Hostname: page-component-76fb5796d-25wd4 Total loading time: 0 Render date: 2024-04-25T13:58:20.964Z Has data issue: false hasContentIssue false
  • English
  • Français

Attitudes towards pharmacotherapy in late-life bipolar disorder

Published online by Cambridge University Press:  18 January 2016

Soham Rej ,
Josien Schuurmans ,
Dominique Elie ,
Max L. Stek ,
Kenneth Shulman  and
Annemiek Dols
Soham Rej*
Affiliation:
Department of Psychiatry, Division of Geriatric Psychiatry, University of Toronto, Toronto, Canada
Josien Schuurmans
Affiliation:
Department of Old Age Psychiatry, GGZ inGeest/VUmc, Amsterdam, the Netherlands
Dominique Elie
Affiliation:
Department of Psychiatry, McGill University, Montreal, Canada
Max L. Stek
Affiliation:
Department of Old Age Psychiatry, GGZ inGeest/VUmc, Amsterdam, the Netherlands
Kenneth Shulman
Affiliation:
Department of Psychiatry, Division of Geriatric Psychiatry, University of Toronto, Toronto, Canada
Annemiek Dols
Affiliation:
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: soham.rej@mail.mcgill.ca.
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

lithiumpatient attitudes towards pharmacotherapyadherencegeriatricbipolar disorder
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 6 , June 2016 , pp. 945 - 950
Copyright
Copyright © International Psychogeriatric Association 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric, A., American Psychiatric, A. and Task Force on, D.-I. (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association.Google Scholar
Arvilommi, P., Suominen, K., Mantere, O., Leppamaki, S., Valtonen, H. and Isometsa, E. (2014). Predictors of adherence to psychopharmacological and psychosocial treatment in bipolar I or II disorders – an 18-month prospective study. Journal of Affective Disorders, 155, 110–117.CrossRefGoogle ScholarPubMed
Awad, A. G. (1993). Subjective response to neuroleptics in schizophrenia. Schizophrenia Bulletin, 19, 609–618.CrossRefGoogle ScholarPubMed
Baldessarini, R. J., Leahy, L., Arcona, S., Gause, D., Zhang, W. and Hennen, J. (2007). Patterns of psychotropic drug prescription for US patients with diagnoses of bipolar disorders. Psychiatric Services, 58, 85–91.CrossRefGoogle ScholarPubMed
Carney, S. M. and Goodwin, G. M. (2005). Lithium – a continuing story in the treatment of bipolar disorder. Acta psychiatrica Scandinavica. Supplementum, 426, 7–12.Google Scholar
Chang, C. W., Sajatovic, M. and Tatsuoka, C. (2014). Correlates of attitudes towards mood stabilizers in individuals with bipolar disorder. Bipolar Disorders, 17, 106–112.CrossRefGoogle ScholarPubMed
Dols, A., Rhebergen, D., Beekman, A., Kupka, R., Sajatovic, M. and Stek, M. L. (2014). Psychiatric and medical comorbidities: results from a bipolar elderly cohort study. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 22, 1066–1074.Google Scholar
Dols, A. et al. (2013). The prevalence and management of side effects of lithium and anticonvulsants as mood stabilizers in bipolar disorder from a clinical perspective: a review. International Clinical Psychopharmacology, 28, 287–296.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Geddes, J. R. et al. (2010). Lithium plus valproate combination therapy versus monotherapy for relapse prevention in bipolar I disorder (BALANCE): a randomised open-label trial. Lancet, 375, 385–395.Google Scholar
Ghose, K. (1991). The need for a review journal of drug use and the elderly. Drugs & Aging, 1, 2–5.Google Scholar
Grof, P. (2010). Sixty years of lithium responders. Neuropsychobiology, 62, 8–16.Google Scholar
Hayes, J. et al. (2011). Prescribing trends in bipolar disorder: cohort study in the United Kingdom THIN primary care database 1995–2009. PloS one, 6, e28725.Google Scholar
Kessing, L. V., Hansen, H. V. and Bech, P. (2006). Attitudes and beliefs among patients treated with mood stabilizers. Clinical Practice and Epidemiology in Mental Health, 2, 8.Google Scholar
Kessing, L. V., Hellmund, G., Geddes, J. R., Goodwin, G. M. and Andersen, P. K. (2011). Valproate v. lithium in the treatment of bipolar disorder in clinical practice: observational nationwide register-based cohort study. The British Journal of Psychiatry : The Journal of Mental Science, 199, 57–63.CrossRefGoogle ScholarPubMed
