The LAI Conversation: Are Patients Rejecting the Treatment—or the Way We Present It? | LAI Series, Part 2 of 3

Want to continue the discussion? Send me a message. Psychosis can be stable for years and daily life can still feel strangely out of reach. We’re talking about the negative symptoms of schizophrenia: the quiet losses in motivation, pleasure, social connection, and emotional expression that don’t always show up in a brief medication visit but can shape every ordinary day. I walk through why these symptoms are easy to miss, why they’re often misunderstood, and why “withdrawn” doesn’t automatica...

Want to continue the discussion? Send me a message. Side effects don’t usually walk into my office wearing a name tag. They show up as “itchy,” “foggy,” “I’m missing something,” or “everything is on the tip of my tongue,” and if we rush to match those words to a checklist, we can miss the real signal and make the wrong medication decision. I break down how I translate patient language into clinically useful information while still respecting the experience exactly as it’s described. Yo...

Want to continue the discussion? Send me a message. One week of conference notes can feel inspiring until you’re back in clinic and a client says, “I’m still depressed.” What changes then? I walk through the question I keep bringing home from PsyCongress: before I add or switch a medication, what exactly am I trying to fix? We get concrete about medication management and “treatment-resistant depression,” because that label can push us to escalate too quickly. I talk through why partial respo...

Want to continue the discussion? Send me a message. A mood questionnaire says the depression is improving. I see more eye contact, more focus, maybe a little more life in the room. And then the client looks at me and says, “I don’t feel any better.” That moment is where bipolar depression treatment gets real, because symptom scores and lived experience can move on different timelines. We talk about how I use self-report measures in medication management without letting them define reco...

Want to continue the discussion? Send me a message. Bipolar depression can get worse for reasons that have nothing to do with “the med failing,” and that is exactly why medication decisions can feel so uncertain in real practice. I take you through part two of my bipolar depression series by telling a few cases that changed how I think about treatment response, especially when the picture gets messy and the obvious next step is not actually obvious. First, I share a young adult case where de...