Soham Rej1, Josien Schuurmans2, Dominique Elie3, Max L Stek2, Kenneth Shulman1, Annemiek Dols2. 1. Department of Psychiatry,Division of Geriatric Psychiatry,University of Toronto,Toronto,Canada. 2. Department of Old Age Psychiatry,GGZ inGeest/VUmc,Amsterdam,the Netherlands. 3. Department of Psychiatry,McGill University,Montreal,Canada.
Abstract
BACKGROUND: Lithium remains a first-line treatment for bipolar disorder, but clinicians have considerable concern over potential adverse effects, especially in older adults. Older patients' attitude towards lithium has not been investigated, even though negative attitudes are closely associated with reduced adherence. We examine the attitude towards lithium pharmacotherapy in older adults with bipolar disorder. METHODS: In a cross-sectional study of 78 patients aged >60 years with bipolar disorder, the association between lithium use and attitudes towards psychotropic pharmacotherapy was assessed using the Drug Attitude Inventory (DAI-10), including multivariate analyses. RESULTS: Compared to patients using alternative psychopharmacological treatments (n =30), lithium users (n=48) showed higher self-reported contentedness, subjective somatic health, and social functioning scores. Although 58.7% of lithium users reported severe adverse effects, lithium users had more positive attitudes towards psychotropic pharmacotherapy compared to non-users (DAI-10 mean score 6.0 vs. 3.9, p =0.01), and this effect was independent of potential confounders. CONCLUSIONS: Older bipolar patients using lithium have a more positive attitude towards psychotropic pharmacotherapy, despite high rates of adverse effects. Future longitudinal studies could investigate whether positive medication attitudes lead to improved treatment adherence and reduced bipolar disorder relapse in older lithium users.
BACKGROUND:Lithium remains a first-line treatment for bipolar disorder, but clinicians have considerable concern over potential adverse effects, especially in older adults. Older patients' attitude towards lithium has not been investigated, even though negative attitudes are closely associated with reduced adherence. We examine the attitude towards lithium pharmacotherapy in older adults with bipolar disorder. METHODS: In a cross-sectional study of 78 patients aged >60 years with bipolar disorder, the association between lithium use and attitudes towards psychotropic pharmacotherapy was assessed using the Drug Attitude Inventory (DAI-10), including multivariate analyses. RESULTS: Compared to patients using alternative psychopharmacological treatments (n =30), lithium users (n=48) showed higher self-reported contentedness, subjective somatic health, and social functioning scores. Although 58.7% of lithium users reported severe adverse effects, lithium users had more positive attitudes towards psychotropic pharmacotherapy compared to non-users (DAI-10 mean score 6.0 vs. 3.9, p =0.01), and this effect was independent of potential confounders. CONCLUSIONS: Older bipolarpatients using lithium have a more positive attitude towards psychotropic pharmacotherapy, despite high rates of adverse effects. Future longitudinal studies could investigate whether positive medication attitudes lead to improved treatment adherence and reduced bipolar disorder relapse in older lithium users.
Entities:
Keywords:
adherence; bipolar disorder; geriatric; lithium; patient attitudes towards pharmacotherapy
Authors: Jennifer B Levin; Michelle E Aebi; Molly Howland; Marina Barboza; Logan Eskew; Curtis Tatsuoka; Kristin A Cassidy; Martha Sajatovic Journal: J Nerv Ment Dis Date: 2020-02 Impact factor: 1.899