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BMC Psychiatry 2013, 13153 httpwww.biomedcentral.com1471-244X13Page 7 ofmania or beliefs about the impact of non-adherence on symptoms "I wanted to know what I actually thought and I believed that the medication was controlling my thoughts - so it had to become stopped" (P35) "Too low felt there was no point as was going to kill myself anyway" (P15) "I am hearing poor voices and they occasionally tell me that the medication is poison" (P7) "I was high as a kite" (P4) "Thought I may feel much LY3023414 In Vivo better if dose missed occasionally" (P16) Additional, where service users reported sensible troubles these may often be understood as combining with side-effects or symptoms using a resulting increased effect "I was stuck in a flat with tiny power right after being on two lots of medication sleeping 16 hours or more with no transport" (P24) 1 shared element from the two themes presented so far could be the way in which decision-making and behaviour tends to be in response towards the day-to-day challenges and demands of living using a extreme and enduring mental illness, in lieu of on longer term considerations. For some, forgetting appeared to become a function of `Feeling nicely enough', that may be, of a remission of symptoms andor being busy or typically engaged with every day life "Just forgot too busy at work" (P15) "Somehow I forgot to take the medication, maybe simply because I was feeling well" (P25) For other folks `forgetting' was part of the knowledge of "Contending with side-effects and symptoms" "last evening I forgot to take my lithium simply because I was as well tired and did not want to really feel sick" (P23) "Last week, was awake for three days didn't take any medicine through this period" (P14) This also incorporated aspects of loss of motivation "too mentally and physically tired to have out of bed and fetch medicationwater" (P27) "I didn't feel like performing anything and taking medication was certainly one of those things" (P37) also because the expertise of symptoms straight impacting on adherence, like delusional thoughts or fears about medication, hopelessness, hallucinations,Gibson et al. BMC Psychiatry 2013, 13153 httpwww.biomedcentral.com1471-244X13Page 6 ofFigure 1 Service user satisfaction with medication.Figure 2 Service user satisfaction with assistance.Gibson et al. BMC Psychiatry 2013, 13153 httpwww.biomedcentral.com1471-244X13Page 7 ofmania or beliefs regarding the impact of non-adherence on symptoms "I wanted to understand what I genuinely believed and I believed that the medication was controlling my thoughts - so it had to be stopped" (P35) "Too low felt there was no point as was going to kill myself anyway" (P15) "I am hearing poor voices and they from time to time inform me that the medication is poison" (P7) "I was higher as a kite" (P4) "Thought I may feel much better if dose missed occasionally" (P16) Further, where service customers reported practical difficulties these may possibly sometimes be understood as combining with side-effects or symptoms with a resulting elevated impact "I was stuck in a flat with little power after getting on two a great deal of medication sleeping 16 hours or much more with no transport" (P24) One shared element in the two themes presented so far will be the way in which decision-making and behaviour tends to be in response towards the day-to-day challenges and demands of living having a severe and enduring mental illness, instead of on longer term considerations.