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Zolezzi M, Eltorki YH, Almaamoon M, Fathy M, Omar NE. Outcomes of patient education practices to optimize the safe use of lithium: A literature review. Ment Health Clin 2018; 8:41-48. [PMID: 29955544 PMCID: PMC6007520 DOI: 10.9740/mhc.2018.01.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Introduction: Lithium is commonly used to treat various psychiatric disorders and is particularly effective in the maintenance phase of bipolar disorder. Unfortunately, this drug has a narrow therapeutic index and, if not monitored regularly, can result in toxicity. Therefore, for lithium to be prescribed safely, clinicians must ensure that patients are well educated on lithium toxicity, its prevention, and symptom recognition. This article summarizes studies that investigated lithium education strategies to help promote the safe use of lithium. Methods: Four electronic databases were searched using key terms and subject headings. Reference lists of relevant papers were also reviewed. The search was limited to literature published in English, without year limits. Eligible studies examined lithium patient education and the impact on patients' knowledge of safe lithium use. Results: Of a total of 517 citations that were retrieved from the electronic database search, 12 were selected for inclusion in this review. Most of the studies included assessed the effect of lithium education on various aspects of patients' knowledge, including but not limited to, lithium toxicity. Of the studies assessing the correlation between lithium knowledge and lithium levels, most demonstrated a positive correlation between lithium knowledge and lithium levels that were more stable and within the higher end of the recommended therapeutic range. Conclusions: Studies evaluating lithium patient education and its effect on improving the safe use of lithium are limited. Nevertheless, this literature review highlights that lithium patient education is critical to promote its safe use.
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Affiliation(s)
- Monica Zolezzi
- Assistant Professor, College of Pharmacy, Qatar University, Doha, Qatar; Clinical Pharmacist, Hamad Medical Corporation Mental Health Hospital, Doha, Qatar,
| | | | | | - Mahmoud Fathy
- Pharmacist HMC, Pharmacy, Al Wakra Hospital, Doha, Qatar
| | - Nabil E Omar
- Clinical Pharmacist, Hamad Medical Corporation-National Center for Cancer Care and Research Hospital, Doha, Qatar
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Psycho-education of families in relation to their siblings' psychiatric illness. Ir J Psychol Med 2009; 26:69-72. [PMID: 30282265 DOI: 10.1017/s0790966700000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this study was to determine the extent of knowledge that family members of intellectually disabled individuals had in relation to their siblings' psychiatric illness. All siblings lived in residential intellectually disabled housing. METHOD We evaluated on three occasions (before providing information about their sibling's psychiatric illness and treatment, and one and six months after providing this information) the families' understanding of their siblings' psychiatric illness. RESULTS Initially families had a poor knowledge of their siblings' psychiatric illness and treatment, but this improved markedly after information was provided by a medical practitioner. This was a short-term effect, as at six months, families understanding had disimproved although not to pre-consultation levels. CONCLUSIONS The provision of information to family members pertaining to their siblings' psychiatric diagnosis and treatment should be incorporated into the routine treatment of intellectually disabled individuals with a psychiatric illness.
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Rosa AR, Marco M, Fachel JMG, Kapczinski F, Stein AT, Barros HMT. Correlation between drug treatment adherence and lithium treatment attitudes and knowledge by bipolar patients. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:217-24. [PMID: 16982121 DOI: 10.1016/j.pnpbp.2006.08.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Non-adherence should always be investigated when there is a failure in bipolar treatments, since it is known that reported non-adherence rates in bipolar disorder treatment for long-term prophylactic pharmacotherapy range from 18% to 52%, with a median prevalence of 44.7%. Several factors are related to the poor adherence and reduction of medication efficiency, such as the different types of bipolar disorder, the presence of side effects, medication interactions, level of patient's knowledge about the disorder and their attitude towards treatment, complexity of medical regimens and the doctor-patient relationship. METHODS Bipolar disorder outpatients under lithium treatment from the Hospital de Clínicas and Materno Infantil Presidente Vargas of Porto Alegre were recruited. All the patients had bipolar disorder and gave informed consent to participate in a clinical interview (106), answered the Lithium Attitudes Questionnaire (LAQ), Lithium Knowledge Test (LKT), Medication Adherence Rating Scale (MARS) and had plasma and red blood cells lithium measurements to assess their medication adherence and the factors that influenced it. RESULTS 85.6% of bipolar disorder were adherent to lithium treatment showing plasma lithium between 0.6 and 1.2 mmol/L. There was an inverted correlation between the total LAQ score with plasma and red blood cells, a positive correlation between LKT and MARS with plasma and red blood cell lithium. CONCLUSION These results confirmed that knowledge level is directly correlated to treatment adherence and patients' attitudes, lower adherence, general opposition to prophylaxis, fear of side effects, denial of therapeutic effectiveness and illness severity.
