The prognostic role of perceived criticism, medication adherence and family knowledge in bipolar disorders

BackgroundIn schizophrenia, high levels of critical comments by significant others are associated with early relapse, especially if medication adherence is sub-optimal. Levels of criticism may be influenced by family knowledge about both the disorder and its treatment. No study has explored whether this combination factors influence outcome in adults with bipolar disorders.MethodsMedication adherence was assessed in 81 individuals with bipolar disorder of whom 75 rated perceived criticism by an identified ‘significant other’ as well as their own perceived sensitivity. 33 (of the 75) had a close family member who agreed to completed an assessment of their knowledge and understanding of bipolar disorders. Psychiatric admissions were then recorded prospectively over 12 months.ResultsPerceived criticism and medication adherence were significant predictors of admission. In the patient–family member dyads (n=33), the odds ratio (OR) for admission was 3.3 (95% confidence intervals 1.3–8.6) in individuals with low levels of medication adherence, high perceived criticism, and a family member with poor knowledge and understanding.LimitationsThe small sub-sample of patient–family member dyads means those findings require replication. Sensitivity to criticism by professional caregivers may not equate to that by relatives.ConclusionsPerceived criticism may be a simple but robust clinical predictor of relapse in mood disorders. High levels of perceived criticism, poor understanding of bipolar disorder by a significant other, and sub-optimal treatment adherence are risk factors for hospitalization in adults with bipolar disorders that are potentially modifiable through the use of strategic psychosocial interventions.