Treatment adherence

Angela has been spending a fair bit of time with Sam in recent months. She is a 29-year-old

single mother with one child. She studies part-time at the local university and has managed

to maintain acceptable grades. She has bipolar disorder that has been well managed with

medication, in different combinations at different pOints in her illness. However, over the last

month she has intermittently missed doses and is consequently becoming unwell. It is puzzling

that she is missing doses because she is very attached to her child and last time she

stopped medication her daughter was placed in care. The following information was obtained

from her in order to undertake a functional analysis.

Financially, Angela was managing well on her supporting parent benefit and the maintenance

paid by the father of her child. However, her former partner was sent to jail 3 months

ago and the maintenance money he was sending her dried up. As a consequence, she

started falling behind in some bills about 8 weeks ago. She has told you that this worries her.

On top of this, her daughter started experiencing stomach aches last week and is cranky

most of the time. Angela has said that she thinks that her daughter may be lactose intolerant

and believes that her local GP did not take her concerns about her daughter's distress seriously

enough when she took her to see him 10 days ago.

Since becoming involved with Sam, Angela has struggled to keep a routine for her and her

daughter and she says she forgets her medication from time to time. Sometimes Angela

loses interest in sex and she thinks that her medication might reduce her libido.

Angela has never received much help from her family because they don't agree with her

diagnosis. He father says that she is just an attention getter and that she puts it on. He says

that is why she cut herself when she was a teenager. Her father states that if she just stopped

'boozing' she wouldn't be so down and need the medication. Angela disagrees, stating that

she has been drinking to help her sleep for years and is drinking no more or less now.

Nonetheless, Angela has tried to cut down on her alcohol use over the last month and this

has interfered with her sleep.