1
|
Loots E, Dilles T, Van Rompaey B, Morrens M. Attitudes of patients with schizophrenia spectrum or bipolar disorders towards medication self-management during hospitalisation. J Clin Nurs 2024; 33:1459-1469. [PMID: 38041238 DOI: 10.1111/jocn.16936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 09/06/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Medication self-management (MSM) is defined as a person's ability to cope with medication treatment for a chronic condition, along with the associated physical and psychosocial effects that the medication causes in their daily lives. For many patients, it is important to be able to self-manage their medication successfully, as they will often be expected to do after discharge. AIM The aim of this study was to describe the willingness and attitudes of patients with schizophrenia spectrum or bipolar disorders regarding MSM during hospital admission. A secondary aim was to identify various factors associated with patient willingness to participate in MSM and to describe their assumptions concerning needs and necessary conditions, as well as their attitudes towards their medication. METHODS A multicentre, quantitative cross-sectional observational design was used to study the willingness and attitudes of psychiatric patients regarding MSM during hospitalisation. The study adhered to guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). RESULTS In this study, 84 patients, of which 43 were patients with schizophrenia spectrum disorders and 41 were patients with bipolar disorders, participated. A majority of the patients (81%) were willing to participate in MSM during their hospitalisation. Analysis revealed patients are more willing to MSM if they are younger (r = -.417, p < .001) and a decreasing number of medicines (r = -.373, p = .003). Patients' willingness was positively associated with the extent of support by significant others during and after hospitalisation (Pearson's r = .298, p = .011). Patients were convinced that they would take their medication more correctly if MSM were to be allowed during hospitalisation (65%). CONCLUSION Most of the patients were willing to self-manage their medication during hospitalisation, however, under specific conditions such as being motivated to take their medication correctly and to understand the benefits of their medication. RELEVANCE TO CLINICAL PRACTICE From a policy point of view, our study provided useful insights into how patients look at MSM to enable the development of future strategies. Since patients are willing to self-manage their medication during hospitalisation, this may facilitate its implementation. PATIENT CONTRIBUTION Patients were recruited for this study. Participation was voluntary, and signed informed consent was obtained from all participants prior to the questionnaire.
Collapse
Affiliation(s)
- Elke Loots
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium
| | - Tinne Dilles
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium
| | - Bart Van Rompaey
- Faculty of Medicine and Health Sciences, Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Manuel Morrens
- Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute, University Department of Psychiatry, University of Antwerp, Antwerp, Belgium
- University Psychiatric Centre Duffel, Duffel, Belgium
| |
Collapse
|
2
|
Beunders AJM, Regeer EJ, van Eijkelen M, Mathijssen H, Nijboer C, Schouws SNTM, van Oppen P, Kok AAL, Kupka RW, Dols A. Bipolarity in Older individuals Living without Drugs (BOLD): Protocol and preliminary findings. J Affect Disord 2024; 348:160-166. [PMID: 38154581 DOI: 10.1016/j.jad.2023.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 12/01/2023] [Accepted: 12/23/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Although clinical guidelines regard prophylactic medication as the cornerstone of treatment, it is estimated almost half of patients with bipolar disorder (BD) live without medication. This group is underrepresented in research but can provide indispensable knowledge on natural course, resilience and self-management strategies. We aim to describe the clinical phenotype of patients diagnosed with BD who have discontinued maintenance treatment. METHODS The mixed-methods BOLD study included 58 individuals aged 50 years and over with BD that did not use maintenance medication in the past 5 years. A preliminary, quantitative comparison of clinical characteristics between BOLD and our pre-existing cohort of >220 older BD outpatients with medication (Dutch Older Bipolars, DOBi) was performed. RESULTS BD-I, psychiatric comorbidities, number of mood episodes and lifetime psychotic features were more prevalent in BOLD compared to DOBi. BOLD participants had a younger age at onset and reported more childhood trauma. BOLD participants reported fewer current mood symptoms and higher cognitive, social, and global functioning. LIMITATIONS Our findings may not be generalizable to all individuals diagnosed with BD living without maintenance medication due to selection-bias. CONCLUSION A group of individuals exists that meets diagnostic criteria of BD and is living without maintenance medication. They appear to be relatively successful in terms of psychosocial functioning, although they do not have a milder clinical course than those on maintenance medication. The high prevalence of childhood trauma warrants further investigation. Future analyses will examine differences between BOLD and DOBi per domain (e.g. cognition, physical health, psychosocial functioning, coping).
