Do psychatirst know when your not taking medications as they prescribed for you?

No: As with any physician, we only know what you tell us. We can do blood or urine tests for some medications, to check if they are in your system, but in general practice, we have no way of knowing what you are doing. I'd be curious to know why you asked this question. Obviously, if you are taking a specific medication for a specific illness, we may suspect you're not taking it if you're still ill.