Medication adherence

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    • #11323

      I have worked with a client for the past few years who has had several hospitalizations (primary Diagnosis is Bipolar I Disorder), and each time these episodes occurred after reducing and/or completely stopping his medications. He often would express in sessions the many impacts of medication side effects, for him these were weight gain, sexual (often times an increase in libido) , feeling tired or slow, loss of dreaming while sleeping, and an overall feeling of ‘not being himself’. The challenge for me as his counsellor has been finding balance in supporting his autonomy and wishes as a person who wants to be free of these side effects, and also knowing that each time he has reduced or stopped another manic episode (and subsequent psychosis) occurs and he has to return to hospital (he is on an extended leave, so he is recalled when this occurs). We would often discuss in sessions the impacts and consequences of hospitalizations on his life, family and overall wellbeing. In his most recent episode, he showed marked growth in insight and perspective, as he knew to take himself to hospital when certain symptoms started occurring that he has learned to recognize in himself, he was able to reduce his hospitalization time considerably – and has been adhering to his medications for the last several months. For my client, it seemed that the work we did together (and the hard work he did on his own) around what symptoms arise when a mania or psychosis episode is coming on, and discussing the increasing impacts and consequences he experienced when hospitalized (loss of income, time away from loved ones, having to re-learn things after each episode) helped in some way for him to recognize that medication (even a low dose) can help him avoid frequent hospitalizations.

    • #11326

      Thank you for sharing this example Angela, I could really relate to this experience and I am sure a lot of other EPI and MHSU clinicians can as well. It was somewhat comforting to read that in this case specifically, you noticed growth in both insight and perspective. I am relatively new in the field and while I really recognized the cycle of clients reducing and or completely stopping medications because of adverse side affects leading to adverse psychosocial consequences including rehospitalization, being recalled, and increased pressure on their support networks, I have not yet noticed a marked difference in insight prior to relapse.
      In my role now, I have developed some strong relationships with clients and have been able to have conversations about the impacts and consequences a potential relapse would have on their lives while they are in the recovery phase. In a lot of cases I can see that my clients really understand the importance medication played and continues to play in their recovery, there are a few cases that give me pause as I can see that both the side effects of medication, as well as the thought of having to be on medication potentially for the rest of their lives is overwhelming and for them outweighs the possibility of becoming sick again. In these cases I can relate to the challenge of finding balance in supporting autonomy and also considering safety concerns and other adverse consequences of a potentially avoidable relapse. I can fully empathize with desire to be free of side effects from antipsychotics, I think it is important to validate that desire while providing support and feedback in considering both the benefits and drawbacks of medication, knowing that in some cases, mediation adherence will not be a priority for our clients at first. I have found it difficult to watch this cycle often knowing where it will lead, I know I have thought many times that I should have done more. Thinking long term, I hope that these continued conversations, providing education and honest feedback, while supporting clients autonomy will result in continued growth in trust, insight and perspective. It was encouraging to read about the case you shared Angela, it reinforced my current practice and was nice to recognize my frustrations and challenges as a shared experience.

    • #11346

      Hi Kade, I appreciated your insight into the importance of developing rapport and relationships with your clients in order to be able to assist in identifying impacts of relapse on their recovery, related to the stopping of medication and risk of relapse. I liked how you discussed having empathy with the side affects some clients may experience, while also being mindful of safety precautions related to avoidable relapse. At the same time you are respecting clients rights to self determination and medical autonomy.

    • #11349

      Hi all
      I agree, relationship with the client is one of the most important things we can develop as professionals. I think that with relationship comes trust which then helps us to have those psychoeducational conversations as well as hold space for the client to make decisions that respect their autonomy, such as whether or not to take meds. I found the video clip from this section interesting to hear from a client perspective, not only the psychological impact but the physical implications of medications. My take away was medication impacts multiple aspects of a clients life, just like their diagnosis does.

      • #11374

        As we now that medication compliance plays very important role in client’s recovery but this is most challenging one as well. I have few clients who does not think that they need any medication. The difficult part is that they stop taking medications without informing case manager or consulting with psychiatrist. There are many reasons that client does not want to take medications. I just talk to one of client’s mother today and she told me that it is embracing for client when that are having visitors and client has to go to the door to take his medication. This client is on daily dispense due to non compliance with medications. I agreed that as case manager we have to build trust but sometimes it is very difficult to engage client. In opinion, family plays important role as family can encourage client and they already have connection with the client.

    • #11378

      I agree, Katherine. When a client trusts us, they are more likely to trust our recommendations. And I think it is common to not want to be on medications, especially when young. Talking about it openly, I think can help work through some of the resistance and help the client feel validated.

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