Adherence to Lithium Prophylaxis: I. Clinical Predictors and Patient's Reasons for Nonadherence

Maarbjerg, Karen; Aagaard, Jørgen; Vestergaard, Per

doi:10.1055/s-2007-1014662

Cited by 78 publications

(55 citation statements)

References 3 publications

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“…The longer duration of illness among our responders accords with Grof [8] but not with Mander [3]. Among nonresponders, previous drug abuse and younger age were consistent with numerous previous reports of noncompliant patients [7]. The use of multiple predictors, both clinical demographic, such as classical clinical BP presentation, illness duration, genetic loading, age, gender and drug abuse, has proved useful in differentiating responders from nonresponders [11,19].…”

Section: Discussionsupporting

confidence: 88%

“…The type of response after continuous Li therapy has prognostic long-term value after the first 6 months according to one author [1], or after periods up to 2 years as reported by others [2,3]. An effort was made to identify predictive factors including clinical presentations and sensory-motor symptoms during an episode [4], grandiosity [1,5,6], mood incongruent features [7], psychopathology during the interepisodic period [8,9], duration of illness [3], number of hospitalizations [10], and family history of bipolar illness [6,11].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Lithium Treatment Responsiveness in Bipolar Patients

Kusalic

Engelsmann

1998

Neuropsychobiology

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Twenty-nine bipolar patients were assessed before the start of lithium therapy to study the prognostic criteria of long-term response to therapy. Assessment included clinical and demographic data and laboratory tests administered before and 2–5 days after initiation of therapy. The tests included calcium and magnesium serum levels, and thyroid hormonal status. Patients were followed up for 2 years. None of the single variables predicted the response to lithium therapy, but a combination of clinical and demographic variables, used in a discriminant function analysis, correctly identified 78.9% of responders. Multiple regression analysis predicted 46.2% of the outcome. The strongest univariate predictors were mood quality, illness duration, and substance abuse.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Predictors of Lithium Treatment Responsiveness in Bipolar Patients

Kusalic

Engelsmann

1998

Neuropsychobiology

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“…Data on differential efficacy are supplemented by evaluation of suicidal behavior and patients' satisfaction with lithium and carbamazepine. Patients' satisfaction with a treatment is a crucial issue in compliance, and noncompliance is the limiting factor for efficacy in a major part of the patients [27,28]. …”

mentioning

confidence: 99%

Differential Efficacy of Lithium and Carbamazepine in the Prophylaxis of Bipolar Disorder: Results of the MAP Study

Kleindienst¹,

Greil

2000

Neuropsychobiology

105

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In a randomized clinical trial with an observation period of 2.5 years, the differential efficacy of lithium versus carbamazepine was compared in 171 bipolar patients (DSM-IV). In order to investigate the efficacy of the two drugs in clearly defined subsamples, a series of subgroup analyses was carried out. First, patients with a bipolar I disorder (n = 114) were analyzed separately. In these patients, lithium was superior to carbamazepine. In contrast, carbamazepine was at least equally as efficacious as lithium in the subsample of patients with bipolar II disorder or bipolar disorder not otherwise specified (n = 57). In a second analysis on differential efficacy, the whole sample was subdivided into a classical subgroup (bipolar I patients without mood-incongruent delusions and without comorbidity; n = 67) and a nonclassical subgroup including all other patients (n = 104). Classical bipolar patients had a significantly lower hospitalization rate under lithium than under carbamazepine prophylaxis (26 vs. 62%, p = 0.012). For the nonclassical group, a tendency in favor of carbamazepine was found. In a third step, we analyzed the impact of episode sequence on differential efficacy. In a global view, the episode sequence prior to the index episode was not correlated to differential efficacy. Our results might, however, indicate that patients with an episode sequence of mania-depression-free interval responded better to lithium. Besides differential efficacy, suicidal behavior and patients’ satisfaction with treatment were investigated. Regarding suicidal behavior, a trend in favor of lithium was found. The data on patients’ satisfaction were significantly in favor of carbamazepine. In conclusion, lithium appears to be superior to carbamazepine in classical bipolar cases and might have additional impact on proneness to suicide. The distinctly larger group of patients with nonclassical features might profit more from carbamazepine which seems to be well accepted by the patients. Hence, treatment alternatives to lithium are desirable for the majority of bipolar patients.

