Treatment adherence in multiple sclerosis: association with emotional status, personality, and cognition
The purpose of the present study was to prospectively examine the association between treatment adherence and common neuropsychiatric symptoms in multiple sclerosis (MS). Patients underwent a thorough psychiatric and neuropsychological evaluation at the outset of the study. Patient adherence to disease modifying therapies was then tracked for 8 weeks using self-report, a medication diary, and an electronic monitoring device that recorded needle disposals. Results indicated that MS patients with current mood or anxiety disorders were almost five times as likely as MS patients with no psychiatric diagnosis to exhibit problems adhering to their disease modifying therapies. Poor adherence was also associated with memory difficulties, anxiety, depression, neuroticism, and low conscientiousness. Findings highlight the importance of conducting a thorough psychiatric and neuropsychological evaluation when clinicians suspect poor adherence to disease modifying therapies. Pharmacological or psychotherapeutic treatment of mood/anxiety disorders, use of scheduled reminders, and/or increased organization and structure may lead to improved treatment adherence in MS.
KeywordsMultiple sclerosis Adherence MEMS Cognition Memory Depression Anxiety
The authors would like to express their gratitude to research assistants Shelly Peterson, Dr. John Jacobson, Josie Tyrer, Emily Guse, Meghan Murphy, Justin Lasater, Lisa Bratcher, and JaNae Fritz. The authors would also like to thank Dr. Amanda Bruce for her thoughtful edits.
This study was funded in part by pilot grant PP1506 from the National Multiple Sclerosis Society.
- Albert, S. M., Flater, S. R., Clouse, R., Todak, G., Stern, Y., & Marder, K. (2003). Medication management skill in HIV: I. Evidence for adaptation of medication management strategies in people with cognitive impairment. II. Evidence for a pervasive lay model of medication efficacy. AIDS and Behavior, 7(3), 329–338.CrossRefPubMedGoogle Scholar
- Arnett, P. A. (2003). Neuropsychological presentation and treatment of demyelinating disorders. In U. K. P. Halligan & J. Marshall (Eds.), Handbook of Clinical Neuropsychology (pp. 528–543). Oxford: Oxford University Press.Google Scholar
- Beck, A. T., Steer, R. A., & Brown, G. K. (2000). BDI-FastScreen for Medical Patients Manual. San Antonio: The Psychological Corporation.Google Scholar
- Benedict, R. H. B., Wahlig, E., Bakshi, R., Fishman, I., Munschauer, F., Zivadinov, R., et al. (2005). Predicting quality of life in multiple sclerosis: accounting for physical disability, fatigue, cognition, mood disorder, personality, and behavior change. Journal of Neurological Sciences, 231(1–2), 29–34.CrossRefGoogle Scholar
- Bosworth, H. (2006). Medication Treatment Adherence. In H. Bosworth, E. Oddone, & M. Weinberger (Eds.), Patient Treatment Adherence: Concepts Interventions, and Measurement. London: Lawrence Erlbaum Associates.Google Scholar
- Costa, P. T., & McCrae, R. R. (1992). Professional manual for the NEO PI-R and NEO-FFI.: Psychological Assessment Resources.Google Scholar
- Insel, K., Morrow, D., Brewer, B., & Figueredo, A. (2006). Executive function, working memory, and medication adherence among older adults. Journal of Gerontology Series B: Psychological Sciences and Social Sciences, 61(2), P102–P107.Google Scholar
- Lezak, M. (1995). Neuropsychological assessment, third edition (3rd ed.). New York: Oxford University Press.Google Scholar
- Milanese, C., La Mantia, L., Palumbo, R., Martinelli, V., Murialdo, A., Zaffaroni, M., et al. (2003). A post-marketing study on interferon beta 1b and 1a treatment in relapsing-remitting multiple sclerosis: different response in drop-outs and treated patients. Journal of Neurology, Neurosurgery and Psychiatry, 74(12), 1689–1692.CrossRefGoogle Scholar
- Mohr, D. C., Boudewyn, A. C., Likosky, W., Levine, E., & Goodkin, D. E. (2001). Injectable medication for the treatment of multiple sclerosis: the influence of self-efficacy expectations and injection anxiety on adherence and ability to self-inject. Annals of Behavioral Medicine, 23(2), 125–132.CrossRefPubMedGoogle Scholar
- Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(20), 22–33.PubMedGoogle Scholar
- Smith, A. (1982). Symbol Digit Modalities Test (SDMT) Manual (Revised). Los Angeles: Western Psychological Services.Google Scholar
- Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto: Consulting Psychologists Press.Google Scholar
- Van Houtven, C., Weinberger, M., & Carey, T. (2006). Implications of nonadherence for economic evaluation and health policy. In H. Bosworth, E. Oddone, & M. Weinberger (Eds.), Patient Treatment Adherence: Concepts, Interventions, and Measurement. London: Lawrence Erlbaum Associates.Google Scholar
- Wechsler, D. (1997). Wechsler Adult Intelligence Scale (3rd ed.). San Antonio: The Psychological Corporation.Google Scholar
- World Health Organization. (2003). Adherence to Long-term Therapies: Evidence for Action. Geneva: WHO.Google Scholar