Non-adherence with long-term prophylaxis: a 6-year naturalistic follow-up study of affectively ill patients

Psychiatry Res. 1999 Dec 27;89(3):247-57. doi: 10.1016/s0165-1781(99)00108-0.


In a retrospective 6-year follow-up, we assessed the reasons for and the frequency and consequences of non-adherence in 76 affectively ill patients receiving lithium prophylaxis in two lithium clinics. Thirty-eight bipolar (50%), 21 unipolar (27.6%) and 17 schizoaffective patients (22.4%) diagnosed according to DSM-III-R, were investigated with a specialized follow-up documentation. Of the patients 53.9% discontinued prophylaxis at some time; 43.2% of the discontinuations occurred during the first 6 months. In contrast to other studies the main reason reported for non-adherence was resistance against long-term treatment. According to the Lithium Attitudes Questionnaire non-adherent patients showed significantly less acceptance of the prophylaxis in general, of the effectiveness of lithium and of the severity of their illness than adherent patients. In a multivariate analysis of various parameters, only the negative attitude to prophylaxis correlated significantly with non-adherence. Significant correlation was found between treatment outcome and duration of initial prophylaxis. During the 6-year follow-up only the adherent patients showed a significant reduction of the number and duration of admissions. Our findings confirmed non-adherence as a major problem in the effectiveness of lithium prophylaxis. The authors recommend prospective investigations of attitudes and the impact of psychoeducation on long-term adherence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antimanic Agents / administration & dosage*
  • Antimanic Agents / adverse effects
  • Bipolar Disorder / drug therapy*
  • Bipolar Disorder / psychology
  • Denial, Psychological
  • Depressive Disorder / drug therapy*
  • Depressive Disorder / psychology
  • Follow-Up Studies
  • Humans
  • Lithium Carbonate / administration & dosage*
  • Lithium Carbonate / adverse effects
  • Long-Term Care / psychology
  • Psychotic Disorders / drug therapy*
  • Psychotic Disorders / psychology
  • Retrospective Studies
  • Treatment Outcome
  • Treatment Refusal* / psychology


  • Antimanic Agents
  • Lithium Carbonate