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From:    Treatment Advocacy Center <tacenews@app.topica.com>
To:    s.ann.c. @ hopetohealing.com
Subject:    ENEWS - TREATMENT ADVOCACY CENTER
Date:    Fri, 17 Feb 2006 23:15:03 +0000

ENEWS - TREATMENT ADVOCACY CENTER

TREATMENT ADVOCACY CENTER
Visit our web site www.psychlaws.org
February 17, 2006

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1. MAYOR CHAVEZ TO LAUNCH KENDRA’S LAW IN ALBUQUERQUE: HOUSE UNANIMOUSLY PASSED REP. GUTIERREZ’ ASSISTED TREATMENT BILL, TIME RAN OUT IN SENATE - Treatment Advocacy Center Press Release, February 17, 2006

2. MEAN STREETS HELL ON EARTH FOR MENTALLY ILL – Miami Herald, January 19, 2006

3. “NO ONE THINKS HE SHOULD BE LET GO”: POSSIBLE FREEDOM FOR RELATIVE WORRIES FAMILY – Post and Courier, February 12, 2006

4. “WE CAN’T HAVE THIS HAPPEN TO NOBODY ELSE WHO’S SICK” – Miami Herald, February 5, 2006

5. AWARENESS OF ILLNESS AND NONADHERENCE TO ANTIPSYCHOTIC MEDICATIONS AMONG PERSONS WITH SCHIZOPHRENIA (ABSTRACT) – Psychiatric Services, February 2006

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1. TREATMENT ADVOCACY CENTER PRESS RELEASE, February 17, 2006

[Editor’s Note: In New Mexico, Kendra’s Law was passed unanimously by the House – but the constitutionally mandated end of the session came before it could be called for a vote on the Senate floor. The law was widely supported – the science and data clearly registered with legislators more than the emotions and fear tactics of opponents. And proponents like Mayor Chavez, Rep. Gutierrez, and Senator Domenici are clear about their intentions.]

MAYOR CHAVEZ TO LAUNCH KENDRA’S LAW IN ALBUQUERQUE: HOUSE UNANIMOUSLY PASSED REP. GUTIERREZ’ ASSISTED TREATMENT BILL, TIME RAN OUT IN SENATE

ARLINGTON, VA – In the wake of the time running out on the New Mexico Legislature to enact Kendra’s Law, Representative Joni Marie Gutierrez, Albuquerque Mayor Martin Chavez and other supporters today said they would persist in their work to implement an assisted outpatient treatment (AOT) law in the state.

Kendra’s Law legislation, sponsored by Gutierrez, was left unresolved as the 30-day legislative session ended Thursday. That bill, which had the support of U.S. Senator Pete Domenici and Governor Bill Richardson, received favorable approval from every legislative committee that considered it, and the House voted unanimously (62-0) for passage. But the Senate did not take a vote before the short session was gaveled to a close at its constitutionally mandated deadline.

Gutierrez, whose bill was also endorsed by advocacy groups like the New Mexico chapter of the National Alliance for the Mentally Ill, vowed to reintroduce the measure next session. In the meantime, Chavez will announce as early as next week that he will not wait and will take action to bring Kendra's Law to Albuquerque as soon as possible.

“I am proud of Representative Gutierrez for her leadership on this issue and for prompting a much needed debate on Kendra’s Law in New Mexico. I regret that time ran out on the bill this year, but appreciate the House’s unanimous support for the legislation,” Domenici said. “Kendra's Law works in other states. It not only prevents possible crimes and tragedies, but offers fair and safe treatment for individuals who suffer from severe mental illnesses. The people of New Mexico need Kendra's Law. With the strong support this bill received across party lines, I am hopeful it will become law in New Mexico soon."

“Existing New Mexico law essentially forces people who lack insight into their illness to hit rock bottom before they can be helped,” said Gutierrez. “It is devastating for families of those lost to the symptoms of their illness to be told they have to wait another year before they can get help. I am pleased that the House unanimously supported this important legislation, and saddened that time ran out before the Senate could vote. We won’t give up. I plan to reintroduce Kendra’s Law the first day of the next session – and know that next year at this time we will have a law that can help people statewide.”