Collapse
Affiliation(s)
- Alexandra J M Beunders
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Eline J Regeer
- Altrecht GGZ Mental Health Care Institute, Outpatient Clinic for Bipolar Disorders, Utrecht, the Netherlands
| | - Marieke van Eijkelen
- Plusminus (Dutch Patient Association for Bipolar Disorder); MIND (Dutch online platform for mental health), Utrecht, the Netherlands
| | - Henk Mathijssen
- Plusminus (Dutch Patient Association for Bipolar Disorder); MIND (Dutch online platform for mental health), Utrecht, the Netherlands
| | | | - Sigfried N T M Schouws
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands
| | - Patricia van Oppen
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Almar A L Kok
- Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Ralph W Kupka
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands; Altrecht GGZ Mental Health Care Institute, Outpatient Clinic for Bipolar Disorders, Utrecht, the Netherlands
| | - Annemiek Dols
- Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands; Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress, Amsterdam, the Netherlands.
| |
Collapse
|
3
|
Dols A, Sekhon H, Rej S, Klaus F, Bodenstein K, Sajatovic M. Bipolar Disorder Among Older Adults: Newer Evidence to Guide Clinical Practice. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:370-379. [PMID: 38695001 PMCID: PMC11058954 DOI: 10.1176/appi.focus.20230010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The term older-age bipolar disorder (OABD) refers to patients with bipolar disorder who are ages 50 and older. Research findings suggest important differences, including the attenuation of manic symptoms with age and the occurrence of multiple somatic comorbid conditions. Although the pharmacological treatment of OABD is fairly similar, adverse effects, somatic comorbidity, and drug-drug interactions are more common. Lithium is effective in treating OABD and may have the potential to be neuroprotective. Anticonvulsants and second-generation antipsychotics have a growing evidence supporting their use in treating OABD. Behavioral intervention can be a helpful adjunct to pharmacological treatment. Clinicians and health care systems need to be prepared to provide care and services to individuals with bipolar disorder throughout the life span. Although older adults have typically been excluded from bipolar disorder RCTs, emerging efforts organized by global advocates and harnessing teams of clinicians and scientists have the potential to advance care.
Collapse
Affiliation(s)
- Annemiek Dols
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
| | - Harmehr Sekhon
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
| | - Soham Rej
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
| | - Federica Klaus
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
| | - Katie Bodenstein
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
| | - Martha Sajatovic
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands (Dols); Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Quebec, Canada (Sekhon, Rej, Bodenstein); McLean Hospital (Harvard Medical School Affiliate), Belmont, Massachusetts (Sekhon); Department of Psychiatry, University of California, San Diego, La Jolla, California (Klaus); Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Sajatovic)
| |
Collapse
|
4
|
Forlenza OV, Hajek T, Almeida OP, Beunders AJ, Blumberg HP, Briggs FB, De-Paula VJR, Dols A, Eyler LT, Forester BP, Gildengers A, Jimenez E, Korten NC, Lafer B, McWhinney SR, Mulsant B, Rej S, Sarna K, Schouws S, Sutherland A, Tsai S, Vieta E, Yala J, Sajatovic M. Demographic and clinical characteristics of lithium-treated older adults with bipolar disorder. Acta Psychiatr Scand 2022; 146:442-455. [PMID: 35837985 PMCID: PMC9588573 DOI: 10.1111/acps.13474] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVES There is limited information on the characteristics of older adults with bipolar disorder (OABD) treated with lithium, along with safety concerns about its use by older adults. The aim of the present study is to describe the demographic and clinical characteristics of OABD receiving lithium therapy, using data from the Global Ageing & Geriatric Experiments in Bipolar Disorder (GAGE-BD). EXPERIMENTAL PROCEDURES Cross-sectional analysis of the GAGE-BD dataset to determine differences and similarities between lithium users and non-users. We analysed data from 986 participants aged 50 years or older (mean age 63.5 years; 57.5% females) from 12 study sites. Two subgroups ('Lithium'; 'Non-lithium') were defined according to the current prescription of lithium. We compared several outcomes between these groups, controlling for age, gender, and study site. RESULTS OABD treated with lithium had lower scores on depression rating scales and were less likely to be categorised as with moderate or severe depression. There was a lower proportion of lithium users than non-users among those with evidence of rapid cycling and non-bipolar psychiatric diagnoses. Assessment of global cognitive state and functionality indicated better performance among lithium users. The current use of antipsychotics was less frequent among lithium users, who also reported fewer cardiovascular comorbidities than non-users. CONCLUSION We found several potentially relevant differences in the clinical profile of OABD treated with lithium compared with those treated with other mood stabilisers. However, the interpretation of the present results must take into account the methodological limitations inherent to the cross-sectional approach and data harmonisation.
