Abstract
ObjectiveAdherence 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.MethodsOne 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 consis tency, concurrent validity, sensitivity and specificity of the LKT for the detection of the knowledge about lithium treatment of bipolar patients.ResultsThe 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%.ConclusionLKT 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.
Highlights
To date, lithium is probably still the gold standard for the long term treatment of bipolar disorder, as shown in classical papers [1], newer studies [2] and a recent and thoughtful meta analysis [3]
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
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
Summary
Lithium is probably still the gold standard for the long term treatment of bipolar disorder, as shown in classical papers [1], newer studies [2] and a recent and thoughtful meta analysis [3]. A marked gap has been noted between the efficacy of lithium in clinical trials and its effectiveness in ordinary clinical practice [4,5], this difference being almost certainly due to poor treatment adherence [4,6,7]. A recent study showed that lithium knowledge was the main difference between adherent and nonadherent bipolar patients [9]. Several studies have shown that psychoeducative interventions are associated with high adherence rates, stabilization of plasma lithium levels, reduction of the total number of episodes and total number of patients needing to hospitalization [10,11,12]. The fact that patients are informed about the disease, the treatment and the risks of not treating it positively, influences adherence, because it facilitates their acceptance of the disease and maintenance therapy [13,14,15]
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