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Bipolar DisorderNCT00763919

Customized Medication Adherence Enhancement for Treating Adults With Bipolar Disorder

A study testing Psychoeducation module, Substance abuse module and Improved communication/rapport with provider module in people with Bipolar Disorder, run by Case Western Reserve University at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

In this study, patients with bipolar disorder who do not take their medications as prescribed will receive specialized education and therapy treatment to determine whether the specialized treatment is effective in helping patients to take their medications consistently. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Bipolar Disorder
What is being tested?
Psychoeducation module, Substance abuse module and Improved communication/rapport with provider module
Could I receive a placebo?
No, everyone receives an active treatment
How many people
43 participants
Where
1 siteUnited States
Study dates
Jul 2008to Oct 2010
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Clinical diagnosis of bipolar disorder (BPD) Type I or Type II, as determined by a standardized diagnostic interview, the Mini-International Neuropsychiatric Interview (MINI)
  • Demonstrated history of poor medication adherence, as determined by self-report or clinician report. In this study, self-reported treatment nonadherence will be identified with the Tablet Routines Questionnaire (TRQ). Poorly adherent individuals will be defined as those who miss 30% or more of medication within either the past week or past month (those missing 30% or more within past week will be considered to be nonadherent over the past month). Clinician-assessed nonadherence will be identified via a clinician version of the TRQ to identify nonadherence of 30% or more over the past 30 days.
  • BPD of at least 2 years' duration
  • Treatment with medication to stabilize mood for at least 6 months

Who cannot join

  • Unable/unwilling to participate in psychiatric interviews, as based on the clinical opinion of the investigator or the treating clinician
  • High risk of suicide, as seen in factors such as active suicidal ideation, recent suicide attempt, or current intent or plan
  • Inability to speak English
  • Individuals who have participated in Project 1, Personal Adherence Evaluation of Individuals Receiving Treatment for Bipolar Disorder (PAE in BD)

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Connections

    Cleveland, Ohio, 44122

Other trials in United States

About this study

Official title: Customized Adherence Enhancement in Bipolar Disorder (CAE in BD)

In this study, patients with bipolar disorder who do not take their medications as prescribed will receive specialized education and therapy treatment to determine whether the specialized treatment is effective in helping patients to take their medications consistently.

Read the detailed description

Bipolar disorder (BPD) is a chronic disorder characterized by manic and depressive episodes that disrupt healthy, functional lives. Despite recent advances in medication treatments, many BPD patients do not take their medications. Medication nonadherence is associated with multiple risks, such as relapse, rehospitalization, lengthier hospital stays, and, in some cases, increased risk of suicide. Some studies have shown that treatment adherence in BPD can be improved, particularly through psychological education, development of self-management strategies or behaviors, and ongoing relapse prevention.

This study will examine the effectiveness of medication adherence treatment modules specialized to deal with specific reasons for nonadherence. Participants, all of whom have a history of medication nonadherence, will undergo structured interviews and complete self-report questionnaires to determine individual reasons for nonadherence. Based on their individual profiles, participants will be assigned to one or more of the following intervention modules:

  1. Psychoeducation: This module uses education about BPD and related treatment to address patient issues such as opposition to preventive efforts, denial of the need for or effectiveness of medication, negative attitudes toward drugs in general, lack of information about mood stabilizers, and stigma or embarrassment related to BPD treatment.
  2. Substance abuse: This module targets substance abuse problems that interfere with medication adherence.
  3. Communication with providers: This module addresses fear of medication side effects by improving communication with health care providers.
  4. Medication routines management: This module addresses difficulties establishing a medication routine and outside opposition to medications by developing strategies for consistent medication adherence routines.

Each module will involve four 60-minute sessions conducted in a 4- to 6-week period. The study therapist will conduct each of these sessions individually with the participant, combining or coadministering modules in a single session if participants are assigned to more than one module. Depending on which module or modules participants are assigned to, they may also be contacted by phone one to three times by the therapist to complete all module materials.

This study will be conducted in two phases. In the first, an initial group of participants will undergo the module treatments and then participants and therapists will be interviewed about the effectiveness and feasibility of the interventions. This feedback will be used to refine the modules. In the second phase, a second group of participants will undergo treatment in the refined modules and provide more feedback. All participants will continue with their regular treatment while undergoing module treatments.