Collapse
Affiliation(s)
- Orestes V. Forlenza
- Department & Institute of Psychiatry, Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, Brazil
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | | | - Alexandra J.M. Beunders
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, the Netherlands
| | | | - Farren B.S. Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Vanessa J. R. De-Paula
- Vanessa J. R. De-Paula, Laboratory of Neuroscience (LIM-27), Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, Brazil
| | - Annemiek Dols
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, the Netherlands
| | - Lisa T. Eyler
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, USA
| | - Brent P. Forester
- Division of Geriatric Psychiatry, McLean Hospital, Belmont; Harvard Medical School, Boston, USA
| | - Ariel Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Esther Jimenez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Nicole C.M. Korten
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, the Netherlands
| | - Beny Lafer
- Department & Institute of Psychiatry, Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, Brazil
| | | | - Benoit Mulsant
- Benoit Mulsant, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada
| | - Soham Rej
- Soham Rej, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Canada
| | - Kaylee Sarna
- Kaylee Sarna, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Sigfried Schouws
- GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, the Netherlands
| | - Ashley Sutherland
- Ashley Sutherland, Department of Psychiatry, University of California at San Diego, San Diego, USA
| | - Shangying Tsai
- Shangying Tsai, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Joy Yala
- Kaylee Sarna, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Martha Sajatovic
- Kaylee Sarna, Case Western Reserve University School of Medicine, Cleveland, USA
- Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD): please see Supplemental Material for members of the GAGE-BD initiative
| |
Collapse
|
5
|
Bednarczyk E, Cook S, Brauer R, Garfield S. Stakeholders' views on the use of psychotropic medication in older people: a systematic review. Age Ageing 2022; 51:6550831. [PMID: 35305087 PMCID: PMC8934150 DOI: 10.1093/ageing/afac060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Indexed: 12/24/2022] Open
Abstract
Background psychotropic medication use has been shown to increase with age and has been associated with increased risk of falls, strokes and mortality. Various guidelines, regulations and tools have been developed to reduce inappropriate prescribing, but this remains high. In order to understand the reasons for this, we aimed to systematically review healthcare professionals’, patients’ and family caregivers’ attitudes towards the use of psychotropic medication in older people. Methods a systematic literature search was carried out from inception to September 2020 using PUBMED, EMBASE, PsycINFO and CINAHL and hand-searching of reference lists. Included studies investigated stakeholder views on psychotropic in adults over the age of 65. Findings were thematically synthesised. Results overall, there was an acceptance of long-term psychotropic medication for older people both living in the community and in residential care. While healthcare professionals were aware of guidelines for the use of benzodiazepines and psychotropic medicines, they identified barriers to following them on individual, team and organisational levels. Alternative non-pharmacological approaches were not always available or accepted by patients. Conclusion psychotropic medicine use in older adults remains a complex issue, which needs to be addressed on a broad level. Attitudes of older people and healthcare professionals encourage long-term use. Meanwhile, various internal and external factors act as barriers to the use of non-drug alternatives in this population. In order to reduce overprescribing of psychotropics, there is a need to increase the acceptability and accessibility of alternative interventions in both care homes and the community.
