Managing Schizophrenia: Medication Challenges and Anxiety Concerns

Q: Managing Schizophrenia: Medication Challenges and Anxiety Concerns

Hello A-Cheng： The condition of schizophrenia can sometimes be influenced by changes in life stress, daily routines, and medication adherence. <br>Even with regular medication, symptoms can fluctuate. <br>Therefore, your brother's changes in condition may require careful evaluati

Medication use in schizophrenia and accompanying anxiety?

Hello, doctor.
I am here to ask a question because a family member is suffering from this illness.
Four years ago, my brother was diagnosed with schizophrenia, experiencing auditory hallucinations and delusions.
He took medication for four months but relapsed and worsened after stopping for five months.
He then sought treatment at a specialized hospital and was prescribed Latuda.
For three years, his condition was stable, and he adhered to the doctor's instructions regarding medication.
However, after Christmas last year, he relapsed again, fearing the voices.
He returned to the specialized hospital for diagnosis and had his Latuda dosage increased.
After taking it for one day, he felt it was ineffective, so he went to another clinic and hospital to obtain Clopine.
He started taking Clopine at the beginning of this year, but his condition has not been as stable as before.
Recently, he has been visiting the hospital 3 to 4 times a week, either receiving short-acting or long-acting injections or picking up medication.
Sometimes, when the auditory hallucinations return, accompanied by panic and anxiety, he wants to take Clopine.
In severe cases, he takes up to 600 mg in a day.
The doctor has also prescribed other medications for anxiety, depression, and to mitigate side effects.
Recently, he has been experiencing auditory hallucinations triggered by stimuli (such as insomnia and anxiety, dining out while listening to music, or playing basketball).
Although not severe, he is deeply fearful and anxious.
Now, he takes medication immediately after meals and wants to sleep.
I found online that Clopine is a medication that should only be used as a last resort, yet he insists on taking it.
I am concerned that long-term use of this medication may affect his white blood cell count and lead to severe side effects (such as pneumonia).
Previously, he received long-acting injections (Invega Sustenna) and tried switching to Zyprexa Zydis, but after one day, he felt it was ineffective and wanted to switch back to Clopine.
It seems that his condition is being managed by medication, but I do not understand why it keeps recurring.
He has been taking Clopine for a month now and has been increasing the dosage on his own.
He hopes to take more to make the symptoms disappear quickly.
Additionally, he does not want to be hospitalized or quit his job.
I am wondering if his constant desire to suppress his symptoms and his ongoing anxiety about relapse are due to the relapse itself or if he is not receiving the appropriate treatment.
Yesterday, he wanted to go to the hospital for a short-acting injection, but the doctor said it should not be done without reason.
He was upset about this, feeling it was a precautionary measure.
Is he being overly anxious? How can we try to boost his confidence?

A Cheng, 20~29 year old female. Ask Date: 2022/02/21

Dr. Lin Mianzhang reply Psychiatry

Hello A-Cheng: The condition of schizophrenia can sometimes be influenced by changes in life stress, daily routines, and medication adherence.
Even with regular medication, symptoms can fluctuate.
Therefore, your brother's changes in condition may require careful evaluation by his physician to understand the reasons for the deterioration.
Given your brother's anxiety and his tendency to adjust his medication on his own, I would recommend that he consider inpatient treatment.
The efficacy of antipsychotic medications typically takes several weeks to manifest noticeable effects; rapid adjustments within just a few days will not yield significant changes.
Additionally, your brother's practice of increasing his medication dosage to very high levels is quite dangerous.
Clopine, at high doses, increases the risk of seizures and has strong sedative effects, as well as the potential to cause hypotension, necessitating cautious use.
If your brother is concerned about work, I suggest approaching the situation from that angle to understand his recent work status and see if you can persuade him to consider hospitalization by indicating that his condition is affecting his job performance.
Alternatively, family members may need to take control of his medication and administer it according to the physician's instructions.
As a family member of someone with schizophrenia, I commend your efforts.
I hope your brother can recover soon.

Reply Date: 2022/02/21

More Info

Managing schizophrenia, particularly in the context of medication challenges and anxiety concerns, can be a complex and multifaceted process. Your brother's experience with schizophrenia, including hallucinations and delusions, is not uncommon, and the journey to find the right treatment can often involve trial and error.
Firstly, it’s important to understand that schizophrenia is a chronic mental health condition that requires ongoing management. The fact that your brother had a period of stability while on medication is encouraging, but the subsequent relapse highlights the unpredictable nature of this disorder. The use of antipsychotic medications, such as Latuda (lurasidone) and Clopine (clozapine), is crucial in managing symptoms, but these medications can have varying effects on different individuals.

The challenges your brother faces with medication adherence and self-medication are significant. It’s not uncommon for individuals with schizophrenia to feel that their medication is ineffective, especially during periods of heightened anxiety or stress. This can lead to a cycle where they increase their dosage without consulting their healthcare provider, which can be dangerous. Clozapine, in particular, is a powerful antipsychotic that is typically reserved for treatment-resistant cases due to its potential side effects, including agranulocytosis (a dangerous drop in white blood cell count) and seizures.
Your concerns about the long-term use of clozapine are valid. Regular monitoring of blood counts is essential for anyone on this medication to prevent serious complications. It’s crucial that your brother communicates openly with his healthcare team about his symptoms and any changes in his medication regimen. This includes discussing his desire to increase his dosage, as self-adjusting medication can lead to adverse effects and worsen his condition.

The anxiety and fear of relapse that your brother experiences are common among individuals with schizophrenia. This anxiety can exacerbate symptoms, creating a vicious cycle. It’s essential to address both the psychotic symptoms and the accompanying anxiety. Cognitive-behavioral therapy (CBT) can be beneficial in helping him develop coping strategies for managing anxiety and understanding his illness better. Encouraging him to engage in therapy, alongside medication, can provide a more holistic approach to his treatment.

In terms of enhancing his confidence, it may help to involve him in discussions about his treatment plan. Empowering him to take an active role in his care can foster a sense of control over his condition. Encourage him to express his concerns and preferences to his healthcare provider, which can help him feel more involved and less anxious about his treatment.
Additionally, establishing a routine can provide stability, which is often beneficial for individuals with schizophrenia. Regular sleep patterns, a balanced diet, and engaging in social activities (even if they are small) can contribute positively to his mental health. Support from family and friends is also crucial; having a strong support system can help alleviate feelings of isolation and anxiety.

Lastly, it’s important to maintain open lines of communication with his healthcare providers. If he feels that his current medication is not effective, it’s essential to discuss this with his psychiatrist rather than seeking alternative medications on his own. A collaborative approach to treatment, where he feels heard and supported, can significantly improve his overall well-being.

In summary, managing schizophrenia involves a careful balance of medication, therapy, and support. Addressing both the psychotic symptoms and the anxiety that accompanies them is crucial for your brother’s recovery. Encouraging open communication with healthcare providers, involving him in his treatment decisions, and fostering a supportive environment can help him navigate this challenging journey.

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