Schizophrenia: Medication, Personality Disorders, and Patient Concerns

Q: Schizophrenia: Medication, Personality Disorders, and Patient Concerns

Hello Ms. <br>P, in response to your questions： 1. <br>Personality disorders typically refer to patterns that negatively impact cognition, emotion, interpersonal relationships, and impulse control, which are stable and persistent over a long period. <br>In contrast, disorders oft

Issues related to medication adherence in schizophrenia?

Hello Dr.
Hsiao, I am P.
I was diagnosed with schizophrenia over two years ago and have been consistently attending follow-up appointments since January 2016 until I discontinued my medication in July 2017 due to feeling well and family opposition to treatment.
However, I started regular follow-ups again this August because I felt my condition was deteriorating.
Unfortunately, the female physician who had been treating me since 2016 left in September, and I was referred to another male physician.
I have several questions that I need your assistance with:
1.
Last week during my appointment, my doctor mentioned that I lean more towards schizotypal personality disorder, which is different from schizophrenia.
Could you please explain the differences between the two?
2.
Since it is referred to as a "personality disorder" rather than a "disorder," does this mean I do not need to take medication?
3.
If medication is necessary, how long would I need to take it? Is there a possibility of discontinuing it?
4.
Recently, I have developed some inappropriate feelings towards my physician.
I suspect this is because my doctor is the only one providing me with a space to express myself, leading to this transference.
This genuinely troubles me, and I am considering switching to another physician.
Would that be appropriate? Should I discuss this with my current doctor?
Thank you, Dr.
Hsiao, for taking the time to answer my questions!

P, 20~29 year old female. Ask Date: 2018/12/24

Dr. Xiao Minghong reply Psychiatry

Hello Ms.
P, in response to your questions: 1.
Personality disorders typically refer to patterns that negatively impact cognition, emotion, interpersonal relationships, and impulse control, which are stable and persistent over a long period.
In contrast, disorders often involve significant impairments in physiological, psychological, and functional aspects, leading to a notable decline in functioning compared to the pre-illness state; the two are not entirely the same.
2.
Personality disorders often have many comorbidities and related issues.
Whether to take medication should be discussed with your physician; if you choose not to take medication, consider other alternative treatment options.
3.
Due to the significant individual differences among patients, it is not possible to assess how long medication should be taken without a prior examination.
4.
If there is transference with your therapist, you may discuss it with your physician to gain a better understanding of transference and facilitate personal growth.
Wishing you all the best! Sincerely, Dr.
Hsiang Ming-Hong.

Reply Date: 2018/12/24

More Info

Hello P,
Thank you for reaching out with your questions regarding schizophrenia, personality disorders, and your current treatment situation. It’s commendable that you are actively seeking to understand your condition and the implications of your treatment. Let’s address your concerns one by one.

1. Difference Between Schizophrenia and Schizotypal Personality Disorder: Schizophrenia is a severe mental disorder characterized by distortions in thinking, perception, emotions, language, and sense of self. It often includes symptoms such as hallucinations, delusions, and disorganized thinking. On the other hand, Schizotypal Personality Disorder (STPD) is classified as a personality disorder and is characterized by a pervasive pattern of social and interpersonal deficits, along with cognitive or perceptual distortions and eccentricities of behavior. While individuals with STPD may experience odd beliefs or magical thinking, they do not typically experience the full-blown psychotic episodes that are characteristic of schizophrenia.
2. Medication Necessity: The term "personality" in STPD suggests that it is more about enduring patterns of behavior and inner experience rather than acute symptoms that require immediate pharmacological intervention. However, this does not mean that medication is unnecessary. If your symptoms are significantly impacting your daily functioning or quality of life, medication may still be beneficial. It’s essential to have a thorough discussion with your psychiatrist about your specific symptoms and whether medication could help manage them.

3. Duration of Medication: The duration of medication for any mental health condition varies widely among individuals. For personality disorders, treatment may focus more on psychotherapy rather than long-term medication. However, if you are experiencing significant distress or impairment, your doctor may recommend medication for a longer duration. It is crucial to have regular follow-ups to assess your progress and determine the appropriateness of continuing or discontinuing medication.

4. Feelings Toward Your Doctor: It’s not uncommon for patients to develop feelings for their therapists or doctors, a phenomenon known as transference. This can occur because the therapeutic relationship often provides a safe space for emotional expression and vulnerability. If these feelings are causing you distress, it is advisable to discuss them with your current doctor. Open communication can help clarify boundaries and ensure that your treatment remains effective. If you feel that changing doctors would be beneficial, it’s perfectly acceptable to seek a new provider. Just ensure that you transition your care appropriately to maintain continuity in your treatment.

In conclusion, it’s vital to maintain an open line of communication with your healthcare provider about your symptoms, treatment preferences, and any concerns you may have. Mental health treatment is highly individualized, and what works for one person may not work for another. Regular follow-ups and honest discussions about your feelings and experiences will help you navigate your treatment journey more effectively.

I hope this information helps clarify your questions. Please take care of yourself, and don’t hesitate to reach out for support when needed. Wishing you all the best in your recovery journey!

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