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Attitudes towards pharmacotherapy in late-life bipolar disorder

Published online by Cambridge University Press:  18 January 2016

Soham Rej*
Department of Psychiatry, Division of Geriatric Psychiatry, University of Toronto, Toronto, Canada
Josien Schuurmans
Department of Old Age Psychiatry, GGZ inGeest/VUmc, Amsterdam, the Netherlands
Dominique Elie
Department of Psychiatry, McGill University, Montreal, Canada
Max L. Stek
Department of Old Age Psychiatry, GGZ inGeest/VUmc, Amsterdam, the Netherlands
Kenneth Shulman
Department of Psychiatry, Division of Geriatric Psychiatry, University of Toronto, Toronto, Canada
Annemiek Dols
Department of Old Age Psychiatry, GGZ inGeest/VUmc, Amsterdam, the Netherlands
Correspondence should be addressed to: Soham Rej, MD, MSc, Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Baycrest Avenue, Room FG-08, Toronto, ON, M4N 3M5, Canada. Phone: +(416) 480-6133; Fax: +(416) 480-5070. Email:



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.


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.


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.


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.

Research Article
Copyright © International Psychogeriatric Association 2016 

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