Albuquerque Mayor Chavez is moving forward to ensure that in the interim, Albuquerque residents will be able to use AOT. In December, he announced his intent to move ahead, saying “I cannot wait for the state to act.” His message today is the same. “We will fight to get this law for Albuquerque,” said the Mayor. “I will not stand by for a year and wait for another tragedy. The small number of people who desperately need this legislation don’t have that kind of time. The Senate may have run out of time – I want to make sure that my citizens do not.” That will mean passing Kendra’s Law at the municipal level.

New Mexico is one of only 8 states without an assisted outpatient treatment law. That means someone too ill to make an informed treatment decision must be left untreated until they are in a crisis and meet the state’s restrictive standard for inpatient commitment, posing a “likelihood of serious harm to themselves or others,” and then the only option is hospitalization in a state that, like most, has too few psychiatric beds.

Proposed legislation (HB174 and SB335) would have allowed courts to order someone with a severe mental illness into outpatient treatment if a judge found they met specific requirements. Nationwide statistics show that AOT laws dramatically reduce hospitalizations, arrests, incarcerations, episodes of violence, victimizations, homelessness, and caregiver stress, and improve medication compliance and quality of life.

“The trend across the country is to rely on the science to make mental health treatment laws more humane and effective. New Mexico is one step closer to that goal today,” said Mary Zdanowicz, executive director of the Treatment Advocacy Center, a national nonprofit organization dedicated to removing barriers to treatment of severe mental illnesses. “The state has many reasoned and passionate advocates, led by the New Mexico chapter of the National Alliance for the Mentally Ill, who will not stop until New Mexico updates its inhumane treatment law. It is just a matter of time. Unfortunately, when you are struggling to get real help for someone you love, waiting even one day can be harrowing. We are impressed with all the local advocates who fight battles for treatment each day, and awed by their commitment to fix the problem statewide.”

Kendra’s Law is modeled after and substantially mirrors the law that created the Kendra’s Law program in New York, a program called “extremely successful “ by the Commissioner of New York’s Office of Mental Health. New York’s statewide, real-life outcome data show that of those in the program, 74% fewer experienced homelessness, 77% less psychiatric hospitalization, 83% fewer arrest, and 87% percent less incarceration. “We know conclusively that the program has been invaluable for individuals who, without Kendra’s Law, previously had limited success in using voluntary mental health services,” noted the Commissioner in a letter to the New Mexico Secretary of Health.

The Treatment Advocacy Center (www.psychlaws.org) is a nonprofit organization dedicated to eliminating barriers to timely and humane treatment for millions of Americans with severe mental illnesses.

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2. MIAMI HERALD, January 19, 2006

[Editor’s Note: The point of passage of assisted outpatient treatment laws should not be lost on anyone who reads newspapers. What often goes unreported is the pain on both sides of the illness. There is the horrible pain of the person lost to symptoms, unable to make informed decisions, too often a victim of violence or delusions. And there is the parallel pain of families waiting in horror for death and violence to catch up with their delusional loved ones.

This is what the family members in New Mexico, led by the tireless advocates in NAMI Albuquerque and NAMI New Mexico, are fighting to repair – a system that prevents their family members from getting help if their illness prevents them from asking for it.

For more on Florida’s law and what it really does allow, visit our website at http://tacenews.c.topica.com/maaevBXaboo2ociNMRbb/ MEAN STREETS HELL ON EARTH FOR MENTALLY ILL

by Fred Grimm

The killing of Norris Gaynor was imagined a thousand times.

Isidore Magin has been haunted by the specter for 30 years. But this is how parents pass their sleepless nights when their children are adrift in streets, disconnected to reality, oblivious to danger, without a home or money or resources or reason. Parents like Magin live for years with perpetual dread, haunted by their children's vulnerability. ''This never leaves you. It's always on your mind,'' he said Wednesday.

The potential victim in his thoughts was his own profoundly troubled daughter, Leslie. For years, she wandered the same streets as did Norris Gaynor, the homeless man beaten to death on a Fort Lauderdale park bench Jan. 12. The attack on Gaynor and two other homeless men by marauding teenagers armed with baseball bats and a golf club was only a manifestation of the fear long nurtured by parents whose mentally ill children sleep in homeless shelters or on park benches.

I first spoke to Isidore Magin in 1994. His daughter, in and out of institutions since she was a teenager, had been picked up by Fort Lauderdale police, an irrational and angry mental wreck, and tossed into a criminal justice system. As her mental condition steadily deteriorated, it took Magin and Public Defender Howard Finkelstein 11 weeks to get her out of jail and into a proper treatment program.