Collapse
Affiliation(s)
- Eliza Bednarczyk
- Research Department of Practice and Policy, School of Pharmacy, University College London (UCL), London, UK
| | - Sarah Cook
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Ruth Brauer
- Research Department of Practice and Policy, School of Pharmacy, University College London (UCL), London, UK
| | - Sara Garfield
- Research Department of Practice and Policy, School of Pharmacy, University College London (UCL), London, UK
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
- NIHR Imperial Patient Safety Translational Research Centre, London, UK
| |
Collapse
|
6
|
Flapper M, van Melick E, van Campen J, Schutter N, Kok R. Tolerability of lithium: A naturalistic discontinuation study in older inpatients (≥60 years). Int J Geriatr Psychiatry 2021; 36:1231-1240. [PMID: 33644915 DOI: 10.1002/gps.5517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/31/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Lithium is one of the most effective treatment options in both bipolar disorder and treatment-resistant depression. The use of lithium in older patients declined during the last decades, probably resulting in undertreatment of older patients. To investigate how well lithium is tolerated in old age, we aimed to determine the frequency, reasons, and possible predictors of discontinuation due to adverse effects in a cohort of inpatients ≥60 years who had started with lithium. METHODS We performed a retrospective cohort study based on chart reviews. Participants were in treatment at Parnassia Group at The Hague, The Netherlands. After inclusion (between January 2010 and December 2016), participants were followed until April 2017, when we performed data extraction and analysis. RESULTS In our sample of 135 patients (median age 69 years, median follow-up duration 18 months), 49 (36.3%) participants discontinued lithium. Only a minority (11 [8.1%]) of the participants discontinued solely due to adverse effects. The majority discontinued lithium due to psychiatric (18, 5%) reasons (most commonly mentioned within this subgroup: lack of effectiveness and noncompliance) or a combination of reasons (7.4%). None of the factors we studied (age, gender, Charlson Comorbidity Index, polypharmacy, renal function, and neurological history) were significantly associated with discontinuation due to adverse effects. CONCLUSIONS The frequency of lithium discontinuation in our cohort was in range with frequencies reported in younger patients. Older age itself should not be a reason to withhold lithium treatment.
Collapse
Affiliation(s)
| | - Els van Melick
- Department of Geriatrics, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Jos van Campen
- Department of Geriatrics, OLVG, Amsterdam, The Netherlands
| | - Natasja Schutter
- Department of Geriatric Psychiatry, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Rob Kok
- Department of Old Age Psychiatry, Parnassia Psychiatric Institute, The Hague, The Netherlands
| |
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW With more individuals reaching older ages, bipolar disorder is no longer a rare illness in the elderly. Despite the growing number of the older individuals with the illness, there are few studies that focus on bipolar disorder in the geriatric population leading to gaps in clinical knowledge and treatment. The aim of this study is therefore to increase understanding by summarizing the available literature on the epidemiology, symptomatology, comorbidities, and treatment recommendations in this cohort, as well as to suggest areas for future clinical and research focus. RECENT FINDINGS The prevalence of bipolar disorder is underestimated in the geriatric population. The illness maintains the main features observed in the other cohorts but it also has some specific characteristics in the older individuals. In this cohort, psychiatric and medical comorbidities tend to be the rule rather than the exception. Higher rates of cognitive impairments than age- and education-matched groups present across all of the illness phases. Treatment is more challenging in the elderly individuals due to higher rates of comorbidities and susceptibility to medication side effects. Two cohorts of older individuals with bipolar disorder can be recognized, those with symptoms that start earlier in life and those with late-life onset. Although the knowledge about elderly bipolar disorder is only slowly growing, it is increasingly recognized as an illness with unique features. More work is needed to improve diagnosis and to establish treatment guidelines.
Collapse
Affiliation(s)
- Ahmad Shobassy
- Department of Psychiatry, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA.