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“…Third, behavioral therapies can be used to enhance treatment engagement and stabilization, that is, to retain patients in a supportive therapeutic program that provides a structure within which pharmacologic treatments and other key services can be productively initiated or maintained. Fourth, because noncompliance with pharmacotherapy is common in dual diagnosis populations and can undermine treatment outcome (Brady 2000;Kemp et al 1996;Maarbjerg et al 1988;Ziedonis and Trudeau 1997), behavioral therapies can play a key role in promoting and maintaining compliance with pharmacologic treatments directed at the psychiatric symptoms, the substance use disorder, or both. Fifth, behavioral therapies can be used to target other psychosocial problems that commonly occur among individuals with co-occurring disorders.…”

Section: Roles Of Behavioral Therapiesmentioning

confidence: 99%

Behavioral therapies for co-occurring substance use and mood disorders

Carroll

2004

Biological Psychiatry

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There has been marked progress in recent years in the development of effective behavioral therapies for substance use disorders and in the largely independent development of behavioral therapies for mood disorders. Until recently, however, there were few well-specified behavioral approaches that incorporated an integrated approach for individuals in whom these disorders cooccur. The emerging literature on the efficacy of several types of behavioral therapy for engaging individuals with co-occurring mood and substance use disorders in treatment, reducing substance use and affective symptoms, enhancing adherence, and preventing disengagement and relapse is reviewed, followed by discussion of the challenges likely to be met in integrating these behavioral approaches into clinical practice. KeywordsCo-occurring disorders; substance use; behavioral therapies; review As described in detail in other articles in this special issue, there is ample evidence that rates of comorbidity between substance use, depression, and bipolar disorders are elevated (Kessler et al 1997;Regier et al 1990), that these dual disorders place considerable stress on the service delivery system (Dickey et al 2002;Drake et al 2004;Rosen et al 2002), and that the risk of poor outcome is higher among individuals with both substance use and mood disorders compared with those that have a single disorder (Brady and Sonne 1995;Brown et al 1998;Feinman and Dunner 1996;McKay et al 2002;Rounsaville et al 1986Rounsaville et al , 1987Thase et al 2001;Tohen et al 1990). What is also becoming clear is that a number of behavioral therapies can play a major role in several aspects of treatment for individuals with these complex disorders. This article will provide an overview of the roles that behavioral therapies (the term behavioral therapy is used here to refer to well-defined, manualized nonpharmacologic interventions rather than broader psychosocial or programmatic approaches) can play in the treatment of co-occurring substance use and mood disorders. Behavioral approaches that have been developed or adapted for these populations will be described, with a brief summary of findings from clinical trials evaluating their effectiveness, followed by a discussion of some of the challenges that will be faced as investigators and clinicians attempt to incorporate these empirically supported behavioral therapies into clinical practice. Roles of Behavioral TherapiesBehavioral therapies may play a range of roles in the treatment of individuals with cooccurring mood and substance use disorders. First, behavioral therapies may be used to directly target and reduce ongoing substance use. Because substance use may play a role in the perpetuation or exacerbation of psychiatric symptoms, the principal rationale for this strategy is that reductions in substance use are likely to reduce symptom severity as well as facilitate accurate assessment and appropriate treatment of the comorbid affective disorder. Second, behavioral therapies can be used to directly addres...

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Adherence to Lithium Prophylaxis: I. Clinical Predictors and Patient's Reasons for Nonadherence

Cited by 78 publications

References 3 publications

Predictors of Lithium Treatment Responsiveness in Bipolar Patients

Predictors of Lithium Treatment Responsiveness in Bipolar Patients

Differential Efficacy of Lithium and Carbamazepine in the Prophylaxis of Bipolar Disorder: Results of the MAP Study

Behavioral therapies for co-occurring substance use and mood disorders

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