Brief Motivational Intervention to Improve Medication Adherence for Adolescents With Bipolar Disorder
Condition: Bipolar Disorder; Medication Adherence
MeSH terms: Bipolar Disorder
Study type: Interventional

Summary: 
      Adolescence is the peak onset period for serious and persistent psychiatric disorders.
      Treatment guidelines for management of major psychiatric disorders in youth include
      pharmacotherapy. There has been substantial progress in recent years in identifying effective
      medications for youth with psychiatric disorders. However, adherence to prescribed
      medications among psychiatric populations is notoriously low, and adolescents rank among the
      least adherent of all patient populations. Given that the consequences of poor medication
      adherence among youth with chronic mental illness are far-reaching, including
      hospitalization, poor functioning, and suicide, there is a desperate need for interventions
      targeting medication adherence in this population.
    

Detailed description: 
      Adolescence is the peak period of onset for serious and persistent psychiatric disorders.
      Treatment guidelines for the management of major psychiatric disorders in adolescence
      indicate pharmacotherapy is a critical element of effective treatment. Unfortunately,
      adolescence is a particularly vulnerable window for poor medication adherence, and little is
      known about the timecourse and specific factors associated with poor medication adherence in
      this population. Given that the consequences of poor medication adherence among youth with
      chronic mental illness are far-reaching, and include hospitalization, profound functional
      impairment and even suicide, there is a desperate need for interventions targeting medication
      adherence in this population. Motivational Interviewing (MI) is an evidence-based approach
      focused on enhancing motivation for change. This model holds great promise for improving
      medication adherence in adolescents with psychiatric disorders because it is developmentally
      sensitive, acceptable to patients and providers, and readily disseminable across clinical
      settings. Research demonstrates that brief motivational interventions (BMIs) utilizing a MI
      approach result in improved treatment adherence among youth with a variety of chronic medical
      conditions. Although widely applied for adolescent substance use behaviors, BMIs have yet to
      be examined for improving medication adherence in youth with severe psychiatric disorders.
      Adolescents with bipolar disorder (BP) are an ideal population with whom to develop a BMI for
      medication adherence because adolescents with BP are among the least adherent of any
      psychiatric population. Experience developing a BMI for this challenging population will
      directly inform intervention for youth with a range of chronic psychiatric disorders. The
      purpose of the proposed study is to conduct a small randomized trial comparing CABS Standard
      Care (SC) augmented with the BMI versus SC alone. Outcomes will be assessed monthly over 6
      months. Participants will include 40 adolescents with BP. This approach is in direct accord
      with the National Institute of Mental Health (NIMH) Strategic Plan in which the development
      and testing of innovative interventions to reduce risk and positively alter trajectories of
      mental illness are informed by research findings regarding robust and malleable risk factors.
      Research in this area is of great public health importance, as it has the potential to lessen
      costs, disrupt the cycle of poor outcomes, and minimize the long-term debilitating effects of
      these serious disorders.
    

Intervention name(s): Brief Motivational Intervention
Intervention type(s): Behavioral
Intervention description(s): A brief motivational intervention centered around Motivational Interviewing (MI) techniques. Sessions are adjunct to standard clinical care, and focus on psychoeducation regarding treatment for bipolar disorder, and resolving ambivalence regarding taking medications for mood disorder.
Other intervention name(s): BMI
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized trial comparing Brief Motivational Intervention + Standard Care versus Standard Care Alone
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: adherence; adolescent; Motivational Intervention