Kriegsman, D. M., Penninx, B. W., van Eijk, J. T., Boeke, A. J. and Deeg, D. J. (1996). Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients' self-reports and on determinants of inaccuracy. Journal of Clinical Epidemiology, 49, 1407–1417.Google Scholar
McKnight, R. F., Adida, M., Budge, K., Stockton, S., Goodwin, G. M. and Geddes, J. R. (2012). Lithium toxicity profile: a systematic review and meta-analysis. Lancet, 379, 721–728.Google Scholar
Miura, T. et al. (2014). Comparative efficacy and tolerability of pharmacological treatments in the maintenance treatment of bipolar disorder: a systematic review and network meta-analysis. The Lancet Psychiatry, 1, 351–359.Google Scholar
Pompili, M. et al. (2013). Mood disorders medications: predictors of nonadherence – review of the current literature. Expert Review of Neurotherapeutics, 13, 809–825.Google Scholar
Priebe, S., Huxley, P., Knight, S. and Evans, S. (1999). Application and results of the manchester short assessment of quality of life (MANSA). International Journal of Social Psychiatry, 45, 7–12.Google Scholar
Radloff, L. S. (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.Google Scholar
Rej, S., Elie, D., Mucsi, I., Looper, K. J. and Segal, M. (2015). Chronic kidney disease in lithium-treated older adults: a review of epidemiology, mechanisms, and implications for the treatment of late-life mood disorders. Drugs & Aging, 32, 31–42.CrossRefGoogle ScholarPubMed
Rej, S. et al. (2014). Prevalence and correlates of renal disease in older lithium users: a population-based study. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 22, 1075–1082.Google Scholar
Renes, J. W., Regeer, E. J., van der Voort, T. Y., Nolen, W. A. and Kupka, R. W. (2014). Treatment of bipolar disorder in the Netherlands and concordance with treatment guidelines: study protocol of an observational, longitudinal study on naturalistic treatment of bipolar disorder in everyday clinical practice. BMC Psychiatry, 14, 58.Google Scholar
Rosa, A. R., Marco, M., Fachel, J. M., Kapczinski, F., Stein, A. T. and Barros, H. M. (2007). Correlation between drug treatment adherence and lithium treatment attitudes and knowledge by bipolar patients. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 31, 217–224.CrossRefGoogle ScholarPubMed
Selle, V., Schalkwijk, S., Vazquez, G. H. and Baldessarini, R. J. (2014). Treatments for acute bipolar depression: meta-analyses of placebo-controlled, monotherapy trials of anticonvulsants, lithium and antipsychotics. Pharmacopsychiatry, 47, 43–52.Google Scholar
Sheehan, D. V. et al. (1998). The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry, 59, 34–57.Google Scholar
Shulman, K. I. et al. (2003). Changing prescription patterns for lithium and valproic acid in old age: shifting practice without evidence. BMJ, 326, 960–961.Google Scholar
Simhandl, C., Konig, B. and Amann, B. L. (2014). A prospective 4-year naturalistic follow-up of treatment and outcome of 300 bipolar I and II patients. The Journal of Clinical Psychiatry, 75, 254–262.CrossRefGoogle ScholarPubMed
Strejilevich, S. A. et al. (2011). Clinical concepts associated with lithium underutilization in the treatment of bipolar disorder. Vertex, 22, 3–20.Google Scholar
van Vliet, I. M. and de Beurs, E. (2007). The MINI-international neuropsychiatric interview. A brief structured diagnostic psychiatric interview for DSM-IV en ICD-10 psychiatric disorders. Tijdschrift voor Psychiatry, 49, 393–397.Google Scholar
Wilting, I., Heerdink, E. R., Mersch, P. P., den Boer, J. A., Egberts, A. C. and Nolen, W. A. (2009). Association between lithium serum level, mood state, and patient-reported adverse drug reactions during long-term lithium treatment: a naturalistic follow-up study. Bipolar Disorders, 11, 434–440.Google Scholar
Yatham, L. N. et al. (2013). Canadian network for mood and anxiety treatments (CANMAT) and international society for bipolar disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disorders, 15, 1–44.CrossRefGoogle Scholar
Young, R. C., Biggs, J. T., Ziegler, V. E. and Meyer, D. A. (1978). A rating scale for mania: reliability, validity and sensitivity. The British Journal of Psychiatry: The Journal of Mental Science, 133, 429–435.CrossRefGoogle ScholarPubMed