背景：情緒穩定劑為雙相症病患第一線治療方式，遵囑服藥可穩定病患情緒，以維持人際關係及社會功能。藥物血中濃度被視為病患遵囑服藥之臨床評量依據，但其與主觀評量之間的相關性仍少有研究探討。
目的：探討門診雙相症病患自評遵囑服藥、情緒穩定劑血中濃度與一年內是否再住院之相關性。
方法：以林靜蘭博士「精神病患遵囑服藥行為測量工具之信效度檢測」之研究資料進行次級資料分析，篩選雙相症病患為研究對象、基本屬性（人口學與疾病屬性）及主觀遵囑服藥行為（簡版服藥態度量表與計畫行為理論遵囑服藥行為量表）等變項，並以病歷回溯情緒穩定劑血中濃度與再住院次數，探討其間關係。
研究結果：共納入115位雙相症病患，以女性、大學以上、未婚及有工作者居多；診斷為第二型雙相症者佔66.1%、平均年齡為40.03±14.00歲、平均發病年齡為33.63±13.52歲、發病五年以下者佔53%、過去曾住院者佔52.2%、平均住院次數為1.54±2.34、一年內未再住院者佔84.3%；每日服藥1次者佔56.6%、平均服藥次數為1.77±1.08次、每日服藥6顆（含）以上者佔40.9%、平均服藥顆數為5.85±4.09顆、服用帝拔癲者佔87.8%、平均服藥劑量及藥物血中濃度--帝拔癲（918.32±187.45mg及68.31±29.46μg/mL）、鋰鹽（750.00±256.46mg及0.71±0.54 mEq/L）服藥態度量表總分平均為6.28分，表示服藥態度仍有待加強；計畫行為理論遵囑服藥行為次量表平均值為：態度（0.92）、主觀規範（0.69）、所感知的行為控制（9.70）與行為意向（6.01），顯示病患未來一週服藥意願高。相關分析發現服藥顆數與服藥態度總分呈低度正相關（r = 0.229, p < .05）、服藥態度總分及主觀規範呈低度正相關（r = 0.229, p <.05; r = 0.219, p < .05）、病齡與主觀規範呈低度正相關（r = 0.217, p < .05）、住院次數與所感知的行為控制呈中度正相關（r = 0.288, p < .01）。複迴歸分析發現服藥次數、所感知的行為控制與行為意向可顯著預測主觀規範（R2 = 0.313），住院次數、藥物血中濃度達高標、主觀規範可顯著預測所感知的行為控制（R2 = 0.271），藥物血中濃度達低標（帝拔癲≥50g/mL、鋰鹽≥0.6mEq/L）、主觀規範可顯著預測行為意向（R2 = 0.260），藥物血中濃度達高標（帝拔癲≥70g/mL、鋰鹽≥0.6mEq/L）可顯著預測計畫行為理論遵囑服藥行為之態度（R2 = 0.073），。邏輯式迴歸分析發現服藥次數每增加一次，藥物血中濃度達治療低標機率增加0.53倍，計畫行為理論遵囑服藥行為之態度每增加一單位，藥物血中濃度達治療高標機率增加1.40倍，過去住院次數每增加一次，一年內再住院機會增加1.26倍。
結論/實務應用：依據Nielsen等人（2012）建議以簡版服藥態度量表8分為遵囑服藥之切點，本研究未遵囑服藥比例佔78.3%，然而卻有56-74%病患藥物血中濃度達高標與低標，顯示主客觀遵囑服藥評量之間存在落差，暗示病患內在動機與實際行為之間的差距或主客觀評量工具之差異。建議未來遵囑服藥之評量宜採多種指標相互參照，而主客觀評量之不一致或矛盾，亦可作為增進遵囑服藥行為之重要參考。

SUMMARY
Improving medication adherence can improve patients’ mood stability, interpersonal relationships and social functioning. However, subjective medication adherence may not be consistent with objective assessments. This study aimed to examine the relationships between medication adherence, serum level of mood stabilizers, and 1-year rehospitalization among outpatients with bipolar disorder (BD). Secondary data analysis based on another study (Lin, 2015) was conducted and serum level of mood stabilizers and 1-year rehospitalization were collected by chart review. Self-reported medication adherence was assessed by 10-item Drug Attitude Inventory (DAI) and Theory Planned Behavior Inventory-Medication Adherence, including Attitude (ATT), Subjective Norm (SN), Perceived Behavior Control (PBC), and Intention (INT). One hundred and fifteen patients with BD were recruited. Times of taking medicines, PBC and INT were significant predictors of SN (R2=0.313); hospitalization times, higher sufficient serum level (Depakine ≥70g/mL; Lithium ≥0.6mEq/L) and SN were significant predictors of PBC (R2=0.271); Lower sufficient serum level (Depakine ≥50g/mL; Lithium ≥0.6mEq/L) and SN were significant predictors of INT(R2=0.260). Logistic regression showed that lower and higher sufficient serum level were associated with times of taking medicines (OR=0.53) and higher ATT (OR=1.40) and participants’ 1-year rehospitalization was associated with their past hospitalization times (OR=1.26). In this study, 78.3% of participants were self-reported non-adherent, but 56% - 74% achieved sufficient serum level. It indicated that subjective and objective medication adherence was not consistent. Future researches are suggested to tailor individualized regimen and develop interventions to improve medication adherence among patients with bipolar disorder.
Keywords: Bipolar disorder; medication adherence; mood stabilizer; serum level of medicines; rehospitalization

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