Schizophrenia and Substance Withdrawal: A Family's Journey - Psychiatry

Initial consultation summary of the patient's condition?

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Hello Doctor: My brother was diagnosed with schizophrenia in May 2019.
Before his diagnosis, he had been taking excessive amounts of non-psychiatric prescribed sedatives and sleeping pills, around 200 pills a month for possibly over three years, without long-term treatment from a mental health professional.
His previous consultations were in the Taipei area, but last August, due to my mother immigrating abroad, my 88-year-old grandmother was unable to care for him, so I arranged for his ongoing care.
However, after being discharged from Songde Hospital, he had access to sedatives at home and did not return for follow-up appointments for 21 months.
He began to exhibit irritability and withdrawal symptoms from the medication.
On July 10, he physically assaulted my mother, which was only stopped when my grandmother intervened.
On August 27, after I took him to visit his original psychiatrist, Dr.
Liu, he became uncontrollably angry that night when reminded of an upcoming appointment, and he attacked me.
I had to ask my grandmother to call the police to initiate involuntary hospitalization procedures.
After three days at Songde, his CPK levels reached over 46,000, indicating rhabdomyolysis, which raised concerns about potential kidney failure, leading to his transfer to the nephrology department at the United Hospital System - Zhongxiao Branch for 48 days of treatment.
He was preparing to return to Songde to continue addressing his original substance abuse issues, but during the transfer, he managed to leave the hospital unnoticed after a nurse removed his IV.
After searching for him and being unable to contact him, I reported him missing to the police for the second time.
A few hours later, my grandmother informed me that he had returned home but requested sleeping pills, which she refused to give him.
When I returned home, I insisted he come back to Songde with me since he was considered a missing person, and under police pressure, he agreed.
However, upon arrival at the emergency room, his CPK levels were again over 1,700, prompting me to seek transfer to a comprehensive hospital for better treatment.
I found Shin Kong Hospital, which has both psychiatric and nephrology departments, where he was admitted for 40 days.
I was able to sign for the protection of severely ill patients, as they only had acute psychiatric wards and no chronic wards.
He expressed a desire to return to Songde for chronic care or to Shin Kong's chronic ward, but Songde could not accommodate him due to internal medicine issues and lack of referral procedures.
Eventually, I found a chronic psychiatric ward at Tucheng Chang Gung Memorial Hospital, but he was indecisive about re-admission and initially refused to sign the hospitalization consent form.
The attending physician found this strange, as he should still be at Shin Kong.
Under pressure to stay for at least 60 days, he eventually signed the admission papers.
During his stay, the chronic ward needed to clear out patients, and he was reluctant to transfer to the chronic ward in Taoyuan Chang Gung, which has vocational rehabilitation functions.
After discussions, he agreed to go to a rehabilitation center, but before discharge, he requested to wait until after his physical examination to ensure continuity of rehabilitation treatment.
The medical team did not accept my suggestion, believing he was highly motivated and improving daily, so they set a discharge date.
Upon returning home on January 11, he began to behave abnormally, refusing to eat and only drinking large amounts of water.
He was also unwilling to visit the planned rehabilitation center or attend the scheduled physical examination.
That evening, he appeared unwell and refused medical attention, and I noticed he looked pale, which raised my concerns.
I called 119, and at St.
Paul’s Hospital, his CPK level was 2,544, confirming rhabdomyolysis.
He only agreed to undergo the physical examination before going to the rehabilitation center in Neili.
He has been at the rehabilitation center until the end of April.
Due to the severe pandemic situation, long-term care facilities are considered high-risk, so after signing an agreement to attend a day center, he returned home.
However, the day center in Taoyuan has stated it may not reopen until July 15 due to the pandemic.
During this time at home, I have observed that his condition is not improving; he does little housework and is indifferent to family members, showing signs of self-centeredness and emotional detachment even from family.
Although he has only been taking half a sleeping pill for four months, his craving for medication persists.
Sometimes I test him, and he still expresses a desire to take more.
I wonder if you have any treatment methods for his substance addiction that could help eliminate his long-standing craving for medication.

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Azuo, 30~39 year old female. Ask Date: 2022/06/21