esta revisión incluye estudios publicados durante un período de 48 meses (enero de 2016 a diciembre de 2019). Identificamos 128 artículos, eliminando dos duplicados. De éstos, se excluyen 115 artículos a base de los criterios de inclusión / exclusión dejando 11 artículos relevantes. Tras la revisión del texto completo, se excluyeron seis estudios. Los estudios finales incluidos fueron cinco. Utilizamos las herramientas de evaluatión de la calidad de los estudios del Instituto Nacional del Corazón, los Pulmones y la Sangre para evaluar la calidad de los artículos encontrados. Los factores de riesgo de ECV en pacientes con el DB y otras enfermedades mentales graves (EMG) a menudo no se detectan correctamente. Los proveedores de atención primaria de la salud deben identificar estos factores de riesgo en el tratamiento de estos pacientes para determinar y recomendar estrategias adecuadas.

Reasons for Nonadherence to Psychiatric Medication and Cardiovascular Risk Factors Treatment Among Latino Bipolar Disorder Patients Living in Puerto Rico: A Qualitative Study.

Latinos with bipolar disorder (BD) have a high rate of nonadherence to psychiatric medication and treatment for other medical conditions such as cardiovascular disease (CVD) risk factors than non-Latinos with BD. The aim of this study is to identify patients' perspectives on the reasons for nonadherence to psychiatric medication and for CVD risk factors conditions in outpatients with BD. Three focus group sessions were held for a total of 22 adults ranging from 23 to 60 years old. Participants had BD, Type I/II and CVD risk factors. Audio-recordings of focus groups were transcribed and a content analysis was performed. Reasons identified as barriers to adherence were somewhat different for BD medications in comparison to CVD risk factors suggesting the need for integrated interventions targeting these barriers to adherence for both BD and CVD risk factors.