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| ID | Type | Description | Link |
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| L1195 |
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| Name | Class |
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| Case Western Reserve University | OTHER |
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This study is a modular intervention that is intended to improve treatment adherence among individuals with bipolar disorder on atypical antipsychotic therapy who have been identified as having treatment adherence problems.
This study is a pilot, prospective project of the effects of customized adherence enhancement (CAE) when added to the medical management (usual care) of outpatients with bipolar disorder (BPD) who are patients at University Hospitals of Cleveland Case Medical Center, and who are known to be at risk for treatment non-adherence. In the proposed trial, CAE is supported by manuals delivered as a series of four modules whose use will be determined based upon an individual's identified treatment adherence vulnerabilities. The modules are components of a single, customized intervention. Although some participants may receive a different combination or number of modules, the participants are neither analyzed separately as a subpopulation nor compared as subpopulations. Therefore participants are all part of a solitary study arm. The effectiveness of the entire customized intervention system is of interest.
All individuals will continue to receive treatment as usual with their regular provider. Those who are enrolled in the study intervention will participate in a series of 4 in-person meetings with the study interventionist over a 4-week time period and 1-2 telephone follow-ups. These meetings with the interventionist will consist of whatever modules were assigned at baseline that are customized to that particular participant's treatment adherence vulnerabilities. A total of 3 to 4 assessment meetings with the research assistant will occur over a three-month time period.
Primary objective The aim of this project is to test the use of a modular-based intervention in a pilot feasibility, acceptability and preliminary efficacy study of customized adherence enhancement (CAE) in a vulnerable population with BPD. We hypothesize that CAE will be: 1) feasible to administer within a academic medical center; 2) acceptable to participants with BPD; and 3) associated with improvements in treatment adherence.
Secondary objectives Individuals who receive CAE will have improvements in BPD symptoms, global psychopathology, overall treatment attitudes and in functional status.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Customized Adherence Enhancement (CAE) | Experimental | Participants will be assigned to receive one or more of the study interventions based upon the participant's responses on the Attitudes toward Mood Stabilizers Questionnaire (AMSQ) and reasons for non-adherence on the Rating of Medication Influences (ROMI). Individuals will participate in a series of 4 60-minute sessions over a 4-week period, with the study therapist who will implement the module-based intervention. The number of modules may differ depending on the baseline adherence profile of the participant. An intervention manual developed by the investigators will provide explicit guidelines regarding how modules may be co-administered in single or multiple sessions to minimize redundancy as well as time and effort burden on study participants. The manual for each module will specifically address how any module could be combined with the other modules. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Psychoeducation module | Behavioral | Individuals will be assigned the psychoeducation module if they are identified as having opposition to prophylaxis, denial of illness severity or therapeutic effectiveness, negative attitudes towards drugs in general, or lack of information about mood stabilizers operationalized as a score of "1" or higher on any of these AMSQ subscales. Additionally, those individuals who are non-adherent/sub-optimally adherent because of stigma or embarrassment over medications or in relation to the use of complementary or alternative treatments will be assigned to participate in the psychoeducation module (ROMI stigma item or complementary/alternative treatment supplemental item). |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Treatment Non-adherence as Measured by the Tablets Routine Questionnaire (TRQ) (Past Month) | Treatment non-adherence is measured as a percentage of medications not taken within the past month at time of assessment. The minimum score is 0 and the maximum score is 100. A higher score implies poorer treatment adherence. | From Baseline to 3 months |
| Change in Treatment Non-adherence as Measured by the Tablets Routine Questionnaire (TRQ) (Past Week) | Treatment nonadherence is measured as a percentage of medications not taken within the past week at time of assessment. The minimum score is 0 and the maximum score is 100. A higher score implies poorer treatment adherence. | From Baseline to 3 months |
| Change in Treatment Adherence as Measured by the Morisky Scale | The minimum score is 0 and the maximum score is 4. A higher score implies poorer treatment adherence. | From Baseline to 3 months |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Symptoms of Bipolar Disorder as Measured by the Young Mania Rating Scale (YMRS) | The minimum possible score is 0 and the maximum score is 60. A higher score implies a worse condition. | From Baseline to 3 months |
| Change in Global Psychopathology as Measured by the Clinical Global Impression Scale (CGI) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Martha Sajatovic, MD | Case Western Reserve University and University Hospitals Case Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University Hospitals Case Medical Center | Cleveland | Ohio | 44106 | United States |
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Recruitment began in January of 2009 and the last participant was enrolled in June of 2010.
