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Page 5 Executive Summary 5. A very limited number of
conversations with consumers suggest the possiblity that although physicains are
generally responsive to requests to reduce medications they are, naturally
enough, cautious and, in some instances, the consumer may reduce thier
medication somewhat more than recommended by the physican. We do not know if
such events are a common occurance, but when they do occur that may offer
an opportunity to test the effectivness of joint consumer-phsycian contol of
medication dosage. Table
32: I Would Like To Know More About The Side Effects My
Psychiatric Medications Can Cause.
No Response = 9 Table 33: I would like to learn about other psychiatric medications that might help me.
No Response = 5 Further, 129
of the 132 persons (97.7%) who
said they do or might, on their own, self-adjust
their medication also said they
want to learn more about one or more aspects of psychiatric medication.
While learning more about medication
might not alter their basic attitudes
or behavior, greater knowledge might assist consumers to discuss, with greater
authority and understanding, their medication issues with their physicians and
might temper any inclinations they
might have to make radical changes in their medication related behavior.
Given the very broad interest that clients have in learning more about
their medication and the possible benefits that might follow in the wake of
having greater knowledge, it appears that Montgomery
County provider organizations and County administrators may wish to
systematically consider the possibility of implementing a medication education
program for consumers and, possibly, for non-medical staff. Approximately
60 percent of those participating
in the survey said they want to learn more about one or more aspects of
medication. Sixty percent also said they wanted to learn more about alternate
forms of treatment (Table 34). If our recommendation Table
34: I Would Like To Learn About Other Types Of Treatment Such As Massage, Acupuncture, Yoga, Aromatherapy, Prayer And
Biofeedback*
No Response = 4 regarding
a medication education program is accepted, those acting on the recommendation
may also wish to consider the wide spread interest in alternative treatments. It
is unfortunate that we did not ask clients how interested they might be in
learning about the usual forms of treatment other than medication. We recognize
that in many settings it is mandatory that treatment plans be periodically
reviewed with clients and that they “sign off” on treatment goals. However,
we wonder if clients knew more
about how specific forms of treatment are supposed to work, they might
be better able to participate in the treatment planning process,
participate more fully in their various forms of treatment and, through such
participation and given the opportunity, possibly refine existing forms of
treatment or design new ones.
A
substantial proportion of those who participated in the survey reported that
they may deliberately or inadvertently change the amount or frequency with which
they take their psychotropic medications. A substantial proportion also report that that they will use caffeine,
nicotine, alcohol or street drugs either singly or in combination (Tables 35 and
36) to help control their symptoms. Slightly more than 64 percent of the
Table
35: Do You Use Any Of The Following To Help Control Symptoms
Table
36: Combinations, If Any, Of Substances Used To Help Control Symptoms
respondents
say they use one or more of these substances. Forty percent said they use
nicotine. This report is similar to smoking rates found among other groups of
mentally ill persons
and at least one study concluded that “Persons
with mental illness are about twice as likely to smoke as other persons .... “6.
The long term health consequences and costs of smoking are widely
recognized and it does not seem excessive to assume that these consequences and
costs are and will be greater or even much greater among the mentally population
than they are among the general population. A smoking cessation program might
yield extensive health and economic benefits. However, while
self-reported “quit rates” are “substantial”6,
Lucksted and others conclude that “Issues and needs that are specific
to smokers who use mental health services must be addressed in the development
of smoking prevention and cessation interventions in psychosocial rehabilitation
and other mental health programs. The importance of messages about smoking that
clients receive from program rules, program staff, and other sources is
highlighted, as is the possibility that the regulation of affect and stress
provided by tobacco use is especially important for people experiencing
psychiatric symptoms”7. Some
have suggested that our respondents under-reported their use of alcohol (8.7%)
and street drugs (5.1%) as a way to help control their symptoms. However, the
information that is available to us
is such that we cannot effectively
probe the use of these substances. That
fact that almost two thirds of the respondents said they use nicotine, caffeine,
alcohol or street drugs to help control their symptoms is, indirectly, a comment
on how satisfied
respondents are with their psychotropic medications. We do not know the origins
of this dissatisfaction. It may be a product of the inherent limits of the
available ___________________________ 6.
Lasser K., Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, and Bor H. Smoking
and Mental Illness: A Population-Based Prevalence Study. Journal of the
American Medical Association. November 2000; 284(20):2606-2610 7.
Lucksted A, Dixon LB, Sembly, JB., A Focus Group Pilot Study of Tobacco
Smoking Among Psychosocial Rehabilitation Clients. Psychiatric
Services. December 2000; 51(12):
1544-1548 medications.
It may be a product of the way that clients are evaluated,
medications are prescribed
and results monitored. It may be a product of the expectations that clients
develop. It may be a product of all these and other factors. The fact of the
matter is that there is a widespread, indirect expression of consumer
dissatisfaction with medications The causes
of this dissatisfaction are, at
least for us, a matter of speculation. Is there anything that can be done to
alleviate the situation? We have no
ready answer to this question. However, given the potential consequences of
using nicotine, alcohol and street drugs, it is not a question that should be
ignored and we believe providers, working closely with consumers and, possibly,
academics and drug companies should organize a systematic way to explore the
issue and, to the extent possible,
design actions that would reduce client’s need to turn to these substances for
help. iv d: side effects Powerful
drugs often produce unwanted side effects and psychotropic medications are no
exception. Side effects can, apparently, become so unpleasant that clients will
stop taking their medication or can make it difficult for clients to function
effectively. Table 37 shows the type of side effects that clients reported.
The number of side effects respondents said they were experiencing ranged from none to 11 (Table 38). Three hundred and four clients, 90.7 percent of all respondents, report (Table 38, next page) they have one or more side effects, an average of 4.3. As Table
38: Number of Side Effects Reported
previously noted (Table 27),
slightly more than 22 percent of all clients (77)
will reduce or stop their medications because of side effects.
However, we did not find a strong relationship between the number of side
effects reported and stopping/reducing medication. Similarly we did not find a
strong relationship between client’s demographic characteristics and the
number of side effects they reported. Our survey did not shed a great deal of light on the important issue of side effects. However it is interesting to note that 2 of the most commonly experienced, “feel tired or sleepy” and “have difficulty concentrating” make have a direct bearing on the client’s capacity to participate in the recovery process. iv e: attitudes
We asked respondents 2 questions regarding their attitudes about medication. As shown earlier in Table 23, 37 clients (11.2%) reported that they thought they didn’t need to be taking their medications. We also asked if clients feel better about themselves if they don’t take their medication. Twenty five percent of the respondents answered “yes” to this question.8 (Table 39). If we combine answers to these two questions we found Table 39: When I Don’t Take Psychiatric Medication I Feel Better About Myself.*
No Response = 26 87 clients
(28.7 % of all who answered) said
that they feel better about themselves when they don’t take medication and/or
that they didn’t think that they needed to be taking medication (Table 40,
next page). Of this group, 55 percent said that they would, ______________________________________ 8. Almost 8 percent of all respondents did not answer this
question. Such a high rate of no response suggests that the question touched on
a sensitive matter. Table
40: Clients Who Believe They Don’t Need To Take Medication And/Or Who
Feel Better About Themselves When They Don’t Take Medication*
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