Evidence map›Paper›PMID 30524703›Full record

ReviewTherapeutic advances in psychopharmacology2018

Medication nonadherence in bipolar disorder: a narrative review.

Ibrahim Jawad, Stuart Watson, Peter M Haddad, Peter S Talbot, R Hamish McAllister-Williams

Open access · bronzeAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Therapeutic advances in psychopharmacology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 68 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
68citing papers in PubMed, 3 pooled it
8.3field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

68 citing papers in PubMed, 3 syntheses or guidelines pooled it, 156 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Trial
  5. Trial
  6. Trial
  7. Trial
  8. Trial
  9. Trial
  10. Trial
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Addressing the unmet needs of bipolar disorder in Australia and beyond.The Australian and New Zealand journal of psychiatry · 2025
    Article
  20. Article

8 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 4 institutions in 1 country.

Ibrahim JawadTees, Esk and Wear Valleys NHS Foundation Trust, Middlesbrough, UK.
Stuart WatsonNorthern Centre for Mood Disorders and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.
Peter M HaddadNeuroscience and Psychiatry Unit, University of Manchester, Manchester, UK Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
Peter S TalbotGreater Manchester Mental Health NHS Foundation Trust, Manchester, UK Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic, Health Science Centre, Manchester, UK.ORCID https://orcid.org/0000-0003-3492-0801
R Hamish McAllister-WilliamsAcademic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Northern Centre for Mood Disorders and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.
Greater Manchester Mental Health NHS Foundation Trust · GBCumbria Northumberland Tyne and Wear NHS Foundation Trust · GBNewcastle University · GBTees, Esk and Wear Valleys NHS Foundation Trust · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

A number of effective maintenance medication options exist for bipolar disorder (BD) and these are regarded as the foundation of long-term treatment in BD. However, nonadherence to medication is common in BD. For example, a large data base study in the United States of America (USA) showed that approximately half of patients with BD were nonadherent with lithium and maintenance medications over a 12 month period. Such nonadherence carries a high risk of relapse due to the recurrent nature of the illness and the fact that abrupt cessation of treatment, particularly lithium, may cause rebound depression and mania. Indeed, medication nonadherence in BD is associated with significantly increased risks of relapse, recurrence, hospitalization and suicide attempts and a decreased likelihood of achieving remission and recovery, as well as with higher overall treatment costs. Factors associated with nonadherence include adverse effects of medication, complex medication regimens, negative patient attitudes to medication, poor insight, rapid-cycling BD, comorbid substance misuse and a poor therapeutic alliance. Clinicians should routinely enquire about nonadherence in a nonjudgmental fashion. Potential steps to improve adherence include simple pragmatic strategies related to prescribing including shared decision-making, psychoeducation with a clear focus on adherence, reminders (traditional and digital), potentially using a depot rather than an oral antipsychotic, managing comorbid substance misuse and improving therapeutic alliance. Financial incentives have been shown to improve adherence to depot antipsychotics, but this approach raises ethical issues and its long-term effectiveness is unknown. Often a combination of approaches will be required. The strategies that are adopted need to be patient specific, reflecting that nonadherence has no single cause, and chosen by the patient and clinician working together.

Indexed as

adherenceAntipsychoticsBipolar DisorderLong acting injectable

Identifiers

PMID30524703
PMCPMC6278745
OpenAlexW2896063467

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.