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| ID | Title | Description |
|---|---|---|
| FG000 | Customized Adherence Enhancement (CAE) | Participants will be assigned to receive one or more of the study interventions based upon the participant's responses on the AMSQ and reasons for non-adherence on the ROMI. Individuals will participate in a series of 4 60-minute sessions over a 4-week period, with the study therapist who will implement the module-based intervention. The number of modules may differ depending on the baseline adherence profile of the participant. An intervention manual developed by the investigators will provide explicit guidelines regarding how modules may be co-administered in single or multiple sessions to minimize redundancy as well as time and effort burden on study participants. The manual for each module will specifically address how any module could be combined with the other modules. |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| Substance use module | Behavioral | Individuals will be assigned the substance use module if they endorse the ROMI substance use item or if substance use is identified as problematic on the clinician assessment. |
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| Improved communication/rapport with provider module | Behavioral | Individuals will be assigned the provider communication/rapport module if they are identified as having fear of side effects operationalized as a score of "1" or higher on these AMSQ items. Additionally, those individuals who are non-adherent/suboptimally adherent because of concern regarding change in appearance "appearing medicated" or who experience side-effect-related distress as identified by the ROMI will be assigned the provider communication module. |
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| Medication routines management module | Behavioral | Individuals will be assigned the medication routines management module if they are identified as having difficulties with medication routines operationalized as a score of "1" or higher on this AMSQ sub-scale, or if they are identified as experiencing outside opposition to medications by the ROMI. |
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The minimum possible score is 1 and the maximum score is 7. A higher score implies a worse condition. |
| From Baseline to 3 months |
| Change in Overall Treatment Attitudes as Measured by the Drug Attitude Inventory (DAI) | The minimum score is 0 and the maximum score is 10. A higher score implies a better attitude. | From Baseline to 3 months |
| Change in Functional Status as Measure by the Global Assessment of Functioning Scale (GAF) | The minimum score is 1 and the maximum score is 100. A higher score implies higher functioning. | From Baseline to 3 months |
| Change in Symptoms of Bipolar Disorder as Measured by the Hamilton Depression Rating Scale (HAM-D) | The minimum score is 0 and the maximum score is 52. A higher score implies a worse condition. | From Baseline to 3 months |
| Change in Symptoms of Bipolar Disorder as Measured by the Brief Psychiatric Rating Scale (BPRS) | The minimum score is 18 and the maximum score is 126. A higher score implies a worse condition. | From Baseline to 3 months |
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| ID | Title | Description |
|---|---|---|
| BG000 | Customized Adherence Enhancement (CAE) | Participants will be assigned to receive one or more of the study interventions based upon the participant's responses on the AMSQ and reasons for non-adherence on the ROMI. Individuals will participate in a series of 4 60-minute sessions over a 4-week period, with the study therapist who will implement the module-based intervention. The number of modules may differ depending on the baseline adherence profile of the participant. An intervention manual developed by the investigators will provide explicit guidelines regarding how modules may be co-administered in single or multiple sessions to minimize redundancy as well as time and effort burden on study participants. The manual for each module will specifically address how any module could be combined with the other modules. |
| Units | Counts |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||||||
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| Age, Categorical | Count of Participants | Participants |
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| Sex: Female, Male | Count of Participants | Participants |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Primary | Change in Treatment Non-adherence as Measured by the Tablets Routine Questionnaire (TRQ) (Past Month) | Treatment non-adherence is measured as a percentage of medications not taken within the past month at time of assessment. The minimum score is 0 and the maximum score is 100. A higher score implies poorer treatment adherence. | Number of participants for analysis was based on all available data at the three month time point. | Posted | Mean | Standard Error | percentage of medication not taken | From Baseline to 3 months |
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| Secondary | Change in Symptoms of Bipolar Disorder as Measured by the Young Mania Rating Scale (YMRS) | The minimum possible score is 0 and the maximum score is 60. A higher score implies a worse condition. | Number of participants for analysis was based on all available data at the three month time point. | Posted | Mean | Standard Error | units on a scale | From Baseline to 3 months |
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| Secondary | Change in Global Psychopathology as Measured by the Clinical Global Impression Scale (CGI) | The minimum possible score is 1 and the maximum score is 7. A higher score implies a worse condition. | Number of participants for analysis was based on all available data at the three month time point. | Posted | Mean | Standard Error | units on a scale | From Baseline to 3 months |
