Executive Function Performance in High and Low Medication Adherent Patients with Euthymic Bipolar I Disorder: a Comparative Study

Overview

Journal BMC Psychiatry

Publisher Biomed Central

Specialty Psychiatry

Date 2025 Mar 14

PMID 40082820

Authors

Mona Rahimi Chahooei

Komeil Zahedi Tajrishi

Ghazaleh Zargarinejad

Amir Shabani

Affiliations

Soon will be listed here.

Abstract

Introduction: Medication nonadherence is a prevalent issue among patients with bipolar disorder, leading to substantial negative consequences. Despite documented cognitive deficits in this population, the relationship between executive dysfunction and medication nonadherence remains unclear. This study aims to investigate the association between executive functions and medication adherence in euthymic patients with bipolar I disorder.

Method: In this cross-sectional, comparative study, we recruited 200 euthymic bipolar I disorder patients aged 18 to 55 years from the outpatient clinic of Iran Psychiatric Hospital in Tehran in 2024, using a convenience sampling method. The euthymic phase was confirmed using the Persian versions of the Young Mania Rating Scale and the Hamilton Rating Scale for Depression. Patients completed the Medication Adherence Rating Scale, along with a series of executive function tests including Go/No-Go, Wisconsin Card Sorting Test, and Iowa Gambling Task. Multivariate analysis of covariance was employed to analyze the results, controlling for demographic and clinical variables as covariates.

Results: Of the participants, 54.5% had low medication adherence. Low adherent patients exhibited significantly poorer performance in Go/No-Go as indicated by higher commission errors (F [1] = 7.63, p = 0.006) as well as the Wisconsin Card Sorting Test, evidenced by a higher number of perseveration errors (F [1] = 8.61, p = 0.004) and fewer completed categories (F [1] = 6.67, p = 0.011), compared to high adherent patients. Notably, although differences in decision-making were observed between the two groups, these did not reach statistical significance (p = 0.139).

Conclusions: This study establishes a correlation between low medication adherence and deficits in executive functions-specifically response inhibition and cognitive flexibility-in patients with bipolar I disorder. Furthermore, even after controlling for covariates, the differences in executive functions between medication adherence groups remained significant.

References

Merikangas K, Jin R, He J, Kessler R, Lee S, Sampson N . Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry. 2011; 68(3):241-51. PMC: 3486639. DOI: 10.1001/archgenpsychiatry.2011.12. View

de Dios C, Ezquiaga E, Agud J, Vieta E, Soler B, Garcia-Lopez A . Subthreshold symptoms and time to relapse/recurrence in a community cohort of bipolar disorder outpatients. J Affect Disord. 2012; 143(1-3):160-5. DOI: 10.1016/j.jad.2012.05.047. View

Etain B, Bellivier F, Olie E, Aouizerate B, Aubin V, Belzeaux R . Clinical predictors of recurrences in bipolar disorders type 1 and 2: A FACE-BD longitudinal study. J Psychiatr Res. 2021; 134:129-137. DOI: 10.1016/j.jpsychires.2020.12.041. View

Levin J, Krivenko A, Howland M, Schlachet R, Sajatovic M . Medication Adherence in Patients with Bipolar Disorder: A Comprehensive Review. CNS Drugs. 2016; 30(9):819-35. DOI: 10.1007/s40263-016-0368-x. View

Leclerc E, Mansur R, Brietzke E . Determinants of adherence to treatment in bipolar disorder: a comprehensive review. J Affect Disord. 2013; 149(1-3):247-52. DOI: 10.1016/j.jad.2013.01.036. View

Wroe A . Intentional and unintentional nonadherence: a study of decision making. J Behav Med. 2002; 25(4):355-72. DOI: 10.1023/a:1015866415552. View

Hong J, Reed C, Novick D, Haro J, Aguado J . Clinical and economic consequences of medication non-adherence in the treatment of patients with a manic/mixed episode of bipolar disorder: results from the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) study. Psychiatry Res. 2011; 190(1):110-4. DOI: 10.1016/j.psychres.2011.04.016. View

