Evaluation of Motivational Interviewing to Improve Psychotropic Medication Adherence in Adolescents

By Hamrin, Vanya; Iennaco, Joanne DeSanto | Journal of Child and Adolescent Psychopharmacology, March 2017 | Go to article overview

Evaluation of Motivational Interviewing to Improve Psychotropic Medication Adherence in Adolescents


Hamrin, Vanya, Iennaco, Joanne DeSanto, Journal of Child and Adolescent Psychopharmacology


[Author Affiliation]

Vanya Hamrin. 1 Department of Psychiatry, Vanderbilt University, Nashville, Tennessee. 2 School of Nursing, Vanderbilt University, Nashville, Tennessee.

Joanne DeSanto Iennaco. 3 Yale School of Nursing, Yale University, New Haven, Connecticut.

Funding: Statistical analysis support was provided by Jeff Gordon, PhD, and Joanne Iennaco, PhD. Grant Funding was provided by Ronald and Leanne Crabbe.

Address correspondence to: Vanya Hamrin, DNP, PMHNP-BC, APRN, Department of Psychiatry, School of Nursing, 1500 21st Ave South, #2200, Vanderbilt University, Nashville, TN 37235, E-mail: vanya.l.hamrin@vanderbilt.edu

Introduction/Problem Statement

Aserious problem exists in the adolescent population with adherence to psychotropic medications. Medication adherence is defined as the patient's conformance with the provider's recommendation with respect to timing, dosage, and frequency of taking medication during the prescribed length of time (World Health Organization 2003) (WHO). Adherence rates to psychotropic medications in youth range from 34% to 89%, as reported by parents and child pill counts, electronic monitoring (Medication Electronic Monitoring System [MEMS]), saliva tests of stimulants, and therapeutic serum levels of mood stabilizers (Ghaziuddin et al. 1999; Burns et al. 2008; Hamrin et al. 2010; Dean et al. 2011; Fontanella et al. 2011; Yang et al. 2012). These rates cannot be compared or averaged as different measures and definitions of adherence were utilized. In the study evaluating parent-reported child medication adherence rates of 89% to stimulants, saliva tests of stimulants demonstrated a 53.5% rate of adherence to methylphenidate in these same youth (Pappadopulos et al. 2009). Therefore, self-report was significantly overestimated and the highest rates of adherence evaluated thus far were inaccurate. The level-dose ratio of drug metabolites was found to be an inaccurate measure of assessing antidepressant adherence (Woldu et al. 2011). Therefore, a more objective and systematic measure of adherence is needed. Several research studies have used the rate of 80% or greater as the measure of satisfactory adherence to medication (Ho et al. 2009; Nakonezny et al. 2010; Brain et al. 2013). Adherence is especially imperative in treatment with the selective serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors (SNRIs) since patients could develop the uncomfortable discontinuation syndrome after 18-24 hours of missing the drug depending on the SSRI half-life. Therefore, patients taking SSRIs or SNRIs would benefit from taking medications from 80% to 100% of the time to prevent adverse effects and achieve optimal drug effect. When looking specifically at adherence to mood-stabilizing drugs, Mullins et al. (2005) and Fontanella et al. (2011) found that antidepressant discontinuation rates were greater than 70% in adult and adolescent patients when evaluating long-term medication maintenance. In addition, the Tordia team evaluated short-term use of the SSRIs for depression and found only 50% of 190 adolescents were adherent to SSRIs as measured by taking 70% of their antidepressants by pill count at 3 months (Waldu et al. 2011). Short-term adherence to medication treatment in a large sample of 5460 youth with bipolar disorder was also problematic, despite the severe consequences of being unmedicated for bipolar disorder (Bhowmik et al. 2013). Medication adherence rates tend to decline during adolescence due to increased autonomy and decreased parental involvement with medication management (Gau et al. 2006; Dean et al. 2011). The WHO (2003) identified that the greatest patient risk factors for medication nonadherence were being of adolescent age, nonwhite race, and having the diagnosis of depression. Outcomes of psychotropic medication nonadherence include longer duration of illness, more psychiatric episodes, reduced likelihood of remission, poorer functional outcomes, increased psychopathology, greater relapse rates, poorer school performance, and difficulty in interpersonal relationships with family, teachers, and friends, as well as increased suicidal behavior (Hamrin et al. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Evaluation of Motivational Interviewing to Improve Psychotropic Medication Adherence in Adolescents
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.