Do clinicians understand why individuals stop taking lithium?
BACKGROUND
Previous research highlights that, over a 2-year period, up to 50% of individuals receiving lithium prophylaxis are non-adherent with medication against medical advice. The main reasons identified by clinicians only partially reflect the reasons given by patients.


METHODS
Seventy-two subjects who were identified from biochemistry laboratory data as receiving lithium for an affective disorder and who gave written informed consent, completed the 'Reasons for Stopping Medication' questionnaire. Forty-one clinicians involved in treating these 72 patients also completed the same questionnaire. Ratings on the 'Reasons for Stopping Medication' questionnaire were compared between adherent and non-adherent patients and between patients and their clinicians.


RESULTS
Adherent (n=39) and previously non-adherent patients (n=33) showed a high level of concordance in their rank ordering of reasons for considering stopping taking lithium (Kendall's W=0.059; P=0.001), with 'bothered by the idea that moods were controlled by medication', 'bothered by the idea of a chronic illness' and 'felt depressed' being the most commonly endorsed items. Clinicians and patients views showed low levels of concordance (Kendall's W=0.019; P=0.32). Clinicians identified 'missing highs', and 'felt well, saw no need to take medication' as the most likely reasons for non-adherence. The differences in the primary reasons for stopping lithium identified by clinicians and patients were statistically significant (chi(2)=61.1; df 40, P=0.005).


CONCLUSIONS
Patients' reasons for stopping lithium appear to be influenced by concerns about what having an affective disorder and taking medication says about them. Clinicians are not fully aware of the main reasons patients would stop prophylactic treatment.
Department of Psychological Medicine, PO Box 96, Institute of Psychiatry, De Crespigny Park City SE5 8AF, UK.
Marie
M
Pope
Jan
J
Scott
D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy*; D003071:Cognition; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use*; D008297:Male; D011795:Surveys and Questionnaires; D016312:Treatment Refusal
D016651:Lithium Carbonate