What we’ve said about Medication adherence

“adherence is a iatrogenic phenomenon. It's up to you to figure out the regimen that you're inviting people to participate in and make it something that they want to do, not something that they don't want to do”

“trust in a provider and having a good, strong therapeutic alliance is such an enormous factor and is as big if not, is bigger than what the actual underlying, can be bigger than what the underlying diagnosis is”

“even taking one medication on a daily basis is a lot harder than people give it credit for, no matter what that medication is for”

“A lot of people don't ever learn that after a patient leaves inpatient, the best thing to do is smush it all into, you know. One time a day dosing”

“there's the continual risk in the background of people just going, you know, I'm tired of this label. I'm tired of these treatments. I'm just going to stop everything. That happens. And I think one of the reasons it happens is because people just get tired of juggling all those pills”

“So if you have a patient that skips several of their doses every week but is still taking their medications several times a week, don't be afraid to use a higher dose Abilify. Let's say they're stable on Abilify 15 in the hospital. We'll give them Abilify 30 and they take it three or four times a week”

“We have our Prozac, which is nice for people who forget to take their medications because it lasts so long”

“I was taught that, hey, this is something you should consider for patients of poor med adherence. They'll know as to withdraw and remember to take medication. I feel like that's very outdated. Set alarm on the phone. Use a pill organizer”

“You as a clinician, when you want people to do something, make it, the lower the barriers, make it as easy as possible for them to actually do it”

“a patient who's not taking medication due to weight gain is a failed medication. And if GLP-1s can help prevent that, then it should be a part of our treatment plans”

“patients actually really like olanzapine. I know a lot of times we think of all medications that cause weight gain or have sexual side effects as like patients are going to hate it. Patients do report liking it”

“don't sugarcoat things um and also like allow like empathize with patients for how annoying these medications can be. I think it's helpful. I think you have to stay hopeful but also stay realistic”

“I think you always have to start with what's the problem for the patient. What is the patient able to see as a problem? And sometimes they see zero mental health problems. So then you'll have to externalize”

“You need to ask, what do you see as the major problem that you're having? And then you need to compare that to your conceptualization of the problem. And then you need to talk openly with the patient about, do we agree on this? Why or why not”

“I say, you know, my role is not to make you have medications. My role is to communicate to you the role of medications and what they can do to help you and work together to see if it's something that works for you”

“I know we don't disagree. I know we don't agree that it's an appropriate treatment for you. But medically, as your doctor, I am recommending it. I think you should continue it because I think it is going to help you”

“your priority is keeping the patient in treatment and monitoring. And in treatment is not on a medication necessarily. In treatment means engaged with monitoring and follow-ups”

“I'd rather have a patient who says, doc, I don't have schizophrenia, but I take my clozapine than a patient who says I have schizophrenia, but I hate antipsychotics and refuse to take them”

“I think in the majority of cases, they simply learn to go along socially. And you can actually test this. You can say, so do you have schizophrenia? And they go like, yes. Why do you believe that? Well, that's what the doctors tell me”

“first year residency is inpatient, where it feels like your entire job is get patient to take medication. And sometimes that can spill over into the future outpatient years. And that's not our role”

“I think as a society, we have a obligation to detect early on when someone's mental illness makes them unable to actually make a rational decision about treatment. And then we have to intervene, but we don't”

“But that becomes another barrier to actually just doing some of these behavior changes. This idea that you're supposed to fill out this thing. Well, I forgot to fill it out yesterday. Maybe I just don't want to do this”