Brief Motivational Intervention to Improve Medication Adherence for Adolescents With Bipolar Disorder

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.

Inclusion Criteria:

1. age 12 years, 0 months to 22 years, 11 months;

2. a diagnosis of BP spectrum disorder via semi-structured interview;

3. willing to engage in treatment at the BP specialty clinic;

4. English fluency and understanding, as the study consists of interviews and surveys
that necessitate English fluency and understanding;

5. able and willing to give informed consent/assent to participate.

Exclusion Criteria:

1. evidence of mental retardation, pervasive developmental disorder, or organic central
nervous system disorder by semi-structured interview, parent report, medical history,
or school records;

2. a life-threatening medical condition requiring immediate treatment;

3. current victim of sexual or physical abuse.