| |
Collapse
|
8
|
Chakrabarti S. Treatment Attitudes and Adherence Among Patients with Bipolar Disorder: A Systematic Review of Quantitative and Qualitative Studies. Harv Rev Psychiatry 2020; 27:290-302. [PMID: 31385812 DOI: 10.1097/hrp.0000000000000228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Systematic reviews about treatment attitudes of patients influencing adherence in bipolar disorder (BD) are rare. METHODS A systematic review was conducted according to the PRISMA guidelines and principles of thematic synthesis. Selectively identified quantitative and qualitative studies were used to examine the attitude-adherence relationship in BD, the types and correlates of treatment attitudes, and the impact of psychosocial interventions on attitudes. RESULTS The final list of 163 articles included 114 observational reports (incorporating 21 psychosocial intervention trials), 45 qualitative/descriptive studies, and 4 patient surveys. A positive association between treatment attitudes and adherence was found in most quantitative and qualitative studies, though the strength of the relationship was unclear. Thematic analysis of qualitative studies suggested that patient attitudes influencing adherence were based on perceived advantages and disadvantages of treatment. The principal correlates of patients' attitudes were family attitudes, the clinician-patient alliance, social support, and patients' knowledge of BD. Though negative attitudes such as denial, concerns about adverse treatment consequences, and stigmatizing effects of treatment were common, many patients believed treatment to be beneficial and necessary. The limited data on the effect of psychosocial interventions indicated that treatments selectively targeting attitudes enhanced adherence. LIMITATIONS The studies were heterogeneous in design; the quality was uneven (fair to poor); and the risk of bias moderate to high. CONCLUSIONS Despite these flaws, awareness of the existing evidence on the attitude-adherence association and other aspects of treatment attitudes in BD can help in efforts to address nonadherence in BD.
Collapse
Affiliation(s)
- Subho Chakrabarti
- From the Department of Psychiatry, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh (India)
| |
Collapse
|
9
|
The Relationship Between Medication Attitudes and Medication Adherence Behavior in Adults With Bipolar Disorder. J Nerv Ment Dis 2020; 208:87-93. [PMID: 31929465 PMCID: PMC7316161 DOI: 10.1097/nmd.0000000000001083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The relationship between medication attitudes and adherence as well as reliable measures of medication attitudes need further study. This study examined the psychometric properties of the Attitudes Toward Mood Stabilizers Questionnaire (AMSQ) in bipolar participants and the relationship between medication attitudes and adherence, measured by the self-reported Tablets Routine Questionnaire (TRQ). Inclusion criteria included mood stabilizer treatment and 20% or more medication nonadherence. Measures were given pretreatment and posttreatment. Average age was 47 years; majority were female (69%), African American (67%), and unmarried (53%). AMSQ's test-retest reliability was ρ = 0.73 (p < 0.001). AMSQ correlated with TRQ (rs = 0.20, p < 0.01) at baseline. Factor analysis identified three factors: positive/favorable attitudes, negative/critical attitudes, and unintentional nonadherence. Change in AMSQ across time correlated with change in TRQ. The AMSQ is valid psychometrically and is sensitive to change. Medication attitudes are related to adherence behavior. Interventions should include targeting specific domains of medication attitudes, such as illness knowledge.
Collapse
|
10
|
Di Lorenzo R, Perrone D, Montorsi A, Balducci J, Rovesti S, Ferri P. Attitude Towards Drug Therapy in a Community Mental Health Center Evaluated by the Drug Attitude Inventory. Patient Prefer Adherence 2020; 14:995-1010. [PMID: 32606616 PMCID: PMC7307441 DOI: 10.2147/ppa.s251993] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Negative attitude towards drug therapy can foster limited adherence to treatment, which remains one of the biggest obstacles for implementing effective treatments, especially long term. PURPOSES The purposes of the study were 1) to evaluate the attitude towards drug therapy among a representative sample of patients treated in a community psychiatric service using 30-item Drug Attitude Inventory (DAI-30); 2) to evaluate the DAI-30 dimensions, applying factorial analysis; and 3) to highlight the socio-demographic and clinical variables correlated to DAI-30 score and factors. METHODS The DAI was administered, over a 7-month period, to all patients treated in our psychiatric outpatient services who agreed to participate in this study and provided their informed consent. Data were statistically analyzed. RESULTS With a response rate of 63.3%, 164 females and 136 males completed the DAI-30 with an average score of 14.24 (±10.46 SD), indicating moderately positive attitude towards drug therapy. The analysis of DAI-30 internal consistency confirmed its reliability (Cronbach's alpha=0.84). Our factorial analysis highlighted three factors: Factor 1 (Cronbach's alpha=0.81), composed of 7 items which indicate positive, trustful attitude; Factor 2 (Cronbach's alpha=0.78), composed of 5 items indicating negative attitude of suspiciousness; and Factor 3 (Cronbach's alpha=0.66), composed of 4 items suggesting defensive and control attitude towards drug therapy. DISCUSSION Among the selected variables, "monotherapy" and "total number of hospitalizations" were negatively correlated to the final score of DAI-30, whereas being "married" was positively correlated to it, in a statistically significant way, using the multiple linear regression model. These correlations suggest that positive attitude towards drug therapy could be reinforced by the condition of being married and reduced by relapses with hospitalization, as literature highlighted, and, paradoxically, by a monotherapy, which could suggest a sort of psychological dependence on therapy and, indirectly, on psychiatric service, potentially correlated to the long-term treatments of our patients.