COLD COMFORT

But even then, as Magin described how his daughter was sinking deeper and deeper into despair in jail, he spoke of the guilt-tinged sense of comfort he experienced while she was locked up. At least he knew where she was. At least he knew that she was off the streets. At least he knew she was safe from robbers, rapists and killers.

I talked to him Monday, and a dozen years later he still harbored those same conflicted thoughts. Leslie, 44, was off the streets last week when Norris Gaynor was murdered. She was in a state mental hospital in a long-term treatment program. When the ghastly attacks became the lead story on local television news and the front page story in the newspaper, Isidore repeated the old mantra. ``At least I knew where she was. I knew she was somewhere safe.''

But in the next few months, Leslie will be released from the program and cast back into a society that offers little in the way of out-treatment, little in the way of housing for the mentally ill. ''Our deepest concern is that she'll end up back on the streets,'' her father said.

He fears the downward spiral familiar to so many parents with mentally afflicted adult children. They stop taking their stabilizing medicine, their mental state deteriorates and they sink deeper into an illness which, by its very nature, prevents them from recognizing that they need help.

Then, they're back on the streets, homeless and vulnerable.

FEW OPTIONS

Parents have few options, said Jessica Bowers of the National Alliance for the Mentally Ill's Florida chapter. The mentally ill can't be forced back into treatment, they can't be forced to move back home, or into any home. There's few legal options to keep their children from entering the cycle of homelessness.

The mentally ill are free to make their own sometimes deluded, self-destructive decisions unless they're an immediate threat to themselves or someone else. Even if they're wandering the streets homeless, confused, paranoid and substituting illegal drugs and alcohol for their prescribed medications. Even if they're obviously vulnerable to predators.

Parents can only despair. ''I get so many calls from parents who are frustrated and worried,'' Bowers said. When attacks on street people make the news, she said, that worry turns into torment.

''Our biggest fear is that someone out there will hurt our children,'' said Magin, who is 81 and plainly exhausted by three decades of worry. ``It's like a pain that never leaves. Not until you pass on.''

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3. POST AND COURIER (Charleston, South Carolina), February 12, 2006

[Editor’s Note: Family members who care for those with untreated severe mental illnesses face tremendous burdens. One study of relatives of individuals with a severe mental illness showed that a fifth had to give up their own occupation. Another study found that family members of patients with bipolar disorder and major depression had mental health care expenses that were about three times higher than those who did not have loved ones without those diseases...

Families also face the very real risk of violence. A 1997 study focusing on the prevalence of abuse faced by families of individuals with a mental illness found that 32 percent of relatives had been struck on at least one or two occasions. Verbal abuse, threats, and temper outbursts were reported by more than 50 percent of the relatives. The American Psychiatric Association notes that "Family members are most at risk of a violent act committed by a mentally ill person … [Another study] found that among those who had attacked people prior to their admission [to a psychiatric hospital], 65 percent ... had attacked a family member."

(If you are in a situation like this, there are some resources on our web site that might help: http://tacenews.c.topica.com/maaevBXaboo2pciNMRbb/)

Studies show that people with mental illnesses are no more likely to be violent than the general public – when they are being treated. It is just one of the many reasons states like New Mexico need better treatment laws.

The Lyon family knows the statistics firsthand. Their years-long battle to get help for their son Christopher ended when he killed his father. His mother noted the irony that his sentence meant that "He finally got the help he needed after years and years of us going to court and trying to get him hospitalized."

The law failed every member of this family. And may be gearing up to do it again.

“NO ONE THINKS HE SHOULD BE LET GO”: POSSIBLE FREEDOM FOR RELATIVE WORRIES FAMILY

by Glenn Smith

Joan and Peter Lyon spent years begging doctors and psychiatrists to commit their son Christopher to a mental hospital where he would get long-term treatment for the disease that tormented and twisted his fragile mind.

Diagnosed with severe paranoid schizophrenia at age 19, Christopher Lyon was ruled by the voices, pictures and fractured thoughts that filled his head. He bounced in and out of treatment but remained belligerent, violent and difficult to control. He became convinced his parents were trying to torture him and manipulate his mind with a remote control "gizmo."

In October 1996, Lyon stepped out of a Florida treatment center and onto a bus to the Lowcountry, where his parents lived on Kiawah Island. It would be their last visit with their son.

