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Ther Adv Psychopharmacol. 2015 Apr;5(2):76-87. doi: 10.1177/2045125314566807.

Use of automated medication adherence monitoring in bipolar disorder research: pitfalls, pragmatics, and possibilities.

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Department of Psychiatry, Case Western Reserve University School of Medicine, 10524 Euclid Avenue, Cleveland, OH, 44106 USA.
Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, OH, USA.



Medication nonadherence occurs in 20-60% of persons with bipolar disorder (BD) and is associated with serious negative outcomes, including relapse, hospitalization, incarceration, suicide and high healthcare costs. Various strategies have been developed to measure adherence in BD. This descriptive paper summarizes challenges and workable strategies using electronic medication monitoring in a randomized clinical trial (RCT) in patients with BD.


Descriptive data from 57 nonadherent individuals with BD enrolled in a prospective RCT evaluating a novel customized adherence intervention versus control were analyzed. Analyses focused on whole group data and did not assess intervention effects. Adherence was assessed with the self-reported Tablets Routine Questionnaire and the Medication Event Monitoring System (MEMS).


The majority of participants were women (74%), African American (69%), with type I BD (77%). Practical limitations of MEMS included misuse in conjunction with pill minders, polypharmacy, cost, failure to bring to research visits, losing the device, and the device impacting baseline measurement. The advantages were more precise measurement, less biased recall, and collecting data from past time periods for missed interim visits.


Automated devices such as MEMS can assist investigators in evaluating adherence in patients with BD. Knowing the anticipated pitfalls allows study teams to implement preemptive procedures for successful implementation in BD adherence studies and can help pave the way for future refinements as automated adherence assessment technologies become more sophisticated and readily available.


bipolar disorder; medication adherence; randomized controlled trial

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