Adherence to lithium prophylaxis: I. Clinical predictors and patient's reasons for nonadherence

Of a group of 133 patients given long-term prophylactic lithium treatment, approximately 25 percent discontinued the treatment prematurely within the first six months. Young male patients dominated in the nonadherent group. Clinically the nonadherent patients were characterized by having had an early onset of the illness, a large number of previous hospital admissions and a recent allocation to the diagnostic category of affective disorder. Furthermore, the presence of personality disorders and substance abuses characterized the nonadherent patients. Diagnostic grouping according to polarity did not allow for any distinction between the adherent and nonadherent patients. One half of the nonadherent patients mentioned the development of somatic side effects as their main reason for discontinuing the treatment. Psychological discomfort, such as development of concentration difficulties or impaired memory, was not stated as a reasons for discontinuation. One fourth of the nonadherent patients had their diagnoses, and consequently their treatment, changed by the physician in charge and one fourth neglected instructions and disregarded appointments.