THE EFFECTS OF ONE-ON-ONE MEDICATION TRAINING ON MEDICATION ADHERENCE IN PATIENTS WITH MOOD DISORDERS AND THE EFFECT OF ELECTROCONVULSIVE THERAPY ON COGNITIVE FUNCTIONING IN PATIENTS WITH DEPRESSION

Abstract

Mood disorders (MD) are among the most common mental disorders worldwide. Low treatment adherence and treatment resistance are two of the most substantial challenges facing clinicians who treat persons with MD. This thesis examined: (1) a pilot study investigating whether a one-on-one personalized medication training program, called PIMM/SAM, improves medication adherence in persons with MD; and (2) a systematic review and meta-analysis on the effects of electroconvulsive therapy (ECT) on cognitive functioning in persons with depression. To evaluate the impact of PIMM/SAM on medication adherence, a randomized controlled trial was launched in a mood disorders inpatient unit to compare PIMM/SAM (partnership in medication management/self-administered medication) program to standard prescribing practice (SPP). Over follow-up in the feasibility portion of the trial, participants in the PIMM/SAM group (n = 7) held fewer negative beliefs about medications and had lower depersonalization scores compared to participants in the SPP group (n = 5). Between-group differences on the Medication Adherence Rating Scale favoured the PIMM/SAM group, but were not statistically significant. To examine the effects of bilateral versus unilateral ECT on cognitive performance in persons with TRD, 18 studies across 10 different cognitive domains were meta-analyzed. In the 8- to 30-day timeframe post-ECT, persons who received bilateral versus unilateral ECT had over double the odds of worse cognitive performance in global cognition, non-verbal memory delayed recall, verbal memory immediate and delayed recall, subjective memory, and verbal memory immediate recall. A personalized medication training program in a mood disorders clinic may have positive implications for medication adherence. The trial to evaluate PIMM/SAM versus SPP is ongoing and further evidence about the training program is expected within the next 12 months. The systematic review and meta-analysis showed that cognitive performance was worse in persons who received bilateral versus unilateral ECT in some cognitive domains at 8 to 30 days post-treatment.