Medication therapy: adherence, knowledge and difficulties of elderly people from bipolar disorder

Abstract

This study aimed to verify the adherence, knowledge and the difficulties of elderly patients with Bipolar Affective Disorder (BAD) in relation to the prescribed pharmacological therapy for the control of this disorder. The study included 17 elderly patients with BAD treated at a Mental Health Center. Semi-structured interviews were conducted and scales were applied. The data were analyzed using a quali-quantitative approach. A low level of adherence to the pharmacological treatment and a deficit in knowledge in relation to the medication were identified, especially regarding the dose and frequency of administration. Among the difficulties inherent to the pharmacotherapy, the obligation of polypharmacotherapy, the desire to quit the pharmacological treatment, limitations in the self-administration of the medication, collateral effects, and doubts about the need for the medication were related. Investment is needed in educational activities and in the promotion of adherence that address the difficulties experienced by elderly people with BAD in the following of the pharmacotherapy in order to ensure safety in the medication therapy.Descriptors: Bipolar Disorder; Medication Adherence; Aged. Identificou-se baixo grau de adesão ao tratamento farmacológico e déficit no conhecimento sobre os medicamentos, especialmente sobre as doses e frequência de administração.Entre as dificuldades inerentes à farmacoterapia relataram-se: a obrigatoriedade da polifarmacoterapia, o desejo de encerrar o tratamento farmacológico, limitações na autoadministração dos fármacos, efeitos colaterais e dúvidas sobre a necessidade dos medicamentos. São necessários investimentos em ações educativas e de promoção da adesão que contemplem as dificuldades vivenciadas pelos idosos com TAB, no seguimento da farmacoterapia, para garantia de segurança na terapêutica medicamentosa.Descritores: Transtorno Bipolar; Adesão à Medicação; Idoso. Terapéutica medicamentosa: adhesión, conocimiento y dificultades de personas ancianas portadoras de trastorno bipolarEste estudio tuvo como objetivo verificar la adhesión, el conocimiento y las dificultades de ancianos con Trastorno Afectivo Bipolar (TAB) en relación a la terapéutica medicamentosa prescrita para control del referido trastorno. Participaron del estudio 17 ancianos con TAB atendidos en un Núcleo de Salud Mental. Fueron realizadas entrevistas semiestructuradas y aplicación de escalas. Los datos fueron analizados con abordaje cualitativo-cuantitativo. Se identificó bajo grado de adhesión al tratamiento farmacológico y déficit en el conocimiento sobre los medicamentos, especialmente sobre las dosis y frecuencia de administración. Entre las dificultades inherentes a la fármacoterapia fueron relatadas la obligatoriedad de la polifármacoterapia, el deseo de terminar el tratamiento farmacológico, las limitaciones en la auto-administración de los fármacos, los efectos colaterales y las dudas sobre la necesidad de los medicamentos. Se concluye que son necesarias inversiones en acciones educativas y de promoción...

Bipolar disorder and medication: adherence, patients' knowledge and serum monitoring of lithium carbonate

“…Most patients with BD did not adhere to drug therapy, as identified in previous studies (3,22,24) . The majority of those who did not adhere to it, had this behavior unintentionally, and this is also corroborated by the literature (24) .…”

“…Simultaneous use of medications can be a problem in following a medical treatment, as it increases the chances of side effects, the difficulties of self-administration of prescribed medications and, consequently, it increases the probability of non-adherence (22) .…”

“…Patients' knowledge concerning the therapeutic framework is a basic condition for the conduction of the treatment if they are responsible for self-administrating the drugs (22) . In the present study, it was possible to note that patients expressed difficulties in adequately reporting the dosage of the drugs prescribed and this fact can compromise their safety in the use of these medications.…”

The applicability of the concept of treatment adherence in the context of the Brazilian mental health system

“…Regarding the research design, Brazilian researchers in the area of Nursing and Psychiatry (18)(19)(26)(27) show a preference for designs considered to be "robust" (28) and for the consistent application of related instruments, such as structured interviews, scales, and tests, to collect data that are then analyzed quantitatively. Only 2 of the studies reviewed (21,26) involve mixed methodologies and utilize a quantitative analysis of the test results and qualitatively analyzed semi-structured interviews.…”

“…It should be emphasized that most of the analyzed studies quantify adhesion to psychopharmacological treatment, measuring the intake of prescription drugs or compliance with other procedures, such as observing schedules, dosages, and treatment durations (18)(19)(26)(27) . In some cases, the measurement was based on the frequency with which the patient follows the recommendations of the consulting professional, returns to the health service for consultation, or adheres to prescribed medical treatments (21) .…”