Participation in this study will last 4 to 6 weeks, with follow-up interviews and assessments ending 6 months after completion of the intervention. In all, there will be five assessments, completed at an initial screening visit, just before treatment, just after treatment, and 3 and 6 months after the completion of treatment. The initial assessments will last 60 to 90 minutes and involve questionnaires and a structured interview. The other four assessments will last 45 to 60 minutes. Treatment adherence, attitudes toward medications, BPD symptoms, and overall functioning will be measured at each assessment. The number of pills used in each participant's prescription bottles will also be counted as a measure of medication adherence.

Being tested
Psychoeducation module, Substance abuse module, Improved communication/rapport with provider module, Medication routines management module
Keywords
Patient Non-Adherence, Patient Non-Compliance, Patient Nonadherence, Patient Noncompliance, Patient Refusal of Treatment, Refusal of Treatment, Treatment Refusal
Medical subject headings
Bipolar Disorder, Patient Compliance, Treatment Refusal

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Psychoeducation moduleBehavioural

    The psychoeducation module will use psychological and medication education to address opposition to prophylaxis, denial of illness severity or therapeutic effectiveness, negative attitudes toward drugs in general, lack of information about mood stabilizers, and stigma or embarrassment over medications or in relation to the use of complementary or alternative treatments.

  • Substance abuse moduleBehavioural

    The substance abuse module will address problematic substance abuse, particularly as it relates to medication adherence.

  • Improved communication/rapport with provider moduleBehavioural

    The provider communication and rapport module will improve health care provider communication to address fear of side effects, concern regarding change in appearance, or side effect-related distress.

  • Medication routines management moduleBehavioural

    The medication routines management module will develop strategies and behaviors that help create medication adherence routines for those who have difficulties with medication routines or experience outside opposition to medications.

Study groups in NCT00763919
Study groupRoleWhat they receive
Customized Adherence Enhancement (CAE)ExperimentalParticipants, all of whom have a history of medication nonadherence, will be assigned to one or more treatment modules based on their individual profiles. Treatment Modules: Psychoeducation module Substance abuse module Improved communication/rapport with provider module Medication routines management module
Receives: Behavioral: Psychoeducation module; Behavioral: Substance abuse module; Behavioral: Improved communication/rapport with provider module; Behavioral: Medication routines management module

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Treatment Adherence Within the Past Month as Measured by the Tablet Routines Questionnaire

    The minimum score is 0 and the maximum score is 100. A higher score implies poorer treatment adherence.

    Measured: baseline and 6 months

  2. Change in Treatment Adherence Within the Past Week as Measured by the Tablet Routines Questionnaire

    The minimum score is 0 and the maximum score is 100. A higher score implies poorer treatment adherence.

    Measured: baseline and 6 months

  3. Change in Treatment Adherence as Measured by the Morisky Scale

    The minimum score is 0 and the maximum score is 4. A higher score implies poorer treatment adherence.

    Measured: baseline and 6 months

  4. Change in Treatment Adherence Within the Past Month as Measured by the Tablet Routines Questionnaire

    The minimum score is 0 and the maximum score is 100. A higher score implies poorer treatment adherence.

    Measured: baseline and 3 months

  5. Change in Treatment Adherence Within the Past Week as Measured by the Tablet Routines Questionnaire

    The minimum score is 0 and the maximum score is 100. A higher score implies poorer treatment adherence.

    Measured: baseline and 3 months

Secondary outcomes (18)
  1. Change in Attitude as Measured by the Attitude Toward Mood Stabilizers Questionnaire (AMSQ)

    The AMSQ is a modification of the Lithium Attitudes Questionnaire. The minimum score is 0 and the maximum score is 19. A higher score implies a poorer attitude.

    Measured: baseline and 6 months

  2. Change in Attitude as Measured by the Rating of Medication Influences (ROMI)

    The minimum score is 0 and the maximum score is 10. A higher score implies a poorer attitude.

    Measured: baseline and 6 months

  3. Change in Depression as Measured by the Hamilton Rating Scale for Depression (HAM-D)

    The minimum score is 0 and the maximum score is 52. A higher score implies a worse condition.

