Schizophrenia: Medication Adjustments and Patient Awareness

Q: Schizophrenia: Medication Adjustments and Patient Awareness

Hello： When starting treatment for schizophrenia, it is important to be very patient. <br>Worsening symptoms are more likely due to the progression of the illness, and typically, the purpose of medication is to reduce the severity of symptoms. <br>Generally, the initial treatment

Schizophrenia

Hello, Doctor! My brother has schizophrenia.
He started taking 2 mg of Artane and 2 mg of Valium each in the morning in mid-March; in the evening, he takes 25 mg of Seroquel and 2 mg of Olanzapine, one of each.
Initially, his mental state was good, and his mood was stable, but he still experienced auditory hallucinations.
By early June, the hallucinations worsened, causing him to freeze up, and he would have a strong reaction when called.
During his follow-up appointment, his medication was adjusted to 2 tablets of Seroquel 25 mg and 1 tablet of Olanzapine 2 mg, which improved the freezing episodes.
However, from late June to early July, his mood became more irritable, unlike his previous calm demeanor; he became suspicious and occasionally exhibited unusual behavior, believing he had special powers.
After another follow-up, his medication was adjusted to 3 tablets of Seroquel 25 mg and 1 tablet of Olanzapine 2 mg.
Could you please explain why, despite ongoing medication, his condition seems to be worsening? I read in some articles that Seroquel might exacerbate mood issues.
Is this true, and should we consider asking the doctor to change his medication for better management of his condition? My brother is aware that he hears unusual voices but does not perceive them as hallucinations; he initially sought help because the voices told him to harm himself.
However, he does not recognize his unusual emotional responses and behaviors as problematic, and he does not proactively inform the doctor about his condition during visits.
How can we help him develop insight into his illness? Thank you for your response.

Mu, 40~49 year old female. Ask Date: 2017/07/12

Dr. Liang Sunyuan reply Psychiatry

Hello: When starting treatment for schizophrenia, it is important to be very patient.
Worsening symptoms are more likely due to the progression of the illness, and typically, the purpose of medication is to reduce the severity of symptoms.
Generally, the initial treatment does not involve high doses, and subsequent follow-ups will adjust the dosage based on the progression of the condition.
If there are any questions, it is advisable to discuss them with the outpatient physician during follow-up visits.
Regarding insight into the illness, patience is also essential; adhering to the medication regimen will lead to better educational outcomes about the illness once symptoms have alleviated.

Reply Date: 2017/07/12

More Info

Understanding schizophrenia and its treatment can be quite complex, especially when it comes to medication adjustments and patient awareness. Your brother's experience with schizophrenia, including the use of medications like Artane, Valium, and Seroquel, reflects the challenges many patients face in managing their symptoms effectively.

Firstly, it's important to recognize that schizophrenia is a chronic mental health disorder characterized by symptoms such as hallucinations, delusions, disorganized thinking, and emotional disturbances. The treatment typically involves antipsychotic medications, which aim to reduce or eliminate these symptoms. However, finding the right medication and dosage can be a trial-and-error process, as individuals respond differently to various drugs.

In your brother's case, it seems that while he initially responded well to the medication, his symptoms have fluctuated over time. The increase in hallucinations and the emergence of manic-like symptoms, such as increased suspicion and feelings of having special powers, suggest that his condition may not be fully stabilized. This is not uncommon; some patients may experience worsening symptoms even while on medication, which can be attributed to several factors, including:
1. Medication Side Effects: Some antipsychotics can cause side effects that may mimic or exacerbate psychiatric symptoms. For example, Seroquel (quetiapine) can lead to sedation, weight gain, and metabolic changes, which might affect mood and behavior. While it is effective for many, it can also lead to increased anxiety or agitation in some patients.

2. Dosing Issues: The effectiveness of antipsychotic medications often depends on the dosage. If the dose is too low, symptoms may not be adequately controlled. Conversely, if the dose is too high, it may lead to increased side effects or exacerbate symptoms. Your brother's dosage adjustments indicate that his healthcare provider is attempting to find the right balance.

3. Psychosocial Factors: External stressors, changes in environment, or lack of support can significantly impact a patient's mental health. If your brother is experiencing stress or changes in his life, this could contribute to the worsening of his symptoms.

4. Insight and Awareness: A significant challenge in treating schizophrenia is the lack of insight that many patients have regarding their condition. Your brother's inability to recognize his symptoms as problematic can hinder effective communication with his healthcare provider. This lack of insight is a common symptom of schizophrenia and can complicate treatment.

To help your brother develop insight into his condition, consider the following strategies:
- Open Communication: Encourage open discussions about his feelings and experiences. Use non-confrontational language and express concern for his well-being rather than labeling his experiences as "abnormal."
- Education: Providing information about schizophrenia and its symptoms can help him understand his condition better. Sometimes, reading materials or watching educational videos together can facilitate this process.

- Involvement in Treatment: Encourage him to participate actively in his treatment plan. This could involve discussing his symptoms openly with his doctor during appointments. You might even consider accompanying him to appointments to help advocate for his needs.

- Support Groups: Connecting with support groups for individuals with schizophrenia can help him see that he is not alone in his experiences. Hearing from others who have similar challenges can foster a sense of community and understanding.

- Regular Monitoring: Keep track of his symptoms and any changes in behavior. Documenting these observations can provide valuable information for his healthcare provider, helping to inform medication adjustments.

Regarding your concern about whether to request a medication change, it is essential to have a candid discussion with his psychiatrist. If you believe that the current medication is exacerbating his symptoms, it is valid to express these concerns. The psychiatrist can evaluate his current treatment plan, consider alternative medications, or adjust dosages based on your brother's specific needs.

In conclusion, managing schizophrenia requires a collaborative approach between the patient, their family, and healthcare providers. By fostering open communication, providing education, and encouraging active participation in treatment, you can help your brother navigate his condition more effectively. Remember that recovery is a journey, and with the right support and treatment adjustments, improvement is possible.

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