Monthly Archives: January 2018

How to Achieve Medication Compliance

By Dr David Laing Dawson

Anosognosia is an unwieldy word meaning lack of insight, or, literally in translation, `without- disease- knowledge`.  In the case of some brain injuries or stroke the brain may become quite specifically unaware of what is missing. The part of the brain that would perceive this is damaged. With mental illness, schizophrenia, bipolar, the apparent lack of insight  or denial of obvious impairment or implausible grandiosity may be more nuanced and variable. It may be part defensive in nature; it may be more a denial of the consequences imagined; it may be more about the power relationship at hand. Some of it may be merely human, the unwillingness to give up a longstanding belief, whether that be of the second coming,  CIA surveillance and persecution, or of being chosen, special, destined for greatness.  Some of it may be a distorted form of the normally complex parent – adult child relationship.

But almost every family with a severely mentally ill member must deal with, at least once, that time when the ill member claims to be fine when obviously not, and refuses to take medication or go for an appointment to the doctor.

How to approach this. What options do you have. Below is an outline for talks I have given on the subject:

Stage 1

  • Calm and slow
  • Non-threatening (posture, position (e.g. side by side), distance, tone, pace)
  • Aim for a negotiated reality. (not the acceptance of your reality)
  • i.e. He may not be willing to admit he is ill or delusional or needs medication but may be willing to agree that he is in trouble, anxious, not well, in pain, not sleeping, and that in the past the pills have helped with that. He may by his behavior be willing to take pills or come for an appointment as long as he doesn’t have to admit to need or illness.
  • Gently find out what he or she fears.
  • Gently find out what his objections are.
  • Allay these objections and seek a “negotiated reality”.
  • Stay away from labels, declarations, and you defining his reality.
  • Offer pill with glass of water without saying anything.

Stage 2

Family intervention, same tactics as above but with whole family or available members, or a specific family member with influence.

Stage 3

Ultimatums. (You can`t live here unless…..)

But before doing this you should assess the level of risk (provoking violence, and/or leaving and putting self at risk). Discuss in family plus with a professional. Must also assess realistically your tolerance for confrontation, anxiety, worry, guilt. And ultimatums are only effective if truly meant, if you are truly willing to carry through with the ultimatum. If the ultimatum works, do not reiterate it unnecessarily.

Stage 4.

Form 1, J.P., Court order, Police intervention.

Before doing this decide on desired outcome, assess odds of achieving this desired outcome as best as possible (i.e. is there a treatment that works? Will they keep him or her long enough? Does the trauma of this kind of intervention justify the long-term outcome?)

Having decided on desired outcome, use all resources to achieve this. Learn the wording of the Mental Health act to get desired outcome. Use this wording to your advantage. Find family mental health friendly lawyer. Discuss with the health professionals who will be receiving the family member.

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Family Doctors and Psychiatric Medication

By Marvin Ross

I’ve heard this more than once but family doctors who wonder why their patient with a serious mental illness is on the psychiatric medication they are on when they seem to be fine.

And so, they suggest that the patient either go off the meds or start to taper them with, of course, disastrous outcomes. The latest case I heard was of a woman I know with stable schizophrenia who has been stable for many years. This is a woman for whom it took years to stabilize and get her to the level she is now.

The patient in question is so in favour of medication that she has been active giving lectures to health care students and other professionals on the importance of them for stability.

But then, her family doctor wondered why she was on the dose she was on. He told her that as you get older, your metabolism slows and you do not need as much medication as before. She agreed to start lowering her dose with the expected result. She slowly became more psychotic to the point where her family had to to go to court to have her hospitalized and forced back on medication.

She is now back to normal stabilized on her meds but considerable time and anguish was wasted on something that did not need to happen.

Of course, my anti-psychiatry critics will suggest that she was addicted to the medications and that her descent back into psychosis could be predicted by her body reacting to the poison that was cut off. That, of course, is nonsense. She needed the medication and when it was taken away, her illness returned. In one of his earlier blogs, Dr Dawson mentioned that when psychosis returns, the individual develops the same delusional thoughts as they originally had. That happened in this case.

Regardless of the illness, if you are on medication, you are doing well, and there are no side effects, then why mess with it. One psychiatrist I quoted in one of my writings pointed out that it is so difficult and time consuming to find the right medication at the proper dose to help a patient, why mess with it when it is found.

Unless there is a really good reason to do so, continue with your dose.

Reminiscences of Hockey and Schizophrenia

By Marvin Ross

This past week Johnny Bower, the 93 year old former great goalie for the Toronto Maple Leafs, passed away. One of the comments made of him was his charitable work along with the fact that he was goalie the last time the Leafs won the Stanley Cup. I’m old enough to remember that it was so long ago.

His passing twigged my memory of the time that the Hamilton Chapter of the Schizophrenia Society of Ontario were the recipients of the charity of old hockey players. I’m not sure when this began but I became involved in the chapter in the late 1990s and was chair for a few years. The largest and most successful fund raising event was the annual National Hockey League (NHL) Alumni Association golf tournament put on for us at a course north of Toronto.

The moving forces were our executive director at the time and Keith McCreary who was one of the founders of the NHL Alumni. Sadly, both are no longer with us. I attended two of the golf tournaments in 2000 and 2001 and Johnny Bower was there along with many of the hockey greats from my childhood. I certainly remember Red Kelly, Dennis Hull, Eddie Shack, at least one of the famed French Connection line for the Buffalo Sabres, and numerous others.

What struck me was their incredible generosity. Some donated memorabilia to be auctioned off and all of them were more than happy to peel off $50 and $100 bills to enter the many raffles that were held. Hockey players of that era did not make the big bucks that they do today as Dennis Hull mentioned in his after dinner stand up comedy routine. He commented that today’s players earn more in a day than most of the guys in that room made in their entire careers. But their generosity to a disease that most of them probably knew very little about was remarkable.

Another guest who was much beloved by the hockey crowd was Michael Burgess who often sang the national anthem at Leaf games and who played Jean Valjean in Les Mis. The players all loved his rendition of Danny Boy which he did that evening. The link above is to his singing on Youtube.

Also incredible was one mother who positioned herself on the first tee and subjected each and every foursome before they teed off with her lecture on the horrors of schizophrenia and the need for more treatment, family support and research. She was not a young woman but stood in the sun and heat for hours without either a pee break or a drink break so that she would no golfer would forget what they were supporting.

That night, I drove home with our executive director and what was left over from the day along with about $10,000 in cash for the bank when I was stopped in a police road block looking for impaired drivers. Fortunately, I had cut myself off early in the evening.

That was September 10, 2001 and we all know what happened the next day 9/11 that changed the world forever.

But, the moral of the story is that there are good people out there who can understand serious mental illness and do their bit to make the lives of those who suffer just a tiny bit better.

schizcover  For more on schizophrenia, see Schizophrenia Medicine’s Mystery Society’s Shame and other Bridgeross titles