An outpatient diagnosed with schizophrenia tells the nurse, "I am here to save the world. I threw away the pills because they make God go away." The nurse identifies the patient's reason for medication nonadherence as:
a. poor alliance with clinicians.
b. inadequate discharge planning.
c. dislike of medication side effects.
d. lack of insight associated with the illness.
ANS: D
The patient's nonadherence is most closely related to lack of insight into his illness. The patient believes he is an exalted personage who hears God's voice rather than an individual with a serious mental disorder who needs medication to control his symptoms. While the distracters may play a part in the patient's nonadherence, the correct response is most likely.
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