The prevalence and nature of lithium noncompliance among Chinese psychiatric patients in Hong Kong.
Based on the multiple criteria of serum lithium level, patients' subjective report and doctors' impression in the previous year, a noncompliance rate of 30% was found among 50 Chinese patients on chronic lithium treatment in Hong Kong. Of numerous variables analyzed, only lithium monotherapy, younger age, and earlier age of onset were significantly associated with noncompliance. Exploratory interviews documented the multidimensionality of lithium noncompliance. They argued against statistical attempts to establish a universal clinical formula for the prediction of lithium noncompliance, and underscored the personal, social and medical contexts in which illnesses were lived and treatments used. For cultural reasons, familiar Western rationales for legitimating lithium noncompliance, such as missing of highs, loss of assertiveness, loss of creativity, and excessive fear of weight gain, were rarely encountered. After 1 1/2-years of attendance and with specific interventions at the lithium clinic, the noncompliance rate decreased from 30% to 14%. The important role of a parent-child-dominated Chinese kinship system in the chronic care of psychiatric patients is also discussed.
Lee
S
S
Department of Psychiatry, Prince of Wales Hospital, Shatin, Hong Kong.
D000293:Adolescent; D000328:Adult; D000341:Affective Disorders, Psychotic / Q000188:drug therapy* / Q000208:ethnology / Q000523:psychology; D000553:Ambulatory Care; D002681:China / Q000208:ethnology; D003469:Culture; D003866:Depressive Disorder / Q000188:drug therapy / Q000208:ethnology / Q000523:psychology; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006723:Hong Kong; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010287:Parent-Child Relations; D015995:Prevalence; D011618:Psychotic Disorders / Q000188:drug therapy / Q000208:ethnology / Q000523:psychology; D016312:Treatment Refusal
D008094:Lithium