Compliance with bipolar disorder

Among patients with bipolar disorder, schizophrenia and major depression the prevalence of comorbid substance use disorders may be as high as 50%. Substance use disorders are usually associated with Axis [I (personality) disorders, poor treatment compliance and poorer response to pharmacotherapy exclusion or at least adequate diagnosis of these patients is therefore essential for clinical trials. 

Weiss RD, Greenfield SF, Najavits LM, et al. Medication compliance among patients with bipolar disorder and substance abuse disorder. J din Psychiatry 1998 59 172-174. 

Maintenance and prophylaxis with lithium, and perhaps other mood stabilizers, favorably alters the longitudinal course of a bipolar disorder. Thus, efforts to enhance long-term compliance are a necessary part of any overall strategy. The incidence of adverse or toxic events is relatively low, and close attention to the more clinically relevant consequences can usually prevent serious sequelae ( 198).An issue of critical importance for future research is the potential efficacy of alternative maintenance medication for those who fail to respond adequately to acute or long-term lithium therapy. 

Patient education about the role of lithium in the prophylaxis of bipolar affective disorder and discussion of the pros and cons of taking the drug are particularly important to encourage compliance with therapy treatment cards, information leaflets and where appropriate, video material are used. 

Comprehensive patient education is critical in ensuring compliance and in ultimately limiting the devastating effects of bipolar disorder. Perhaps the most difficult fact for the patient to accept is the need for long-term treatment. In addition, patients must become active participants in identifying target symptoms and critical side effects, especially with lithium. 

---