Neurobiology and medication adherence
Deborah S. Finnell, APRN, advises promoting medication adherence one stage at a time (Current Psychiatry, August 2005). Research suggests that neurobiologic interventions can help achieve this objective.
Blood pressure reduction is associated with longer, less-recurrent speech hesitation pauses (SHPs) of approximately 2 seconds.1 This supports the hypothesis that promoting neuroplasticity in small steps may have a lasting benefit in adults.2
SHPs are linked to rhythmic and prefrontal cortical modulation of dopamine lateralized to the right hemisphere, regulating brainstem cardiovascular control and coping behavior.1 Matching SHPs in spontaneous dialogues is a joint, mutually responsive rhythm with prelinguistic origins.
These findings suggest that interventions can be tailored to match the clinician’s communication style with that of the patient.1 This may influence the patient’s knowledge and beliefs about medication, help him/her become more engaged in and satisfied with treatment, and promote adherence.3
Ernest H. Friedman, MD
East Cleveland, OH
- Friedman EH. Neurobiology of managing perceived stress (letter). J Natl Med Assoc 2005;97:583-4.
- Hayward P. Small steps to neuroplasticity in adults. Lancet Neurology 2002;1:401.
- Friedman EH. Non-adherence research design in bipolar disorder (letter). Clin Approach Bipolar Disord 2005;4:19.
Dr. Finnell responds
In concert with Dr. Friedman’s point about congruent communications, clinicians should be ready to teach patients about a medication’s pharmaco-dynamics. Helping patients discover the neurobiological basis for mental disorders and psychotropics empowers them, eases their defenses, and reduces the stigma they experience.1
While this instruction is important during the precontemplation stage described in my article, clinicians should continue educating patients as they adopt medication-taking behavior. As patients gain experience with taking medications and understand more about them, additional evidence-based information should be provided.
Deborah S. Finnell, DNS, APRN
Assistant professor of nursing
State University of New York, Buffalo
- Finnell D. The case for teaching patients about the neurobiological basis of addictions. J Addict Nurs 2000;3/4:149-58.