Correlation between drug treatment adherence and lithium treatment attitudes and knowledge by bipolar patients

Universidade Federal de Ciências da Saúde de Porto Alegre, Pôrto de São Francisco dos Casaes, Rio Grande do Sul, Brazil
Progress in Neuro-Psychopharmacology and Biological Psychiatry (Impact Factor: 3.69). 02/2007; 31(1):217-24. DOI: 10.1016/j.pnpbp.2006.08.007
Source: PubMed


Non-adherence should always be investigated when there is a failure in bipolar treatments, since it is known that reported non-adherence rates in bipolar disorder treatment for long-term prophylactic pharmacotherapy range from 18% to 52%, with a median prevalence of 44.7%. Several factors are related to the poor adherence and reduction of medication efficiency, such as the different types of bipolar disorder, the presence of side effects, medication interactions, level of patient's knowledge about the disorder and their attitude towards treatment, complexity of medical regimens and the doctor-patient relationship.
Bipolar disorder outpatients under lithium treatment from the Hospital de Clínicas and Materno Infantil Presidente Vargas of Porto Alegre were recruited. All the patients had bipolar disorder and gave informed consent to participate in a clinical interview (106), answered the Lithium Attitudes Questionnaire (LAQ), Lithium Knowledge Test (LKT), Medication Adherence Rating Scale (MARS) and had plasma and red blood cells lithium measurements to assess their medication adherence and the factors that influenced it.
85.6% of bipolar disorder were adherent to lithium treatment showing plasma lithium between 0.6 and 1.2 mmol/L. There was an inverted correlation between the total LAQ score with plasma and red blood cells, a positive correlation between LKT and MARS with plasma and red blood cell lithium.
These results confirmed that knowledge level is directly correlated to treatment adherence and patients' attitudes, lower adherence, general opposition to prophylaxis, fear of side effects, denial of therapeutic effectiveness and illness severity.

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Available from: Helena M T Barros
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    • "In addition, adherence to medication was assessed only by self-questionnaire. Although the accuracy of such a method that reflects subjective experience of patients is well documented (Rosa et al., 2007; Thompson et al., 2000), it has been demonstrated that patients' self-report scores tend to overestimate adherence to medication in comparison to serum concentrations (Jonsdottir et al., 2010). Moreover, based on several previous works, we decided to test specifically the relationship between non-planning impulsivity and adherence to medication. "
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    ABSTRACT: Adherence to medication is a major issue in bipolar disorder. Non-planning impulsivity, defined as a lack of future orientation, has been demonstrated to be the main impulsivity domain altered during euthymia in bipolar disorder patients. It was associated with comorbidities. To investigate relationship between adherence to medication and non-planning impulsivity, we included 260 euthymic bipolar patients. Adherence to medication was evaluated by Medication Adherence Rating Scale and non-planning impulsivity by Barrat Impulsiveness Scale. Univariate analyses and linear regression were used. We conducted also a path analysis to examine whether non-planning impulsivity had direct or indirect effect on adherence, mediated by comorbidities. Adherence to medication was correlated with non-planning impulsivity, even after controlling for potential confounding factors in linear regression analysis (Beta standardized coefficient=0.156; p=0.015). Path analysis demonstrated only a direct effect of non-planning impulsivity on adherence to medication, and none indirect effect via substance use disorders and anxiety disorders. Our study is limited by its cross-sectional design and adherence to medication was assessed only by self-questionnaire. Higher non-planning impulsivity is associated with low medication adherence, without an indirect effect via comorbidities. Copyright © 2015 Elsevier B.V. All rights reserved.
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    • "Knowledge and attitude were, however, positively correlated. On the other hand, Rosa et al. (2007) reported that in their study knowledge level was directly related to treatment adherence. Even though we found attitudes to be quite stable, they can likely be modified (Strauss and Johnson, 2006). "
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    • "The specific mechanisms of action of psychoeducation are mainly the improvement in adherence to treatment (Colom et al., 2000), the implementation of a regular lifestyle (Vieta, 2005), and the better detection by the patient and/or his family of early warning signs of recurrences (Perry et al., 1999). These goals may be achieved partly through knowledge about the illness and behaviour change directly (Rosa et al., 2007), but also through intermediate variables such as the locus of control or the attitude towards "
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    ABSTRACT: Psychoeducation is now considered as part of the integrated treatment for bipolar disorder. But the psychological changes involved in it have been poorly studied. We compared the locus of control (LOC, a key variable for health-related behaviours as well as for education practices), the knowledge about lithium [Lithium Knowledge Questionnaire (LKQ)] and attitude about lithium [Attitude towards Lithium Questionnaire (ALQ)] before and after a brief hospital based psychoeducational programme for euthymic patients with bipolar disorder (ICD-10 criteria) receiving lithium prophylaxis. The occurrence of hospitalisations was recorded during the two years before and after the patients underwent psychoeducation. All patients were reassessed after 24 months. 50 consecutive participants at a psychoeducational programme were evaluated. The LKQ but not the ALQ scores increased significantly after the programme. The external "powerful others" component of the LOC significantly increased after psychoeducation. The observed changes were maintained after 24 months. The patients' level of satisfaction was excellent and sustained. There was only a trend for a decrease in the rate of hospitalisations. The knowledge about lithium was assessed with an experimental instrument. Patients followed in a university department may not be representative of bipolar patients at large. Psychoeducation enduringly increases the knowledge about lithium and induces long term changes in the locus of control that may reflect a shift in illness representations. The LOC may be an important target of psychoeducation for euthymic patients with bipolar disorder.
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