Patient Preference and Adherence (Jul 2018)
Bipolar disorder and adherence: implications of manic subjective experience on treatment disruption
Abstract
Samuel Bulteau,1,2 Marie Grall-Bronnec,1,2 Pierre-Yves Bars,3 Edouard-Jules Laforgue,1 François Etcheverrigaray,4 Jean-Christophe Loirat,3 Caroline Victorri-Vigneau,2,4 Jean-Marie Vanelle,1 Anne Sauvaget1 1CHU de Nantes, Addictology and Liaison Psychiatry Department, Nantes, France; 2University of Nantes-University of Tours, INSERM, SPHERE U1246 – “methodS for Patients-centered outcomes & HEalth REsearch”, l’Institut de recherche en Santé 2, Nantes, France; 3Clinique du Parc, Nantes, France; 4CHU de Nantes, Department of Clinical Pharmacology, Nantes, France Objective: Therapeutic observance is one of the cornerstones of bipolar disease prognosis. Nostalgia of previous manic phase has been described as a cause of treatment retrieval in bipolar disorder. But to date no systematic study has examined manic episode remembering stories. Our aim was to describe manic experience from the patient’s point of view and its consequences on subjective relation to care and treatment adherence. Patients and methods: Twelve euthymic patients with bipolar I disorder were interviewed about their former manic episodes and data was analyzed, thanks to a grounded theory method. Results: Nostalgia was an anecdotal reason for treatment retrieval in bipolar I disease. Although the manic experience was described as pleasant in a certain way, its consequences hugely tarnish the memory of it afterward. Treatment interruption appears to be mostly involuntary and state-dependent, when a euphoric subject loses insight and does not see any more benefit in having treatment. Conclusion: Consciousness destructuring associated with mood elation should explain treatment disruption in bipolar I patients more than nostalgia. Taking a manic episode story into account may help patients, family, and practitioners to achieve better compliance by improving their comprehension and integration of this unusual experience. Keywords: nostalgia, mania, compliance, insight, psychoeducation
