The combat of non-compliance during prophylactic lithium treatment.

Non-compliance is the most frequent cause of recurrence during prophylactic lithium treatment and is associated with poor response and high levels of suicidality. Non-compliance is a complex phenomenon and may have a number of causes. When manic-depressive patients fare badly under the conditions of so-called 'naturalistic' trials, this usually indicates that such conditions are inadequate for long-term maintenance treatment. Prophylactic lithium treatment must be accompanied by measures to sustain compliance and counteract drop-out, and these measures build on three cornerstones, namely information, support and supervision.