Medication Adherence / Compliance

by IMS
(California)

My son is 15 and has been diagnosed as Bipolar and has been taking risperidone for the last 2 months off and on.


I say off and on because he will think he is doing better and then stops taking it. When he stops taking it he gets violent.
He has thrown a dresser at me when he thought I was teasing him about his medication. What I said was that he needs to see that he does better on his medication. He also challenges my husband and if our younger children say something to him he will charge them and has hurt both of them.
Just yesterday he was arrested for assault and threatening to kill my husband and my younger son. He bit my arm when I was holding him from trying to hurt my other son.
My question is (i have many) how do we deal with him thinking he doesn't need his medication. He doesn't go to school we have set in motion Home Hospital school, he won't play sports(very talented) and he won't go to counseling.

Our hope is now that he is in the Juvenal system they will help us get on board.

How do we as parents support him without taking away from our other two children? We have a younger son who is angry and doesn't understand that we have "given" in to our older son and resents his brother for all the pain and drama he has caused in our family.



Answer

Medication Non adherence is common among people who have mental illness. Unfortunately ,the research indicates usually the reason people are non complaint with their meds is that they don't believe they are sick. When my children are non adherent, I point out all the things that have happened in their life that seem to indicate something is wrong, and emphasize that it is not because they are bad, but because they are sick. I may trace the family lineage of the disorder to illustrate that it is a genetic disorder and they are not blame. Sometimes this is helpful and sometimes it is not. When it is clear that this is not helping I abandon the strategy. Unfortunately there is some evidence to suggest that some people with bipolar disorder have a complete lack of insight into the fact that they are ill.

Another reason for non compliance is substance abuse. Substance abuse reduces the teens insight and makes it challenging for those around to assess the symptoms as well. Hopefully, your child is not using substances, but I would suspect it is a possibility.
Other reasons may exist, however. I would really suggest that you find a therapist that can develop a good rapport with teens who are non complaint. Obviously it may be medication side effects or ineffectiveness that is causing your child to refuse to take meds, or it may be a fear that it will be stigmatizing in some way or means that they are damaged. As I mentioned before the number one reason people are non adherent to their medication regime is not believing they are ill, but these are also possibilities.
I don't know with your son what in particular is causing him not to take his medication, or refuse therapy, but my guess is that it is probably his lack of insight into his illness. I would suggest that you have a talk with him, and start to figure out what may be something that you could use to motivate him to take his medications. Then whatever it might be use that to help persuade him to take his medications. If he is not open to persuasion it is helpful to find something to bargain with.

I hope that involvement in the juvenile justice system does help your son. It is important that those involved focus on gaining his trust so that they can wield some influence rather than forcing him to comply out of fear.

Regarding Siblings

There is no easy answer here. Siblings need to understand that they have a brother or sister who is sick due to mental illness. I would spend as much time educating him about this as possible, and get him into therapy so he can process these issues and get some assistance navigating through the stress this causes him.

Focus on safety is of paramount importance, and arrangements may need to be made for him to spend time with friends or family when things are particularly heated at home.

Additionally, you may need to go to great extremes to ensure that your other children don't get neglected. It is likely in the face of this that it may be easy for that to happen. Key to this is to get the help you yourself need, and use your support systems that are in place as much as possible. Repeatedly check in with the others about how they are feeling and what they need to feel safe and nurtured.


Good luck!

Kristen

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