Collapse
Affiliation(s)
- Rosaria Di Lorenzo
- Mental Health and Drug Abuse Department of AUSL-Modena, Psychiatric Intensive Treatment Facility, Modena41122, Italy
- Correspondence: Rosaria Di Lorenzo Email
| | | | - Anushree Montorsi
- School of Nursing, University of Modena and Reggio Emilia, Modena41124, Italy
| | - Jessica Balducci
- School of Specialization in Psychiatry, University of Modena and Reggio Emilia, Modena41124, Italy
| | - Sergio Rovesti
- General and Applied Hygiene, Department of Biomedical, Metabolic and Neural Sciences, Public Health Section, Modena, 41125, Italy
| | - Paola Ferri
- Nursing, Department of Biomedical, Metabolic and Neural Sciences, Public Health Section, Modena, 41125, Italy
| |
Collapse
|
11
|
Mandal S, Mamidipalli SS, Mukherjee B, Hara SKH. Perspectives, attitude, and practice of lithium prescription among psychiatrists in India. Indian J Psychiatry 2019; 61:451-456. [PMID: 31579157 PMCID: PMC6767820 DOI: 10.4103/psychiatry.indianjpsychiatry_451_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Lithium "the magic pill" past its discovery remained the respite for patients with bipolar disorders for decades. The prescriptions of lithium were replaced by other drugs because of the cumbersome monitoring, adverse effect profile, narrow therapeutic index, and frequent comorbidities in patients. The objectives of this study were to understand the knowledge, attitude, and practice of lithium by a subset of psychiatrists in India, which will help us understand the theory-practice gap and for devising strategies to bridge the existing gap. MATERIALS AND METHODS The current study was an online survey which included 103 psychiatrists from India of either gender and any age group. Predesigned questionnaire about the knowledge, attitude, and practice of lithium use was circulated for 1 month (March 2018). We received 135 responses (31% response rate), of which 32 were incomplete. Hence, the total sample of psychiatrists included in the study was 103. RESULTS The results suggest that most practitioners included in the survey had knowledge about the effects, adverse effects, and the monitoring protocols and were comfortable in using lithium in patients on outpatient basis. Despite being aware of the indications, the psychiatrists were skeptical in starting lithium due to multitude of perceived barriers such as comorbidities, patient's low adherence to blood monitoring, and adverse effects. CONCLUSIONS Clinicians should be well aware of the adverse effects, monitoring protocols, which will help them to use lithium in a more appropriate manner.
Collapse
Affiliation(s)
- Sucharita Mandal
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | | | - Bhaskar Mukherjee
- Department of Psychiatry, Malda Medical College, Malda, West Bengal, India
| | - Suchandra K Hari Hara
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| |
Collapse
|
12
|
Shulman KI, Almeida OP, Herrmann N, Schaffer A, Strejilevich SA, Paternoster C, Amodeo S, Dols A, Sajatovic M. Delphi survey of maintenance lithium treatment in older adults with bipolar disorder: An ISBD task force report. Bipolar Disord 2019; 21:117-123. [PMID: 30375703 PMCID: PMC6587471 DOI: 10.1111/bdi.12714] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Despite the growing numbers and proportion of older adults with bipolar disorder (OABD), there are very limited guidelines for the use of lithium with its double-edged potential for effectiveness and toxicity in this population. The primary aims of this Delphi survey were: (a) To determine the place of lithium among the preferred choices for maintenance treatment of OABD. (b) To provide detailed clinical guidelines for the safe and effective use of lithium in OABD. METHODS In the face of limited evidence, the Delphi survey method was used to achieve consensus by a group of 25 experts in OABD from nine countries. An oversight committee monitored and analyzed the results of each survey and formulated more focused questions with each subsequent iteration. RESULTS A 100% response rate was achieved for all three iterations of the survey. Lithium was the preferred choice for maintenance monotherapy in OABD. Serum levels of 0.4-0.8 mmol/L were recommended for ages 60-79 and serum levels of 0.4-0.7 mmol/L were recommended for ages 80 and over. Specific recommendations achieved consensus for second line monotherapy as well as for other drugs to be used in combination with lithium if necessary. Guidelines for routine monitoring of lithium in OABD were provided for laboratory investigations and clinical assessments. CONCLUSIONS Lithium remains the preferred choice for maintenance monotherapy in OABD. Laboratories should report the therapeutic range for serum levels of lithium separately for older adults.
