A pilot study of concordance therapy for individuals with bipolar disorders who are non-adherent with lithium prophylaxis


Corresponding author: Prof Jan Scott, PO Box 69, Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. Tel: +44(0) 207 848 0014; Fax: +44(0) 207 848 0287; e-mail: j.scott@iop.kcl. ac.uk


Objectives:  To assess the acceptability and feasibility of concordance therapy (CCT) in improving adherence with lithium prophylaxis in individuals with bipolar disorder.

Methods:  Ten subjects with bipolar I disorder and self-reported problems with lithium adherence were recruited. Eight participated in a 6-month study of CCT delivered by an expert in cognitive therapy. Reliable and valid assessments of self-reported adherence with lithium, attitudes towards, and knowledge of lithium and serum plasma lithium levels were measured pre- and post-intervention. Subjects' views of CCT were also recorded.

Results:  Statistically significant improvements in attitudes towards lithium (mean score baseline = 6.8; follow up = 4.1; Effect size = 1.6) were associated with improvements in self-reported adherence. Laboratory results demonstrated statistically significant increases in serum plasma lithium levels (mean increased from 0.41 to 0.6; effect size 1.7). Subjects viewed CCT as an acceptable intervention. However, only four of the 10 subjects completed all seven half-hour therapy sessions and homework tasks.

Conclusions:  This small open study suggests that CCT may represent a useful addition to the ‘stepped care’ package of treatment for individuals with bipolar disorders. Research is underway to assess its efficacy and to establish whether novice therapists can also apply the model effectively.