Within days of his arrival, Lyon savagely killed his 65-year-old father, a retired Navy submarine captain, stabbing him more than 70 times in a North Charleston motel room. Lyon was found not guilty by reason of insanity, and a judge ordered him confined to a state mental hospital in Columbia.

"He finally got the help he needed after years and years of us going to court and trying to get him hospitalized," his mother said.

When Joan Lyon last saw her son nearly a decade ago, she assumed it was for the last time. But doctors now are recommending that a judge release her 45-year-old son to an unsecured group home for the mentally ill in the Upstate. Lyon's family sees this as a recipe for disaster.

"He has threatened my life and my wife's life," said Bill Truxal of Largo, Fla., Lyon's brother-in-law. "No one in the family thinks he should be let go. . He's either going to hurt someone in Charleston or hurt someone here."

State mental health officials won't comment on Lyon's case or even confirm that he is a patient in their care. But prosecutors say a mental health review team is recommending Lyon's release from the Columbia Care Center, a secure medical prison facility, because his condition has improved in recent months with the aid of new medication.

A hearing had been scheduled in Charleston County for Feb. 3, but prosecutors won a delay while they push to have Lyon examined by an independent psychiatrist, Assistant Solicitor Edward Knisley said.

"Our concern is that we are starting here with someone who committed a horrible crime and has a 30-year-plus history of severe mental illness," Knisley said. "You don't discharge someone like that because you have a year of good behavior. That is a decision that should probably be made over a much longer period of time."

In and out of treatment

As a child, Christopher Lyon was a bright student and a gifted athlete who easily made friends wherever his father's military career landed the family, from Hawaii to upstate New York.

That changed when he entered his freshman year at Salem College in West Virginia. Lyon, who had been eager to venture out on his own, was suddenly calling his parents several times a day and talking incoherently at times.

During a drive home to New York with his parents that year, Lyon suddenly lunged for the steering wheel and tried to force their car off the road in the Poconos. He leapt from the car and ran off. After police located him, Lyon was taken to a hospital, where doctors diagnosed his schizophrenia, his mother said.

In the years that followed, Lyon ended up in mental hospitals and treatment centers more than 40 times, but rarely stayed more than a few days or weeks before doctors deemed him safe to return to society. Then he would promptly stop taking his medicine, board a bus to parts unknown and begin cursing, mumbling and fighting all over again as the sickness swallowed his mind.

He ended up in places such as Denver, Atlantic City, N.J.; Dallas and Idaho Falls, Idaho, the city of his birth. One time, a hankering for lobster led to a bus trip to Vermont. Another time, he ended up in Miami, where he lived on the streets for a year. Along the way were periods of hard living, street brawls and suicide attempts. He also threatened to kill family members and once beat his father during a rage, family members said.

Lyon ended up in treatment centers five times in 1996, only to be released after medicine helped calm his behavior. In late September of that year, he was hospitalized again in Florida after striking a hotel bartender with a beer bottle. He was released within days, and a treatment center staff member gave him a lift to a bus station, where he bought a ticket for South Carolina, relatives said.

Last visit home

Peter and Joan Lyon were on a cycling vacation in Europe at the time. A friend was staying at their home with their younger son, who also is schizophrenic but has not been prone to violence. When Christopher arrived in the area, the friend arranged a room for him at Rodeway Inn on Rivers Avenue in North Charleston.

His parents returned home soon after and agreed to take Lyon money and clothing. They usually insisted that he check into a hospital and get medication before they would agree to see him. This time, they didn't press the issue.

"We had been on vacation. We were relaxed, not thinking," his mother said. "We had let our guard down."

After stopping for lunch at Citadel Mall on Oct. 18, 1996, Joan Lyon went to retrieve their dog from a boarding facility, while her husband of 43 years went on to North Charleston to see Christopher. "That was the last time I saw him," she said.

When Peter Lyon didn't return home, police went to the motel and found him dead in his son's room. Police arrested Christopher Lyon after tracking him to a motel in West Ashley. Prosecutors said he had been convinced his father was going to force him to undergo spinal taps.

Lawyer Laura Knobeloch, who represented Lyon in the murder case, said it was clear that he needed hospitalization. He was delusional, paranoid and convinced that some tormenting force he called "the collar people" were trying to control him. "He was out of his mind," she said. "You couldn't even have a conversation with him."

