Predictors and Patterns of Adherence to Mood Stabilizers in Patients with Bipolar Affective Disorder in a Tertiary Care Hospital in South India – A Retrospective Study

Background: Bipolar affective disorder (BPAD) is known to be a chronic, episodic illness in psychiatry. Most patients with BPAD are prescribed mood stabilizers which need to be taken on a long-term basis for years together. Side effects of these drugs make compliance difficult. Objective: The present study intended to investigate the predictors of relapse in BPAD patients due to non-adherence and the factors responsible for the same. Methodology: The study was conducted in the Department of Psychiatry and Medical Records Department of Father Muller Medical College Hospital. Treatment charts and case history files from the years 2011 to 2021 of patients with BPAD on treatment with either lithium, valproate, or both were reviewed retrospectively. A total of 256 patients diagnosed with BPAD were assessed and relapses for both lithium and valproate or their combination were noted separately and analyzed. Results: Of the 256 patients included in the study, adherence rates among those on lithium (68.96%) were significantly higher than those on valproate monotherapy (35.42%) or a combination of both medications (44.23%), with P = 0.011. Among the factors influencing non-compliance, both valproate (40.26%) and lithium (40.0%) had documented side effects, however, none were found to be statistically significant. Conclusion: The study helps us to identify the common reasons for non-adherence and also the rates of non-adherence with the individual drugs. This information helps us in choosing a better drug to reduce the chances of non-adherence and thus prevent relapses.