Enhancing treatment of bipolar disorder using the patient's belief system

OBJECTIVE: To report a patient with bipolar disorder in whom elements of the patient's belief system were used to foster acceptance of medication treatment. CASE SUMMARY: A 21-year-old white man with bipolar disorder began refusing prescribed divalproex sodium treatment. On consultation, the psychiatric pharmacist identified key elements of the patient's belief system and used this information in developing a plan to foster patient acceptance of lithium carbonate treatment DISCUSSION: Noncompliance with treatment for bipolar disorder is common, and reluctance to accept initial pharmacotherapeutic intervention often occurs. There are many possible reasons for this phenomenon. Patients may not believe in pharmacotherapy and/or in its benefit, fear adverse reactions, or deny that they are ill. We report a patient in denial of his illness and believing that divalproex sodium was causing adverse effects. A psychiatric pharmacist consultant identified certain patient beliefs that were ultimately important in developing a treatment plan that was acceptable to the patient. The consultant, accompanied by a colleague, used persuasive technique in proposing treatment with the natural product lithium. The patient was discharged within 1 week of accepting the lithium therapy. CONCLUSIONS: When a patient refuses to accept needed treatment, it is important to carefully examine the reasons for this refusal, focusing on the patient's beliefs about the illness and the therapy. Intervention strategies can be developed, using this information, to foster treatment adherence and produce positive outcomes.