Joan Lyon didn't attend the trial and quickly moved to Las Vegas before eventually settling in Arizona. She was afraid of her son and wanted to start a new life far away.

The road to forgiveness

For most of the past decade, Christopher Lyon did not respond well to treatment, remaining distant and occasionally violent, fighting with others in the mental hospitals where he resided, family members and authorities said.

Then, about a year ago, Joan Lyon received a call from a caseworker who said her son had experienced a breakthrough on Clozaril, a powerful anti-psychotic drug. He wanted to speak to her. Nervously, she agreed.

"It was emotional because I never thought I would ever have a conversation with him," she said. "I thought when it happened that I had really lost the both of them."

Their phone call lasted just five minutes and consisted of brief, awkward updates on their lives. But a connection had been renewed, and a flurry of letters followed.

Joan Lyon can see her son getting better, his thoughts and writing becoming more coherent with each letter. He often asks about their family dog, a 13-year-old Brittany spaniel named Tabitha. He asks his mother to send him things, such as a Sony Walkman or size 32 jeans. They have not discussed his father's death. Joan Lyon said she knows in her heart that her son's disease was to blame.

"You have to forgive," she said. "If you don't, it just ends up hurting you."

Still, she and her family were shocked to learn two weeks ago that he could soon be released. A judge's decision could come by month's end.

"I'm surprised they are even considering discharging him," said Lisa Truxal, Lyon's sister. "A social worker told me he was one of the sickest people they had there... He has only been stable for a year and a half on the new medication."

Risky release?

Bill Truxal said the family is convinced Lyon will simply follow the pattern that has defined his adult life, shirking his medicine and wandering off in search of family members he has threatened in the past.

That scenario is even more likely with no one to force Lyon to take his medicine, which is expensive and requires regular blood tests to check for health complications, he said.

"If you find someone not guilty by reason of insanity then I think you have an obligation to keep them safe from themselves and from others," he said. "Who are we trying to help here?"

Truxal and other family members are convinced that budget problems and a shortage of beds are prompting the state Department of Mental Health to consider releasing Lyon. State officials, however, deny that is the case and point out that the agency has asked lawmakers for $1.9 million to add 20 beds for the criminally insane and other clients.

"I do not believe the Department of Mental Health would discharge a client who had been not guilty by reason of insanity just because a bed was needed," said John Hutto, an agency spokesman.

Joan Lyon doesn't want to take that chance.

"He's still my son and I want the best for him," she said. "But he was sick too long. He's not stable enough."

Reach Glenn Smith at 937-5556 or gsmith@postandcourier.com.

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4. MIAMI HERALD, February 5, 2006

[Editor’s Note: The system failed Troy Rigby completely, as well. Stories like this one remind us all that families are struggling every day against terrific odds to save the lives of the people they love.]

“WE CAN’T HAVE THIS HAPPEN TO NOBODY ELSE WHO’S SICK”

Michael Mayo

When Troy Rigby told his sister Juliet he was leaving New Jersey for Florida last August, she was upset.

"He didn't tell me until the minute he left," Juliet Rigby Lopes recalled Friday. "I was concerned about him. But I told myself he's a grown adult, and it's his life."

He drove to Florida with his uncle, David Rigby, of Pompano Beach. It was supposed to be a two-week trip. But he found a job with a roofer and liked the weather, which reminded him of his native Guyana, according to his sister, Merlene Rigby, 39, of Miami. So Troy stayed.

Like many who have mentally ill relatives, Juliet worried about what might happen to her baby brother.

"When he has one of his episodes, me and my mother always took care of him," said Juliet, 42, of Irvington, N.J. "We know what to look for, the signs and the symptoms."

Life has been a roller coaster for the Rigby family since Troy was diagnosed with schizophrenia and bipolar disorder in August 2003. He was in and out of hospitals and mental institutions. He was on and off all sorts of medications. He couldn't land a job and was rejected when he applied for social security disability.

To hear Troy Rigby's sisters tell his tragic life story is to be reminded of how far this society has to go when it comes to the mentally ill. It's a story that hit me especially hard, as my oldest brother is schizophrenic and has been hospitalized in New York for most of the past three decades.

At least he's in a secure place where the staff knows him.

Troy Rigby, 29, wasn't so lucky.

