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Melissa Avery-Weir @melissaaveryweir

nytimes.com/2017/11/06/upshot/

I hadn't realized that it was so difficult to get patients to take meds on schedule across the board. I knew that was a thing in having a mental illness--the very condition often undercuts one's interest in being well or gives a false sense of wellness--but heart attack patients? Oof.

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@melissaaveryweir It's pretty universal. A lot of it is just the usual challenge of building new habits. That's why things like the week-of-meds boxes are so helpful.

But something that I think health care providers forget is anyone dealing with chronic symptoms is going to have reduced mental function. Working through pain or ignoring discomfort or working around asthma takes up some of your mental bandwidth, so you have less mental bandwidth for things like remember to take your new meds.

@melissaaveryweir And if you've built the habit of taking meds with, say, breakfast, but you have a bad day and can't eat breakfast, it's easy to forget the meds bc the schedule disruption messes with the habit.

Also, executive dysfunction is a bigger problem for mental health patients in taking meds that either not wanting to be well or thinking we are well.

@JessMahler These are really good points. The spoon theory applies in many of these chronic illnesses, and I didn't think of that. "Executive dysfunction" is a new term to me! I'm glad there's a name for that concept, because I've struggled to describe those behaviors without falling into gross "diagnosing" (e.g., saying someone is "being ADHD" or "manic"). Not that I go around describing people's behavior through that lens often, but it occasionally comes up.

@melissaaveryweir Executive dysfunction is an important idea that IMO doesn't get discussed enough. There's a good overview intro here, though it suffers from not having info from the perspective of someone dealing with executive dysfunction and in places sounds like executive dysfunction is an all or nothing thing.

@melissaaveryweir Speaking of executive dysfunction...

Here's the link