Rosa Adriane Ribeiro, Marco Marion, Fachel Jandyra M G, Kapczinski Flávio, Stein Airton Tetelbom, Barros Helena M T
Division of Phamacology, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Brazil.
Prog Neuropsychopharmacol Biol Psychiatry. 2007 Jan 30;31(1):217-24. doi: 10.1016/j.pnpbp.2006.08.007. Epub 2006 Sep 18.
Non-adherence should always be investigated when there is a failure in bipolar treatments, since it is known that reported non-adherence rates in bipolar disorder treatment for long-term prophylactic pharmacotherapy range from 18% to 52%, with a median prevalence of 44.7%. Several factors are related to the poor adherence and reduction of medication efficiency, such as the different types of bipolar disorder, the presence of side effects, medication interactions, level of patient's knowledge about the disorder and their attitude towards treatment, complexity of medical regimens and the doctor-patient relationship.
Bipolar disorder outpatients under lithium treatment from the Hospital de Clínicas and Materno Infantil Presidente Vargas of Porto Alegre were recruited. All the patients had bipolar disorder and gave informed consent to participate in a clinical interview (106), answered the Lithium Attitudes Questionnaire (LAQ), Lithium Knowledge Test (LKT), Medication Adherence Rating Scale (MARS) and had plasma and red blood cells lithium measurements to assess their medication adherence and the factors that influenced it.
85.6% of bipolar disorder were adherent to lithium treatment showing plasma lithium between 0.6 and 1.2 mmol/L. There was an inverted correlation between the total LAQ score with plasma and red blood cells, a positive correlation between LKT and MARS with plasma and red blood cell lithium.
These results confirmed that knowledge level is directly correlated to treatment adherence and patients' attitudes, lower adherence, general opposition to prophylaxis, fear of side effects, denial of therapeutic effectiveness and illness severity.
双相情感障碍治疗失败时，应始终调查不依从情况，因为已知双相情感障碍长期预防性药物治疗的报告不依从率在18%至52%之间，中位患病率为44.7%。有几个因素与依从性差和药物疗效降低有关，如双相情感障碍的不同类型、副作用的存在、药物相互作用、患者对该疾病的了解程度及其对治疗的态度、治疗方案的复杂性以及医患关系。
招募了阿雷格里港总统瓦加斯临床医院和母婴医院接受锂治疗的双相情感障碍门诊患者。所有患者均患有双相情感障碍，并已签署知情同意书参与临床访谈（106例），回答锂态度问卷（LAQ）、锂知识测试（LKT）、药物依从性评定量表（MARS），并进行血浆和红细胞锂测量，以评估其药物依从性及其影响因素。
85.6%的双相情感障碍患者坚持锂治疗，血浆锂浓度在0.6至1.2 mmol/L之间。LAQ总分与血浆和红细胞之间呈负相关，LKT和MARS与血浆和红细胞锂呈正相关。
这些结果证实，知识水平与治疗依从性和患者态度直接相关，依从性较低、普遍反对预防、害怕副作用、否认治疗效果和疾病严重程度。
