ArticleJournal of affective disorders2019
Complex polypharmacy in bipolar disorder: Side effect burden, adherence, and response predictors.
Article in Journal of affective disorders, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
What it found
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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.
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.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- Practice Guidelines for Bipolar Disorder by the JSMD (Japanese Society of Mood Disorders).Psychiatry and clinical neurosciences · 2024Guideline
- Pooled it
- Distinct Patterns of Intentional and Unintentional Overdose Among Psychiatric Patients With Bipolar and Substance Use Disorders.Rhode Island medical journal (2013) · 2026Article
- Trajectories of psychotropic drug use patterns in psychiatric inpatients with acute depressive episodes of bipolar disorder: results from a pharmacovigilance program in German-speaking countries from 2007 to 2024.International journal of bipolar disorders · 2026Article
- Understanding Antipsychotic Polypharmacy in Bipolar Disorder: The Role of Long-Acting Injectable Antipsychotics in a Naturalistic Inpatient Setting.The Psychiatric quarterly · 2026Article
- Assessing treatment adherence in psychiatry: a comparison of clinical judgment and therapeutic drug monitoring in acute care.International clinical psychopharmacology · 2026Article
- Clinical practice guidelines for the management of bipolar disorder: 2025 update.Indian journal of psychiatry · 2026Article
- Medication adherence and its clinical and psychosocial correlates in inpatients with bipolar disorder in Vietnam: a cross-sectional study.Frontiers in psychiatry · 2026Article
- Outpatient Management of Bipolar Disorder in Older Adults.Current psychiatry reports · 2025Review
- Means to an end: Characteristics and follow-up of emergency department patients with a history of suicide attempt via medication overdose.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2025Article
- Complex Psychotropic Polypharmacy in Soweto-based community psychiatry clinics.The South African journal of psychiatry : SAJP : the journal of the Society of Psychiatrists of South Africa · 2025Article
- Psychotropic medications adherence status and its determinants among older adults with severe affective and psychotic disorders: a multicenter cross-sectional study.Therapeutic advances in psychopharmacology · 2025Article
- Treatment of bipolar depression: clinical practice vs. adherence to guidelines-data from a Bavarian drug surveillance project.Frontiers in psychiatry · 2024Article
- CaMKK2 as an emerging treatment target for bipolar disorder.Molecular psychiatry · 2023Review
- Factors associated with hospitalization times and length of stay in patients with bipolar disorder.Frontiers in psychiatry · 2023Article
- Prescription Patterns for Bipolar Disorder in Asian Countries: Findings from Research on Asian Prescription Pattern-Bipolar Disorder.Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology · 2022Article
- Estimated glomerular filtration rate in Korean patients exposed to long-term lithium maintenance therapy.International journal of bipolar disorders · 2022Article
- Acceptance, coping strategies and health behaviors in bipolar disorder patients taking and not taking lithium carbonate.Health psychology report · 2022Article
- Real-World Patterns of Utilization and Costs Associated with Second-Generation Oral Antipsychotic Medication for the Treatment of Bipolar Disorder: A Literature Review.Neuropsychiatric disease and treatment · 2021Review
- The Genetics of Response to and Side Effects of Lithium Treatment in Bipolar Disorder: Future Research Perspectives.Frontiers in pharmacology · 2021Review
Corrections and comments
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Authors and funding
14 authors at 6 institutions in 1 country.
Funding
Abstract
backgroundComplex polypharmacy (CP) is common in bipolar disorder (BD). We assessed the associations between CP, adherence, and side effect burden, and patient traits associated with clinical improvement in relationship to CP.
methodsWe conducted a secondary analysis of 482 adult BD participants in the Bipolar CHOICE trial. We examined the associations between CP (use of ≥3 BD medications) and non-adherence (missing >30% of BD medication doses in the last 30 days) and side effect burden (Frequency, Intensity and Burden of Side Effects Rating scale) using multivariate models with patient random effects. We used logistic regression to assess the patient traits associated with remission among those with majority CP use (Clinical Global Impression-Severity for BD score ≤2 for 8+ weeks).
results43% of patients had any CP and 25% had CP for the majority of the study. CP was associated with non-adherence (OR = 2.51, 95% CI [1.81, 3.50]), but not worse side effect burden. Among those with CP, 16% achieved remission; those with non-adherence, comorbid social or generalized anxiety disorder, or BD I vs. II were less likely to achieve remission among those with CP. LIMITATIONS: There could be unmeasured confounding between use of CP and side effect burden or adherence. Adherence was measured by self-report, which could be subject to reporting error.
conclusionsBD patients with CP were less likely to adhere to therapy, and those with worse adherence to CP were less likely to clinically respond. Clinicians should assess medication adherence prior to adding another agent to medication regimens.
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Registered trials
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.