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Affiliation(s)
- Adriane Ribeiro Rosa
- Division of Phamacology, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Brazil
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Rosa AR, Andreazza AC, Gazalle FK, Sanchez-Moreno J, Santin A, Stein A, Barros HMT, Vieta E, Kapczinski F. Adaptation and validation of the Portuguese version of the Lithium Knowledge Test (LKT) of bipolar patients treated with lithium: cross-over study. Clin Pract Epidemiol Ment Health 2006; 2:34. [PMID: 17147815 PMCID: PMC1716160 DOI: 10.1186/1745-0179-2-34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2006] [Accepted: 12/05/2006] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Adherence problems are a common feature among bipolar patients. A recent study showed that lithium knowledge was the main difference between adherent and non adherents bipolar patients. The Lithium Knowledge Test (LKT), a brief questionnaire, was developed as a means of identifying aspects of patients' practical and pharmacological knowledge which are important if therapy is to be safe and effective. The original English version is validated in psychiatric population, but a validated Portuguese one is not yet available. METHODS One hundred six patients selected were diagnosed with bipolar disorder (I or II) according to DSM-IV criteria and had to be on lithium treatment for at least one month. The LKT was administered on only one occasion. We analysed the internal consistency, concurrent validity, sensitivity and specificity of the LKT for the detection of the knowledge about lithium treatment of bipolar patients. RESULTS The internal consistency, evaluated by Cronbach's alpha was 0.596. The mean of total score LKT by bipolar patients was 9.0 (SD: 0.75) for men and 8.74 (SD: 0.44) for women. Concurrent validity based on plasma lithium concentration showed a significant correlation between the total LKT score and plasma lithium (r = 0.232; p = 0.020). The sensitivity was 84% and specificity was 81%. CONCLUSION LKT is a rapid, reliable instrument which appears to be as effective as a lengthier standard interview with a lithium clinic doctor, and which has a high level of acceptability to lithium patients. We found that the psychometric assessment of the Portuguese version of LKT showed good internal consistency, sensitivity and specificity.
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Affiliation(s)
- Adriane R Rosa
- Bipolar Disorders Program, Centro de Pesquisas, Clinic Hospital of Porto Alegre, Brazil and Post-Graduate Medical Science Program, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- Bipolar Disorders Program, Clinical Institute of Neuroscience, Clinic Hospital of Barcelona, Villarroel 170, Barcelona 08036, Barcelona, Spain
| | - Ana Cristina Andreazza
- Bipolar Disorders Program, Centro de Pesquisas, Clinic Hospital of Porto Alegre, Brazil and Post-Graduate Medical Science Program, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- Department of Biochemistry, Science Institute of Basic Disease, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Fernando Kratz Gazalle
- Bipolar Disorders Program, Centro de Pesquisas, Clinic Hospital of Porto Alegre, Brazil and Post-Graduate Medical Science Program, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
- Post-Graduate Psychiatry Program, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Jose Sanchez-Moreno
- Bipolar Disorders Program, Clinical Institute of Neuroscience, Clinic Hospital of Barcelona, Villarroel 170, Barcelona 08036, Barcelona, Spain
| | - Aida Santin
- Bipolar Disorders Program, Centro de Pesquisas, Clinic Hospital of Porto Alegre, Brazil and Post-Graduate Medical Science Program, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Airton Stein
- Pharmacology Departament, Federal Fundation University of Medical Sciences of Porto Alegre, Brazil
| | - Helena MT Barros
- Pharmacology Departament, Federal Fundation University of Medical Sciences of Porto Alegre, Brazil
| | - Eduard Vieta
- Bipolar Disorders Program, Clinical Institute of Neuroscience, Clinic Hospital of Barcelona, Villarroel 170, Barcelona 08036, Barcelona, Spain
| | - Flávio Kapczinski
- Bipolar Disorders Program, Centro de Pesquisas, Clinic Hospital of Porto Alegre, Brazil and Post-Graduate Medical Science Program, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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