Navigating Schizophrenia: Supporting a Family Member's Treatment Journey

Q: Navigating Schizophrenia: Supporting a Family Member's Treatment Journey

Hello Ms. <br>Wu： Thank you for your hard work. <br>I can sense your concern for your mother, and the challenges you face are common among families of individuals with schizophrenia. <br>This condition affects various aspects of a person's thinking, emotions, and behavior. <br>In

Family members of individuals with schizophrenia?

Hello, doctor.
My mother (50 years old) was diagnosed with schizophrenia two years ago, but she has been seeking solutions through religious means and has low insight into her condition.
She believes that some "twitches" in her body and the voices she hears are caused by supernatural forces.
Additionally, the side effects of medication significantly affected her previous job, so she only took medication for two months two years ago and refused to continue.
Recently, she suddenly expressed a desire to take medication again (her symptoms have worsened; she occasionally feels movements in her abdomen, starts reciting Buddhist scriptures, claiming to exorcise entities from her body, and sometimes makes sudden movements and shouts as if conversing with her abdomen).
I accompanied her to the hospital, where she was prescribed a new medication.
Both the doctor and I informed her about the potential side effects and the adjustment period.
However, after just one day of taking the medication, she claimed the side effects were too severe and refused to continue.
Her reasoning was that she hadn't taken medication for two years without it affecting her life, and she had not harmed herself or others.
I argued that it significantly impacts her life and emotions, but she believes her emotional expression is normal.
She also plans to stop working and intends to go to a temple for spiritual practice, so she thinks it won't affect her.
Conversely, now that she has started taking medication, she experiences side effects like weakness in her limbs, fatigue, prolonged sleep, and feels that these are what truly affect her life, even leading her to thoughts of suicide.
Additionally, she is very inclined to handle her situation through religious means, and there are many individuals trying to sell her various rituals, which frustrates her.
She feels that "my family is not helping me, so my condition is so severe," which exacerbates her emotional state.
I feel powerless, as there is a significant divergence in understanding and believing in effective treatment methods.
I have no idea how to handle this situation.
Question 1: The new medication prescribed by the doctor is Paliperidone.
How long should we estimate for her to adjust and for the side effects to decrease? Are there any specific risks or side effects associated with this medication? The doctor's response was quite vague, which concerns me.
Question 2: The doctor suggested switching to an injectable form but did not explain the differences in side effects between injections and oral medication.
Are there additional risks associated with the injections? Besides the longer duration of effectiveness and preventing the patient from forgetting to take their medication, is it truly better than oral medication?
Question 3: Today is the third day of taking the new medication, and I just learned that she secretly took only half a pill yesterday and today (the prescribed dosage is one pill per day).
What impact could this have?
Question 4: How can I persuade her to take the medication? How can I help her adhere to the new medication during this adjustment period? (Her doctor has not established a trusting relationship with her, making it difficult for the doctor to assist.) She believes her condition does not affect her life; is it still necessary to persuade her to take medication?
Question 5: How should I handle her desire to seek help from spiritual leaders or shamans? Thank you, doctor, for taking the time to understand my concerns!

Ms. Wu, 20~29 year old female. Ask Date: 2020/04/05

Dr. Lin Mianzhang reply Psychiatry

Hello Ms.
Wu: Thank you for your hard work.
I can sense your concern for your mother, and the challenges you face are common among families of individuals with schizophrenia.
This condition affects various aspects of a person's thinking, emotions, and behavior.
Individuals with schizophrenia often experience abnormalities in processing external information and have impaired judgment, which can lead to a disconnection from reality and diminished decision-making abilities.
Lack of insight into their illness is also a symptom of schizophrenia.
Therefore, as a family member of the patient, it is essential to understand that recognizing their illness can be extremely difficult for them.

