A study of medication refusal by involuntary psychiatric patients

The authors evaluated 31 patients consecutively admitted to a locked acute treatment unit in California to determine the severity of their symptomatology, their attitudes toward treatment, and whether they would refuse medication if they had the opportunity (patients in California do not have the right to refuse). Fifteen patients indicated that they would refuse medication if given the opportunity. Although they did not differ in diagnosis from the other patients, they showed evidence of more severe psychosis and higher mood elevation and had less positive attitudes toward treatment. Two-week follow-up of 12 patients in the refuser group showed that they were less likely to refuse drugs and were clinically improved; however, six of the patients still preferred to refuse medication despite their clinical improvement. The authors discuss their findings in the context of the broader issue of when a mentally ill person should be forced to give up the power to make decisions about drug treatment.