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| Secondary | Change in Overall Treatment Attitudes as Measured by the Drug Attitude Inventory (DAI) | The minimum score is 0 and the maximum score is 10. A higher score implies a better attitude. | Number of participants for analysis was based on all available data at the three month time point. | Posted | Mean | Standard Error | units on a scale | From Baseline to 3 months |
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| Secondary | Change in Functional Status as Measure by the Global Assessment of Functioning Scale (GAF) | The minimum score is 1 and the maximum score is 100. A higher score implies higher functioning. | Number of participants for analysis was based on all available data at the three month time point. | Posted | Mean | Standard Error | units on a scale | From Baseline to 3 months |
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| Secondary | Change in Symptoms of Bipolar Disorder as Measured by the Hamilton Depression Rating Scale (HAM-D) | The minimum score is 0 and the maximum score is 52. A higher score implies a worse condition. | Number of participants for analysis was based on all available data at the three month time point. | Posted | Mean | Standard Error | units on a scale | From Baseline to 3 months |
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| Secondary | Change in Symptoms of Bipolar Disorder as Measured by the Brief Psychiatric Rating Scale (BPRS) | The minimum score is 18 and the maximum score is 126. A higher score implies a worse condition. | Number of participants for analysis was based on all available data at the three month time point. | Posted | Mean | Standard Error | units on a scale | From Baseline to 3 months |
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| Primary | Change in Treatment Non-adherence as Measured by the Tablets Routine Questionnaire (TRQ) (Past Week) | Treatment nonadherence is measured as a percentage of medications not taken within the past week at time of assessment. The minimum score is 0 and the maximum score is 100. A higher score implies poorer treatment adherence. | Number of participants for analysis was based on all available data at the three month time point. | Posted | Mean | Standard Error | percentage of medications not taken | From Baseline to 3 months |
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| Primary | Change in Treatment Adherence as Measured by the Morisky Scale | The minimum score is 0 and the maximum score is 4. A higher score implies poorer treatment adherence. | Number of participants for analysis was based on all available data at the three month time point. | Posted | Mean | Standard Error | units on a scale | From Baseline to 3 months |
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Customized Adherence Enhancement (CAE) | Participants will be assigned to receive one or more of the study interventions based upon the participant's responses on the AMSQ and reasons for non-adherence on the ROMI. Individuals will participate in a series of 4 60-minute sessions over a 4-week period, with the study therapist who will implement the module-based intervention. The number of modules may differ depending on the baseline adherence profile of the participant. An intervention manual developed by the investigators will provide explicit guidelines regarding how modules may be co-administered in single or multiple sessions to minimize redundancy as well as time and effort burden on study participants. The manual for each module will specifically address how any module could be combined with the other modules. | 4 | 43 | 1 | 43 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| broken vertebrae | Musculoskeletal and connective tissue disorders | Non-systematic Assessment | Participant was in a car accident and received a broken vertebrae |
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| worsening depression | Psychiatric disorders | Non-systematic Assessment | Participant hospitalized for worsening depression |
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| congestive heart failure | Cardiac disorders | Non-systematic Assessment | Participant was hospitalized and diagnosed with congestive heart failure |
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| worsening mania | Psychiatric disorders | Non-systematic Assessment | Participant took more medication than prescribed hoping to treat their mania and was hospitalized |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
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| substance abuse | Psychiatric disorders | Non-systematic Assessment | Subject caused a car accident while drunk driving |
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| Title | Organization | Phone | Extension | |
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| Christopher Bialko | University Hospitals Case Medical Center | 216-286-4362 | Christopher.Bialko@UHhospitals.org |
| ID | Term |
|---|---|
| D001714 | Bipolar Disorder |
| D010349 | Patient Compliance |
| D016312 | Treatment Refusal |
| ID | Term |
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| D000068105 | Bipolar and Related Disorders |
| D019964 | Mood Disorders |
| D001523 | Mental Disorders |
| D010342 | Patient Acceptance of Health Care |
| D000074822 | Treatment Adherence and Compliance |
| D015438 | Health Behavior |
| D001519 | Behavior |
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| Native Hawaiian or Other Pacific Islander |
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| Black or African American |
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| More than one race |
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| Unknown or Not Reported |
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