Belzeaux R, Correard N, Boyer L, Etain B, Loftus J, Bellivier F . Depressive residual symptoms are associated with lower adherence to medication in bipolar patients without substance use disorder: results from the FACE-BD cohort. J Affect Disord. 2013; 151(3):1009-15. DOI: 10.1016/j.jad.2013.08.028. View

Lingam R, Scott J . Treatment non-adherence in affective disorders. Acta Psychiatr Scand. 2002; 105(3):164-72. DOI: 10.1034/j.1600-0447.2002.1r084.x. View

10.

Gutierrez-Rojas L, Jurado D, Martinez-Ortega J, Gurpegui M . Poor adherence to treatment associated with a high recurrence in a bipolar disorder outpatient sample. J Affect Disord. 2010; 127(1-3):77-83. DOI: 10.1016/j.jad.2010.05.021. View

11.

Levy B, Medina A, Manove E, Weiss R . The characteristics of a discrete mood episode, neuro-cognitive impairment and re-hospitalization in bipolar disorder. J Psychiatr Res. 2011; 45(8):1048-54. PMC: 3194763. DOI: 10.1016/j.jpsychires.2011.01.005. View

12.

Chakrabarty T, Kozicky J, Torres I, Lam R, Yatham L . Verbal memory impairment in new onset bipolar disorder: Relationship with frontal and medial temporal morphology. World J Biol Psychiatry. 2015; 16(4):249-60. DOI: 10.3109/15622975.2014.1000373. View

13.

Pagliaccio D, Wiggins J, Adleman N, Harkins E, Curhan A, Towbin K . Behavioral and Neural Sustained Attention Deficits in Bipolar Disorder and Familial Risk of Bipolar Disorder. Biol Psychiatry. 2016; 82(9):669-678. PMC: 5354995. DOI: 10.1016/j.biopsych.2016.09.006. View

14.

Mason L, Eldar E, Rutledge R . Mood Instability and Reward Dysregulation-A Neurocomputational Model of Bipolar Disorder. JAMA Psychiatry. 2017; 74(12):1275-1276. DOI: 10.1001/jamapsychiatry.2017.3163. View

15.

Kravariti E, Dixon T, Frith C, Murray R, McGuire P . Association of symptoms and executive function in schizophrenia and bipolar disorder. Schizophr Res. 2005; 74(2-3):221-31. DOI: 10.1016/j.schres.2004.06.008. View

16.

Bourne C, Aydemir O, Balanza-Martinez V, Bora E, Brissos S, Cavanagh J . Neuropsychological testing of cognitive impairment in euthymic bipolar disorder: an individual patient data meta-analysis. Acta Psychiatr Scand. 2013; 128(3):149-62. DOI: 10.1111/acps.12133. View

17.

Martinez-Aran A, Scott J, Colom F, Torrent C, Tabares-Seisdedos R, Daban C . Treatment nonadherence and neurocognitive impairment in bipolar disorder. J Clin Psychiatry. 2009; 70(7):1017-23. DOI: 10.4088/JCP.08m04408. View

18.

Correard N, Consoloni J, Raust A, Etain B, Guillot R, Job S . Neuropsychological functioning, age, and medication adherence in bipolar disorder. PLoS One. 2017; 12(9):e0184313. PMC: 5584797. DOI: 10.1371/journal.pone.0184313. View

19.

Fuentes I, Rizo-Mendez A, Jarne-Esparcia A . Low compliance to pharmacological treatment is linked to cognitive impairment in euthymic phase of bipolar disorder. J Affect Disord. 2016; 195:215-20. DOI: 10.1016/j.jad.2016.02.005. View

20.

El-Missiry A, Elbatrawy A, Missiry M, Moneim D, Ali R, Essawy H . Comparing cognitive functions in medication adherent and non-adherent patients with schizophrenia. J Psychiatr Res. 2015; 70:106-12. DOI: 10.1016/j.jpsychires.2015.09.006. View