Reply To: Medication Adherence

#11318

Yes Jacob – empathy is key. Start with that. Clients won’t mind you trying to be aware of, and understand, what it is like to be them day to day.

Katelyn and Breeanne
I feel every clinician, new or seasoned, has had the experience of a client who is either resistant to their medication, or starts then stops, or declines to take the medication to from the start. Especially the standard first and second generation antipsychotics. Especially with the open world of the internet to access information about these pharmaceutical substances, it can make education, support and medication adherence challenging. As you have mentioned above, it’s about at least really listening to the client and their questions and concerns, providing that education (including when it appears under-provided by the psychiatrist) including risks and benefits, and conclude that the common and primary goal is to keep someone out of hospital, keep them happy and healthy (as best we can), and support them in identifying and pursuing their life goals, desire, ambitions. Hopefully their life goals aren’t to just not take antipsychotic medications. If we aren’t aware of their concerns then we certainly can’t help them a way that may be the most supportive.

I have a client now that became unwell again, likely aggravated by heavy Cannabis use and psilocybin, and then was able to settle and reduce his psychotic symptoms through common antipsychotics Loxapine, Risperidone, and some short-term clonazepam. Now that he’s more lucid and organized he has stopped taking said medication because he doesn’t want “to get hooked on the pharmaceutical wheel of dependence/addiction”. He said he’s started taking CBD oil for his mental health (While still smoking THC Cannabis 2-3x/week “only when I’m offered). I endorse the effectiveness of antipsychotics but sympathize with clients as to the reluctance and resistance to not taking them. They have harmful side-effects for many clients, but of course the argument that it keeps them out of hospital and closer to having a ‘normal life’ then they would have otherwise. My client appears to be doing pretty good absent the medication and taking the CBD oil. Medications is at the foundation of the medical model of treatment for clients; if they have stopped taking the medication or resistant (assuming they’re a voluntary client) I think it is always important to stay connected, maintain the working relationship. For me, keeping that connection focused on their wellness has resulted in clients being at least a little more open to the possibility of taking some medication (which some of re-started) that will keep them a little better, and a little safer, and give them a little more of their life back.
The client and I talked about research in the area of CBD and psychosis and how, like many new, ‘alternative’ options of support are growing much research (Random controlled trials for example) need to be done; this takes a lot of time and money.
I found a meta-analysis study to review if you like.

https://link.springer.com/article/10.1007/s00213-021-05905-9#ref-CR49