Medication noncompliance in schizophrenia: codification and update

Risk of relapse and recidivism makes the failure to take antipsychotic medication as prescribed a significant issue in forensic psychiatry. This question may arise in such contexts as the setting of bail, plea bargaining, the insanity defense, and sentencing. We have reviewed the literature on medication noncompliance in schizophrenia and present here the results, organized by topics relevant for the work of forensic mental health experts. Reported rates of noncompliance vary widely, reflecting major differences in the populations studied and the methods used as well as the complexities involved in defining noncompliant behavior. A noncompliance rate of 50 percent has been attributed globally to chronic patients, both medical and psychiatric. The tendency of significant factors to interact precludes a simple typology of noncompliance. However, environmental security and supportiveness correlate positively with adherence; whereas anxiety, paranoia, grandiosity, depression, and side effects correlate negatively. Clinicians' assessments of whether medication is being taken have proven to be unreliable. Although monitoring by chemical measurement, particularly a radioreceptor assay for urine samples, can be useful, depot injection ensures that prescribed medication is being taken. Less invasive means of promoting compliance are described; psychodynamic and ethical issues to be considered in the monitoring and promotion of compliance over extended time periods are presented. We also probe the link between medication noncompliance and behavioral relapse. The time between default and relapse is most often measured in weeks. Whether due to medication withdrawal or not, the relapse pattern of each individual tends to repeat, allowing its recognition before recidivism occurs. Restarting medication at this stage, especially with a dosage increase, is usually effective. In sum, the forensic mental health expert can now readily use a large and diverse literature to assist with a variety of significant issues.     

The environmental nightmare of the economic miracle: Land abuse and land struggles in Taiwan

Abstract

This is an article about gut feelings: The kind of gut feeling you get when you step out of an elegant wood-paneled coffee shop in Taipei, where you have sipped a dense European brew at U.S. $6.00 for a small cup, and are assaulted by a whirl of grit and trash in the humid eddies of air, the noxious fumes of motorcycles, and the growl and honk of nearby traffic. The mounting nausea you feel when you cannot avoid eyeing slop spilled from restaurant pails left for pickup by pig farms, mounds of used styrofoam bowls and drink cartons, mangy dogs rooting in the corner garbage heaps awaiting early morning collection, and scraps of rotting wood and rusting metal from long-abandoned carts. The unease you feel when you seek escape from the congested city center and find debris from construction sites egregiously scattered in supposedly scenic spots, and industrial and household waste piled up on every otherwise open piece of land, whether vacant lot or graveyard knoll. The choke and dry cough that becomes habitual after a few days of too many hours in stop-and-go city traffic, evenings of endless banquets with chain smokers, and nights in which the smoke of chemical emissions from faraway factories—venting illegally but with impunity under cover of darkness—seeps into your apartment, where you thought you were safe with your cool tiled floors and humming air conditioners.     

STUBBORN LEGACIES OF WAR: Japanese Devils in Sarajevo

Japanese Devils, a documentary of personal confessions of war crimes by Japanese Imperial soldiers in China duringWorldWar II, was invited to the Sarajevo Film Festival, in August, 2002. Accompanying the film and its director to Sarajevo, the author, an American, sensitive to the postwar Japanese experience, discovered a people and city still deeply traumatized by war. The visit prompted a series of questions about the origins of genocide, the consequences of targeting civilians in war, and our collective responsibility to question and listen to the stories of perpetrators, as civilians increasingly become explicit targets in hostilities.     

Nothing but gloom: Women and academia in the new Germany

The real losers in restructuring the former East German university system are women scholars. Women are not only the first to lose their positions in the process of Abwicklung they are also the last to be considered in the new stage of rebuilding the university system. Thus the politics of Abwicklung, has to be understood as a microcosm of the gendered nature of German unification as a whole. Unification has provided German conservatives the opportunity to roll back not only the social policies of the east, but also the feminist achievements in the west. While this process may, because of the specificity of unification, be restricted to the German situation, nevertheless many studies show that even without the process of unification, women in virtually all former eastern European countries are experiencing their ‘forced’ return to the private sphere.     

Balancing acts in construction: A study of two women painters in Denmark and Britain

The construction industry is the most male-dominated labour market in every country in Europe. In Britain and Denmark, women constitute only 1% of those employed in this industry. In spite of the barriers to women entering and remaining in skilled construction work, inroads have been made. Amongst housepainters in Denmark, for instance, women constitute 27% of the workforce and 40% of trainees, and in a number of local authorities' Direct Labour Organisations in Britain, relatively high proportions are to be found. Through the example of two women painters in Britain and Denmark, each with over 14 years' continuous employment, the authors identify the opportunities and obstacles to women entering and remaining in the construction industry. The commonalities and differences between the two countries are illustrated, and it is shown how integration has successfully occurred where social and working conditions are better. The paper concludes that gender segregation and the exclusion of women can be attributed to structural discrimination through training and recruitment mechanisms, the nature of labour relations, employment conditions and the wage system.