Moreover, the medications used to treat schizophrenia, specifically antipsychotics, often have side effects that can vary between different drugs.
If side effects occur, adjunctive medications to mitigate these effects or switching medications can be discussed with the physician.
Here are responses to your specific questions:
1.
The common side effects of Paliperidone include rigidity, tremors, and restlessness.
These side effects can often be improved with adjunctive medications.
Typically, if a therapeutic dose is reached, side effects may appear within one to two weeks and usually do not alleviate over time.
2.
Numerous studies have shown that long-acting injectable antipsychotics have a superior rate of preventing relapse compared to oral medications.
Therefore, using long-acting injectables is generally more effective in avoiding relapse.
Additionally, the side effects of injections are similar to those of oral medications.
3.
If an effective dose is not reached, the therapeutic effect will be compromised, leading to a slower improvement in symptoms and making it more challenging for symptoms to completely resolve.
4.
If side effects are significant, it may be difficult to persuade her to take the medication.
It is advisable to discuss with the physician the possibility of adjusting the medication.
If she can take medication, it is still recommended, as her symptoms have already significantly impacted her functioning.
5.
A better approach may be to seek assistance from trusted individuals in the religious community who believe in psychiatric treatment and are willing to encourage the patient to take medication.
Completely prohibiting her from seeking religious assistance may be challenging.
Alternatively, consider persuading her to be hospitalized.
During hospitalization, healthcare professionals can invest more effort in gradually helping her develop insight into her illness (though this can also be difficult), but over time, the chances of success may increase.
Wishing your mother a speedy recovery!

Reply Date: 2020/04/05

More Info

Navigating the complexities of supporting a family member with schizophrenia can be incredibly challenging, especially when they exhibit a low insight into their condition and prefer alternative methods of treatment, such as religious practices. Your mother's situation, where she has been diagnosed with schizophrenia but has opted to seek solutions through religious means, is not uncommon. Here are some insights and strategies that may help you in this journey.

Understanding the Medication
1. Paliperidone and Its Adjustment Period: Paliperidone, an atypical antipsychotic, typically requires a few weeks to reach its full therapeutic effect. Side effects may diminish over time as the body adjusts to the medication. Common side effects include sedation, weight gain, and extrapyramidal symptoms (movement disorders). It's essential to monitor her closely during this period and maintain open communication with her healthcare provider about any concerning symptoms.

2. Injection vs. Oral Medication: The option of switching to an injectable form of antipsychotic medication can be beneficial for individuals who struggle with adherence to oral medications. Injectables can provide a more consistent therapeutic level and reduce the risk of missed doses. However, they can also have side effects, including injection site reactions and potential for longer-lasting side effects. Discussing these options with her doctor in detail can help you understand the best course of action.

3. Impact of Reduced Dosage: If your mother is taking only half of her prescribed dose, it may not provide the therapeutic benefits intended. This could lead to a resurgence of symptoms or inadequate management of her condition. It’s crucial to communicate the importance of adhering to the prescribed dosage and to discuss any concerns she has about side effects with her doctor.

Encouraging Treatment Compliance
4. Building Trust and Communication: Since your mother has a strained relationship with her doctor, it may be beneficial to seek a second opinion or find a mental health professional with whom she feels more comfortable. Building a trusting relationship with a healthcare provider can significantly impact her willingness to engage in treatment.

5. Engaging in Open Dialogue: Encourage her to express her feelings about the medication and any side effects she experiences. Validating her feelings while gently emphasizing the importance of medication in managing her symptoms can help. You might say, "I understand that you feel the medication is affecting you, but it’s important to give it a fair chance. Let’s talk to your doctor together about how you’re feeling."
6. Incorporating Religious Beliefs: Acknowledge her desire to seek help through religious means. You might suggest integrating her spiritual practices with her treatment plan. For example, you could propose that she continues her religious practices while also taking her medication, framing it as a holistic approach to her well-being.

Addressing Alternative Beliefs
7. Handling Alternative Treatments: When it comes to her interest in seeking help from religious figures or alternative healers, it’s essential to approach the topic delicately. You could express concern for her well-being and suggest that while exploring these avenues is okay, they should not replace medical treatment. You might say, "I think it’s great that you find comfort in your beliefs, but I also believe that medication can help you feel better and more stable."
8. Educating About Schizophrenia: Providing her with information about schizophrenia and its treatment can help her understand the importance of medication. This could include discussing how medication can help manage symptoms and improve her quality of life.

Final Thoughts
Supporting a family member with schizophrenia requires patience, empathy, and a willingness to engage in difficult conversations. It’s essential to prioritize her safety and well-being while respecting her autonomy. Encourage her to maintain open lines of communication with her healthcare provider and explore all available treatment options. Remember, it’s a journey that may take time, but with consistent support and understanding, she can find a path that works for her.

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