Women with Bipolar Disorder in American Prisons: Medication Compliance

The article that I chose was about a study regarding medication adherence among female inmates with bipolar disorder. The objective of the study was to find the percentage of incarcerated females with bipolar disorder that do and do not adhere to their medications. The researchers formed a hypothesis which stated that the percentage of the studied females with non-adherence to their medications would be between 20% and 50%. They also hypothesized that medication adherence would increase over time as the patient’s symptoms decrease.

The researchers’ hypothesis was tested by assessing medication adherence on a daily basis throughout the study. Medication adherence was examined at an individual and also group (institutional level. The two were then compared for trends. In addition, medication adherence was compared to the number and type of symptoms the patients would experience. The results from the study showed that patients exhibited the greatest difficulty with medication adherence with mood stabilizing drugs such as lithium. Following after mood stabilizers, antipsychotic drugs (such as risperidone) and antidepressants (like fluoxetine) were next (Ehret, et al.

, 2013). The study also revealed that the researchers’ hypothesis was correct in that medication adherence does increase over time; hence symptoms decrease or even dissipate. The study can be related to abnormal psychology in a few ways. There are several reasons (referring back to abnormal psychology) why someone with bipolar disorder may become non-adherent to medications. First, the medications can cause a lot of negative side effects in the individual. This can lead to distress and can spark doubt that the medications have potential for a positive outcome (in the view of the patient).

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Lastly, many people that suffer from bipolar disorder get an extreme high while in a manic state; therefore, they often choose not to take the medication because they wish to maintain the high feelings created by the mania. Not only can the results be applied to bipolar disorder but other disorders as well in which the patient plays a role in the treatment method being used. The medications are an important factor in treating the patient. Medications often decrease the symptoms of the disorder. As we were able to see from the research, one reason why the patients did not take medications was due to the side-effects. The longer the patient takes the medication their behavior will force them to realize that they need the medication and will soon take it without having to be reminded or told to do so.

The only criticism that I have about the study was that no personal interaction took place between the researchers and the patients. Such questions that could have been asked might include the following: “do you believe that this medication is working for you?” – “what are some problems that you experience when it comes to taking this medication?” – “have you ever previously been on a medication that treated your symptoms well?” I feel that the researchers could have gained more insight if they had created a dialogue with the patients. Sometimes interaction provides us with a clearer picture as opposed to using observation methods alone. I also believe that many patients that do not adhere to their medications experience quite a bit of frustration as a result. Therefore, the researchers are provided with an opportunity to understand those frustrations and perhaps get deeper into the actual psychology of the patient.

Although I am highly unqualified to conduct such a study, there are a few things that I would have done different. The first thing that I would have been different would have been to examine and observe patients with full charting only. I feel that it is important to gain a full understanding of how long exactly a patient has not been compliant with his or her medication. Secondly, I would have followed up with patients and asked why they did not adhere to the medications. The third and last thing that I would have done different would have been to examine patients in other correctional facilities. For example could an institution in Michigan have different methods or approaches in addressing medication adherence than the surveyed institutions in Connecticut?

I understand that in such institutions prescribers are often provided with guidelines or specific treatment protocols. So, I believe that patients are most definitely receiving different treatment types and medications in other states. Something that I found very interesting in the results of this study was that the patients who initially started out with little or no medication adherence problems ended up having significant adherence problems later on; vice versa, those who did not start off well ended up adhering to the medications a lot better as time passed. One other thing that I found interesting was that when a prescriber or other clinician educated a patient for three months, the patient usually would end up missing very few doses of his or her medications. In my opinion, it is important for the prescriber or other clinician to be the patient’s advocate when it comes to adhering to medication. Some patients may not believe that a particular medication is working for them, so it is up to us to provide them with positive reassurance.

All in all I thought that the study was well-rounded and that all bases were covered, however I would have liked to have seen more patients evaluated. Even though the researchers  enlightened us about the missing patient charts, I still would have liked to have seen that only patients with complete charting were examined.