Faulty decision-making: Impact on treatment adherence in bipolar disorder

In spite of advances in the pharmacologic treatment of bipolar disorder, people with this illness and those who provide their care continue to struggle with the problem of treatment adherence. Studies documenting adherence rates have focused on single point assessments (eg, every 6-18 months) that incorrectly assume these end points reflect daily behaviors. People pharmacologically treated for bipolar disorder make daily decisions to consume medication or avoid it with the decision process influenced by symptoms, including mood and cognitive impairment as well as decision-making paradigms. This article suggests a new conceptualization of adherence that explicates its dynamic nature including daily decision-making processes that can facilitate or deter use of pharmacotherapy. A better understanding of this dynamic process will help clinicians and patients to plan ahead for fluctuations in adherence that can predispose patients to relapse. Suggestions are provided for addressing memory impairments, faulty decision-making paradigms, and poor problem-solving skills as they pertain to enhancing treatment adherence.