Abstract：
Objective: Youth with bipolar spectrum disorders (BSD) are frequently prescribed second-generation antipsychotics (SGAs). Nonadherence to treatment often results in increased mood symptoms and diminished quality of life. We examined SGA adherence rates and adherence barriers among youth who have overweight/obesity and are diagnosed with BSD enrolled in a multisite pragmatic clinical trial. Methods: SGA adherence and adherence barriers at baseline via patient- and caregiver report was assessed. Adherence was defined as taking ≥70% of prescribed SGA doses in the past week. The weighted Kappa statistic was used to measure child-caregiver agreement about adherence rates, barriers, and caregiver assistance. Regression analyses were used to examine associations of caregiver assistance, age, sex, race, insurance status, dosing frequency, and number of concomitant medications with adherence. Barriers to adherence were analyzed separately for youth and their caregivers, using logistic regression to assess associations between informant-reported barriers and informant-reported adherence. Results: Participants included 1485 patients and/or caregivers. At baseline, 88.6% of patients self-reported as adherent; 92.0% of caregivers reported their child was adherent. Concordance between patients and caregivers was moderate (k = 0.42). Approximately, 50% of the sample reported no adherence barriers. Frequently endorsed barriers included forgetting, side effects, being embarrassed to take medications, and preferring to do something else. Concordance between informants regarding adherence barriers was weak (k = 0.05-0.36). Patients and caregivers who did not endorse adherence barriers reported higher adherence than those who endorsed barriers. Male sex and having once daily dosing of medications were associated with lower adherence. Discussion: One-week patient- and caregiver-reported adherence was high in this sample. Half of the sample reported adherence barriers. Most commonly endorsed barriers were forgetting, side effects, being embarrassed, and preferring to do something else. Caregivers and patients have unique perspectives regarding adherence barriers. Understanding and addressing treatment barriers in clinical practice may facilitate adherence.
摘要：
目的：患有双相谱系障碍（BSD）的年轻人经常被处方为第二代抗精神病药（SGAs）。不坚持治疗通常会导致情绪症状增加和生活质量下降。我们检查了超重/肥胖并被诊断为BSD的年轻人参加多中心务实临床试验的SGA依从性和依从性障碍。方法：通过患者和照顾者报告评估基线时的SGA依从性和依从性障碍。坚持被定义为在过去一周内服用≥70%的处方SGA剂量。加权Kappa统计量用于衡量儿童照顾者对依从率的共识，障碍,和照顾者援助。回归分析用于检查护理人员援助的关联，年龄,性别,种族,保险状况,给药频率,以及合并用药与依从性的数量。分别分析了青年及其照顾者的依从性障碍，使用logistic回归评估被调查者报告的障碍和被调查者报告的依从性之间的关联.结果：参与者包括1485名患者和/或护理人员。在基线,88.6%的患者自我报告为坚持；92.0%的看护人报告他们的孩子是坚持的。患者和护理人员之间的一致性是中等的（k=0.42）。大约,50%的样品报告没有粘附性屏障。经常认可的障碍包括遗忘，副作用,为服用药物感到尴尬，更喜欢做别的事情。线人之间关于粘附障碍的一致性很弱（k=0.05-0.36）。不认可依从性障碍的患者和护理人员报告的依从性高于认可障碍的患者和护理人员。男性和每天服用一次药物与较低的依从性相关。讨论:在该样本中,患者和护理人员报告的一周依从性较高。一半的样品报告了粘附性障碍。最常见的障碍是遗忘，副作用,尴尬，更喜欢做别的事情。护理人员和患者对依从性障碍有独特的观点。了解和解决临床实践中的治疗障碍可能会促进依从性。
