Objective: A 3-month prospective trial of a psychosocial intervention - customised adherence enhancement (CAE) - was conducted with 43 medication-nonadherent individuals with bipolar disorder.

Methods: CAE modules were administered as indicated by a screen that identifies reasons for nonadherence.  The primary outcome was change in adherence to mood-stabilising medications as measured by the Tablet Routines Questionnaire and pill counts.  Secondary outcomes included change in symptoms, measured by the Hamilton Rating Scale for Depression (HAM-D), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS).

Results: Participants completed 76% of sessions.  Dropout at 3 months was 13 (30%).  Adherence improved from a baseline mean +/- SD of 34% +/- 27% of tablets missed in the past month to only 10% +/- 15% (p less than 0.001).  BPRS, HAM-D and YMRS scores all indicated significant improvement at 3-month follow-up (p less than 0.05).

Conclusions:  Although conclusions must be tempered by the uncontrolled design, CAE appeared to be well accepted and was associated with improvements in adherence, symptoms and functioning.