    Measured: baseline and 6 months

  4. Change in Symptoms of Bipolar Disorder as Measured by the Young Mania Rating Scale (YMRS)

    The minimum score is 0 and the maximum score is 60. A higher score implies a worse condition.

    Measured: baseline and 6 months

  5. Change in Symptoms of Bipolar Disorder as Measured by the Brief Psychiatric Rating Scale (BPRS)

    The minimum score is 18 and the maximum score is 126. A higher score implies a worse condition.

    Measured: baseline and 6 months

  6. Change in Global Psychopathology as Measured by the Clinical Global Impression for Bipolar Disorder (CGI-BP)

    The minimum score is 1 and the maximum score is 7. A higher score implies a worse condition.

    Measured: baseline and 6 months

  7. Change in Functional Status as Measured by the Global Assessment of Functioning (GAF) Scale

    The minimum score is 1 and the maximum score is 100. A higher score implies higher functioning.

    Measured: baseline and 6 months

  8. Change in Perception of Physical Health as Measured by the 12-item Short Form Health Survey (SF-12)

    The minimum score is 1 and the maximum score is 99. A higher score implies higher perceived physical health.

    Measured: baseline and 6 months

  9. Change in Perception of Mental Health as Measured by the 12-item Short Form Health Survey (SF-12)

    The minimum score is 1 and the maximum score is 99. A higher score implies higher perceived mental health.

    Measured: baseline and 6 months

  10. Change in Depression as Measured by the Hamilton Rating Scale for Depression (HAM-D)

    The minimum score is 0 and the maximum score is 52. A higher score implies a worse condition.

    Measured: baseline and 3 months

  11. Change in Symptoms of Bipolar Disorder as Measured by the Young Mania Rating Scale (YMRS)

    The minimum score is 0 and the maximum score is 60. A higher score implies a worse condition.

    Measured: baseline and 3 months

  12. Change in Symptoms of Bipolar Disorder as Measured by the Brief Psychiatric Rating Scale (BPRS)

    The minimum score is 18 and the maximum score is 126. A higher score implies a worse condition.

    Measured: baseline and 3 months

  13. Change in Global Psychopathology as Measured by the Clinical Global Impression for Bipolar Disorder (CGI-BP)

    The minimum score is 1 and the maximum score is 7. A higher score implies a worse condition.

    Measured: baseline and 3 months

  14. Change in Functional Status as Measured by the Global Assessment of Functioning (GAF) Scale

    The minimum score is 1 and the maximum score is 100. A higher score implies higher functioning.

    Measured: baseline and 3 months

  15. Change in Attitude as Measured by the Attitude Toward Mood Stabilizers Questionnaire (AMSQ)

    The AMSQ is a modification of the Lithium Attitudes Questionnaire. The minimum score is 0 and the maximum score is 19. A higher score implies a poorer attitude.

    Measured: baseline and 3 months

  16. Change in Attitude as Measured by the Rating of Medication Influences (ROMI)

    The minimum score is 0 and the maximum score is 10. A higher score implies a poorer attitude.

    Measured: baseline and 3 months

  17. Change in Perception of Physical Health as Measured by the 12-item Short Form Health Survey (SF-12)

    The minimum score is 1 and the maximum score is 99. A higher score implies higher perceived physical health.

    Measured: baseline and 3 months

  18. Change in Perception of Mental Health as Measured by the 12-item Short Form Health Survey (SF-12)

    The minimum score is 1 and the maximum score is 99. A higher score implies higher perceived physical health.

    Measured: baseline and 3 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Oct 2008 (estimated)
  2. Study startJul 2008
  3. Primary completionOct 2010
  4. Study completionOct 2010

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
43 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00763919
Sponsor's protocol ID
R34MH078967-02
Other IDs
R34MH078967
Status last verified
Oct 2014
First submitted
29 Sep 2008
Last updated
20 Oct 2014
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A study testing Psychoeducation module, Substance abuse module and Improved communication/rapport with provider module in people with Bipolar Disorder, run by Case Western Reserve University at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 20 Oct 2014. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 21 Dec 2011). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Treatment Adherence Within the Past Month as Measured by the Tablet Routines Questionnaire (time frame: baseline and 6 months). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Oct 2014.

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