title: Attitudes towards pharmacotherapy in late-life bipolar disorder.
abstract: 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.
authors.affiliation: Department of Psychiatry,Division of Geriatric Psychiatry,University of Toronto,Toronto,Canada.
authors.forename: Soham
authors.initials: S
authors.lastname: Rej
authors.affiliation: Department of Old Age Psychiatry,GGZ inGeest/VUmc,Amsterdam,the Netherlands.
authors.forename: Josien
authors.initials: J
authors.lastname: Schuurmans
authors.affiliation: Department of Psychiatry,McGill University,Montreal,Canada.
authors.forename: Dominique
authors.initials: D
authors.lastname: Elie
authors.affiliation: Department of Old Age Psychiatry,GGZ inGeest/VUmc,Amsterdam,the Netherlands.
authors.forename: Max L
authors.initials: ML
authors.lastname: Stek
authors.affiliation: Department of Psychiatry,Division of Geriatric Psychiatry,University of Toronto,Toronto,Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Shulman
authors.affiliation: Department of Old Age Psychiatry,GGZ inGeest/VUmc,Amsterdam,the Netherlands.
authors.forename: Annemiek
authors.initials: A
authors.lastname: Dols
mesh_terms: D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010349:Patient Compliance; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014505:Urban Population
chemical_list: D011619:Psychotropic Drugs; D008094:Lithium
keywords: adherence; bipolar disorder; geriatric; lithium; patient attitudes towards pharmacotherapy