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勸服思覺失調病者持續服藥 加強病識感處理副作用

To Persuade Psychiatric Patients to Continue Taking Medication

Increase Their Insight of Illness and Manage Side Effects

When we are sick, it is natural for us to see a doctor and take the prescribed medication to get well. However, while some psychiatric patients are willing to see a doctor, they are unwilling to take their prescribed medication. According to guidelines from the Hospital Authority, psychosis patients should take medication to stabilise their condition. Unfortunately, many psychosis sufferers have poor awareness of their illness and thus do not take their medication. The Hospital Authority’s guidelines indicate that there is a 50% chance of recurrence if psychosis patients who stop their medication for 5 years. Family members can consider approaching professionals to learn ways to help patients face their illness and increase their medication compliance so patients can maintain their mental well-being.

Awareness of illness refers to the patients’ ability to have a clear picture of their health condition, or whether they can identify if they are well or unwell. Psychosis sufferers usually have poor awareness of their illness. They do not know or do not believe that they are ill. Some sufferers may even think that they can recover without medication.

Manage Stress, Increase Awareness of Illness, Reduce Side Effects

To manage and help patients continue taking medication, counsellors from The Companions suggests the following three approaches:

1. Alleviate and Address Stress

All of us face stress during the process of growing up or from society. Stress needs to be well managed regardless of whether we are a patient or not. We had a client who migrated from China at a young age and has an accent. Others often teased him about his accent; hence he developed an inferiority complex and refused to talk. Another client has a birthmark on his face. He always felt that others think that he had a disease, which stressed him tremendously over time. Such stressor should be addressed and managed by anyone, both healthy individuals as well as psychosis sufferers. While the negative thoughts may not change regardless of our mental health condition, managing this stressor can change how we react to other people’s teasing.

There was a client who had financial pressures and refused to take mediciation as he was worried that he could not afford the cost. Instead of only advocating the benefits of taking medication, we should also be mindful of any financial pressure that sufferers may face and help them manage this stressor.

2. Managing Insight of Illness

Enhance the patient’s awareness of illness through conversations. For example, if a patient often hears the sound of water dripping from a tap in auditory hallucinations, a counsellor can highlight to the patient: “Last night you heard the ‘dip dip dip’ sound of water dripping. This morning, you have taken medicine. Do you still hear the sound? …Oh, isn’t it special? Once you have taken medicine you don’t hear it anymore!”. Such dialogues enhance the patient’s awareness / insight of their illness, helping he or she realises that they have an existing illness. These dialogues, which highlight the positive effect of medication, also help the patient accepts the illness and not be overly worried. Even though he or she may experience long-term symptoms, these can be managed with medication.

3. Managing the Side Effects of Medication

Side effects of psychiatric medication are classified as positive and negative. Positive side effects include increased appetite, low blood pressure and giddy spells etc. Negative effects include drowsiness, slow response and poor memory etc. Although new injectable medications have fewer side effects, they may not be suitable for all patients. Side effects can be distressing to the patients, particularly those with poor awareness of illness. They may think that since they are not ill, or have recovered, why do they have to suffer the side effects unnecessarily. Counsellors suggest that family and friends should develop a deep understanding of the sufferer’s condition and the various side effects of their medications to come up with ways to address them. For instance, a medicine may cause a patient experience dryness in the mouth often. To manage this, family and friends can help ensure there is a water bottle close by at all times so that the patient can have frequent sips of water. Examine the various side effects and make the relevant changes in lifestyle and habits (of the family members and patients) to manage them. Addressing the side effects will reduce their impact on the patient’s quality of life, thereby enhancing medication compliance. 

Most importantly, family and friends should encourage patients to learn to live and cope with the illness and the medication’s side effects to ensure medication compliance.

Tips on Managing Side Effects from Psychosis Medication:

  1. Increased appetite, weight gain, high blood glucose, high blood lipids levels: Maintain a balanced diet and try to eat more vegetables
  2. Disrupted sleep, low energy levels: Exercise for at least 20 minutes daily and set a regular rest schedule 
  3. Dryness in the mouth, blurred vision: Carry a water bottle around, learn to rest quietly
  4. Other more serious/unique side effects: Consult a psychiatrist on the respective remedies

The Companions
Dr. KK Cheng
Counsellor