OBJECTIVES: Bipolar Disorder (BP) is a condition in which adherence to therapy and medication is vital to help patients avoid severe social and emotional problems. Patient beliefs are one of many important factors that determine patient adherence. We sought to systematically review the literature on the role of patient beliefs about their BP, their medications, and their health care team, and the impact these beliefs have on adherence to both medication and therapy.    METHODS: A systematic literature review was performed using Medline, PubMed and PsychInfo. The eligibility criteria for studies were as follows: studies published from January 1, 2000 through March 28, 2010; patient sample comprised BP patients only; adherence to either medication or therapy was a primary study outcome; measures of patient beliefs or belief system were reported.  Titles and abstracts were screened for potentially relevant studies. RESULTS: A total of 10 studies met our study inclusion criteria; study participants usually consisted of BP patients recruited from outpatient clinics and similar sites.  A wide variety of beliefs ranging from disease denial, doubt of medication efficacy, fear of side effects, desire for alternative treatment, and conflicting religious ideas all had a negative impact on adherence to medication and therapy. A strong patient-provider relationship, belief that medication was necessary, and belief that benefits outweighed risks were identified as beliefs that positively impacted patient adherence. CONCLUSIONS: The majority of primary literature on BP patient beliefs and adherence focuses mostly around the patient-provider relationship, and concerns about medication side effects. There is a lack of studies that deal with other patient beliefs such as how they feel about their diagnosis, their belief in medication efficacy, and how their spiritual beliefs affect adherence. A better understanding of patient beliefs may help improve clinicians’ counseling techniques, and help them to encourage greater adherence to medication and therapy.