Do clinicians understand why individuals stop taking lithium?

Full Abstract

BACKGROUND:
Previous research highlights that, over a 2-year period, up to 50% of individuals receiving lithium prophylaxis are non-adherent with medication against medical advice. The main reasons identified by clinicians only partially reflect the reasons given by patients.

METHODS:
Seventy-two subjects who were identified from biochemistry laboratory data as receiving lithium for an affective disorder and who gave written informed consent, completed the 'Reasons for Stopping Medication' questionnaire. Forty-one clinicians involved in treating these 72 patients also completed the same questionnaire. Ratings on the 'Reasons for Stopping Medication' questionnaire were compared between adherent and non-adherent patients and between patients and their clinicians.

RESULTS:
Adherent (n=39) and previously non-adherent patients (n=33) showed a high level of concordance in their rank ordering of reasons for considering stopping taking lithium (Kendall's W=0.059; P=0.001), with 'bothered by the idea that moods were controlled by medication', 'bothered by the idea of a chronic illness' and 'felt depressed' being the most commonly endorsed items. Clinicians and patients views showed low levels of concordance (Kendall's W=0.019; P=0.32). Clinicians identified 'missing highs', and 'felt well, saw no need to take medication' as the most likely reasons for non-adherence. The differences in the primary reasons for stopping lithium identified by clinicians and patients were statistically significant (chi(2)=61.1; df 40, P=0.005).

CONCLUSIONS:
Patients' reasons for stopping lithium appear to be influenced by concerns about what having an affective disorder and taking medication says about them. Clinicians are not fully aware of the main reasons patients would stop prophylactic treatment.

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Author information

Author/s: Pope, Marie (M); Scott, Jan (J);

Affiliation: Department of Psychological Medicine, PO Box 96, Institute of Psychiatry, De Crespigny Park City SE5 8AF, UK.

Journal and publication information

Publication Type: Journal Article

Journal: Journal of affective disorders (J Affect Disord), published in Netherlands. (Language: eng)

Reference: 2003-May; vol 74 (issue 3) : pp 287-91

Dates: Created 2003/05/09; Completed 2003/10/15; Revised 2004/11/17;

PMID: 12738048, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Bipolar Disorder - drug therapy
Cognition
Female
Humans

Humans
Lithium Carbonate - therapeutic use
Male
Questionnaires
Treatment Refusal

Associated Chemicals: Lithium Carbonate (554-13-2)

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