He is in his final days, on life support at North Broward Medical Center in Deerfield Beach, after a series of traumatic events ended with him unconscious and unresponsive in his cell at the North Broward Jail's Mental Health Unit in Pompano Beach.

On Jan. 23, in the midst of a mental health crisis, Rigby had the misfortune of being put on a commercial flight by his uncle.

Then he landed in the grips of a criminal justice system that wouldn't let go until it was too late.

In this respect, Juliet said New Jersey is more advanced than Florida.

She told how Troy relapsed in 2004, escaped from a hospital and landed in the Somerset County Jail after he broke into a car. When he continually defecated on himself, the authorities realized a jail might not be the best place for him. He was taken to a medical center, then transferred to the state mental hospital.

Here, the Broward's Sheriff Office keeps mentally ill criminal suspects in custody, providing treatment through its contracted medical provider, Armor Correctional Health Services. The Sheriff's Office said its policies are appropriate and it followed proper procedures in this case.

Deputies used multiple Tasers to subdue and arrest Rigby when he disrupted the Continental flight and jumped onto the airport tarmac. He was given a brief physical examination at Broward General Medical Center before being cleared to go to the main jail for booking. The next day he was transferred to the Mental Health Unit of North Broward Jail.

The day after that, Jan. 25, he had a violent scuffle with detention deputies, which his family said led to an injection of Ativan, a sedative, and Prolixin, an antipsychotic.

The day after that, Jan. 26, he was rushed to the hospital near death. His family was told he had a massive coronary.

Juliet Rigby Lopes flew into South Florida when she got the news on Jan. 27. Juliet and Merlene had a meeting with a Sheriff's Office major, Winnifred McPherson, and a physician last weekend.

They left with more questions than answers.

"Maj. McPherson, she couldn't look us in the face," Juliet said. "After the meeting, I said to my sister, `I don't trust this lady. They're trying to hide something.' I don't know what happened to my brother but we're going to find out. We can't have this happen to nobody else who's sick."

Michael Mayo can be reached at mmayo@sun-sentinel.com or 954-356-4508.

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5. PSYCHIATRIC SERVICES, February 2006

[Editor’s Note: We often cite research in our materials, because we believe that good laws are based on good science. That is why we wanted to share the latest of many studies confirming that lack of insight into illness, most often caused in people with severe mental illnesses by a neurological deficit known as anosognosia, which notes in part that “patients who lacked awareness had significantly longer episodes of antipsychotic nonadherence, were more likely to completely cease taking the antipsychotic medication, were more likely to have severe positive symptoms, and were more likely to be psychiatrically hospitalized after nonadherence than those who were aware of their illness.”]

AWARENESS OF ILLNESS AND NONADHERENCE TO ANTIPSYCHOTIC MEDICATIONS AMONG PERSONS WITH SCHIZOPHRENIA (ABSTRACT)

Mark Olfson, M.D., M.P.H., Steven C. Marcus, Ph.D., Joshua Wilk, Ph.D. and Joyce C. West, Ph.D., M.P.P.

OBJECTIVE: The purpose of this study was to assess the effects of patients' awareness of their illness on the clinical presentation, management, and course of nonadherence to antipsychotic medications among patients with schizophrenia.

METHODS: A national survey was conducted of psychiatrists who were treating patients with schizophrenia. The survey was sent to 771 psychiatrists, of whom 534 responded, for a response rate of 69 percent.

The psychiatrists were asked to report on presentation, management, and course for one adult patient with schizophrenia who had been under their care for at least one year and who had been nonadherent to oral antipsychotics at some point in the past year.

Patients who were aware that they had a mental illness were compared with those who were not aware.

RESULTS: Of the 534 respondent psychiatrists, 310 reported on an eligible patient, and 300 of these patients were classified by illness awareness.

Ninety-seven patients, or 32 percent, were not aware that they had a mental illness. These patients who lacked awareness had significantly longer episodes of antipsychotic nonadherence, were more likely to completely cease taking the antipsychotic medication, were more likely to have severe positive symptoms, and were more likely to be psychiatrically hospitalized after nonadherence than those who were aware of their illness.

Psychological interventions and several types of family interventions were significantly less effective among patients who lacked awareness.

CONCLUSIONS: A lack of awareness of mental illness is common among patients with schizophrenia who are nonadherent to antipsychotics. Such nonadherence tends to be especially disruptive and unresponsive to simple commonly used psychological interventions.

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