Regarding your enquiry as to why a person with a mental illness, and in particular Clive, would discontinue medication, I am able to give you my professional opinion as follows:- The class of drugs used to treat schizophrenia is known as anti-psychotics (sometimes called neuroleptic's or major tranquilliser's).

· Clive's history of treatment includes the use of a number of different typical anti-psychotics and more recently the use of a-typicals.
· All of these medications have the potential to produce unwanted side-effects and especially the old typical anti-psychotics which Clive was initially treated with.
· Some of these side-effects can be particularly distressing and Clive has experienced a number of these, specifically akathisia (20-25% of patients treated with the older drugs are affected - according to the Maudsley Prescribing Guidelines, 2003). When Clive describes having felt 'suicidally depressed' on medication he has not been exaggerating.
Akathisia is a subjectively unpleasant state of restlessness and involuntary movements which contribute to anxiety and lowering of mood and untreated akathisia has been linked to suicide (Van Putten and Marder, Journal of Clinical Psychiatry 1987).
· Clive has a sensitivity to medication and has even experienced a reaction to Aspirin.
· Even on the newer medication as recently as March, 2004 he experienced unwanted side-effects and I carried out a Liverpool University Side-Effect Rating Scale and a Barnes Akathisia Rating Scale which indicated marked akathisia even after a dose reduction.

Issues of concordance are continually arising in the field of mental health, especially if the person involved has experienced unwanted side-effects that are far worse in their view, than the illness itself. Added to this it should be remembered that when treated under the Mental Health Act the individual has a reduced ability to participate in treatment choices.

Also coming to terms with having a mental illness is difficult enough, especially if this is likely to require long-term treatment.

Clive has now found a medication, the side-effects of which have been carefully monitored, which he takes willingly and he can find no reason why he would need to discontinue.

On a positive note I would like to quote from the Diagnostic & Statistical Manual IV (American psychiatric Association).

Schizophrenia - paranoid type (295:30).
"These individuals usually show little or no impairment on neuropsychological or other cognitive testing. Some evidence suggests that the prognosis for the paranoid type may be considerably better than for other types of schizophrenia, particularly with regard to occupational functioning and capacity for independent living".

This is one of the reasons Mental Health Services have sought to support Clive in finding a medication he can trust not to make him feel like taking his own life and one which addresses his illness, thus avoiding re-hospitalisation.

Alison Bass CPN May 2005