Adherence to treatment regimen in a lithium carbonate clinic

Adherence to a prophylactic regimen for primary affective disorder was studied with the Standardized Compliance Questionnaire given to 48 outpatients to determine perceptions of their illness, treatment, mood state, and side effects. Clinicians rated the course of the illness for 12 months. Adherence was defined as lithium level between 0.5 and 1.5 mEq/L and attendance at 75% of clinic appointments for nine months. One patient was nonadherent with both indices, whereas 11 were nonadherent with neither medication regimen or appointment keeping, suggesting that each behavior should be scrutinized separately. Elevated mood was associated with overall nonadherence, marriage was associated with adherence to drug regimen, and perception of continuity of care was associated with appointment-keeping adherence. No association was found between nonadherence and diagnostic subcategory or between adherence and reported side effects. The relationship between nonadherence and poor outcome was significant.