Collapse
Affiliation(s)
- Kenneth I. Shulman
- Department of Psychiatry, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoONCanada
| | - Osvaldo P. Almeida
- Western Australian Centre for Health & Ageing, Medical SchoolUniversity of Western AustraliaPerthAustralia
| | - Nathan Herrmann
- Department of Psychiatry, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoONCanada
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoONCanada
| | - Sergio A. Strejilevich
- Bipolar Disorder ProgramNeurosciences Institute, Favaloro UniversityBuenos AiresArgentina
| | | | - Sean Amodeo
- Department of Psychiatry, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoONCanada
| | - Annemiek Dols
- Department of Old Age PsychiatryGGZinGeest/VumcAmsterdamthe Netherlands
| | - Martha Sajatovic
- Department of PsychiatryCase Western Reserve University School of Medicine, University Hospitals Case Medical CenterClevelandOhio
| |
Collapse
|
13
|
Grover S, Mehra A, Chakrabarti S, Avasthi A. Attitude toward psychotropic medications: A comparison of the elderly and adult patients with affective and psychotic disorders. JOURNAL OF GERIATRIC MENTAL HEALTH 2019. [DOI: 10.4103/jgmh.jgmh_36_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
14
|
Rej S, Quayle W, Forester BP, Dols A, Gatchel J, Chen P, Gough S, Fox R, Sajatovic M, Strejilevich SA, Eyler LT. Measurement tools for assessment of older age bipolar disorder: A systematic review of the recent global literature. Bipolar Disord 2018; 20:359-369. [PMID: 29108106 DOI: 10.1111/bdi.12566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/04/2017] [Accepted: 09/15/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES More than 50% of people with bipolar disorder will be age 60 years or older by 2030. There is a need for more data to guide assessment and treatment in older age bipolar disorder (OABD); however, interpretation of findings from small, single-site studies may not be generalizable and there are few large trials. As a step in the direction of coordinated large-scale OABD data collection, it is critical to identify which measurements are currently used and identify potential gaps in domains typically assessed. METHODS An international group of OABD experts performed a systematic literature review to identify studies examining OABD in the past 6 years. Relevant articles were assessed to categorize the types of clinical, cognitive, biomarker, and neuroimaging OABD tools routinely used in OABD studies. RESULTS A total of 53 papers were identified, with a broad range of assessments. Most studies evaluated demographic and clinical domains, with fewer studies assessing cognition. There are relatively few biomarker and neuroimaging data, and data collection methods were less comprehensively covered. CONCLUSION Assessment tools used in the recent OABD literature may help to identify both a minimum and a comprehensive dataset that should be evaluated in OABD. Our review also highlights gaps where key clinical outcomes have not been routinely assessed. Biomarker and neuroimaging assessment could be further developed and standardized. Clinical data could be combined with neuroimaging, genetic, and other biomarkers in large-scale coordinated data collection to further improve our understanding of OABD phenomenology and biology, thereby contributing to research that advances care.
Collapse
Affiliation(s)
- Soham Rej
- GeriPARTy Group, Division of Geriatric Psychiatry, Jewish General Hospital, McGill University, Montreal, Canada
| | - William Quayle
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZ inGeest, EMGO Institute of Care and Health Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Jennifer Gatchel
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Peijun Chen
- Departments of Psychiatry& Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Centre, Cleveland, OH, USA.,Psychiatry Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Sarah Gough
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Rebecca Fox
- GeriPARTy Group, Division of Geriatric Psychiatry, Jewish General Hospital, McGill University, Montreal, Canada
| | - Martha Sajatovic
- Departments of Psychiatry& Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Centre, Cleveland, OH, USA
| | - Sergio A Strejilevich
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA
| |
Collapse
|