Medications for Schizophrenia: A Guide for Families

Q: Medications for Schizophrenia: A Guide for Families

Hello： <br>1. <br>The efficacy of Seroquel (Quetiapine) is generally stronger than that of Risperdal (Risperidone), with Seroquel being an active metabolite of Risperdal. <br>Some studies suggest that its effects may be slightly better than those of Risperdal, but the difference

I would like to inquire about medications for anosognosia?

Hello Doctor, my sister has been on psychiatric medication for a long time (she started around the age of 19 and is now 42).
Initially, we thought she had severe obsessive-compulsive disorder, but later my parents mentioned she had mild amnesia.
Three years ago, she consulted a traditional Chinese medicine practitioner who advised her to reduce her psychiatric medication, and as a result, she stopped taking Seroquel (she felt she didn't have schizophrenia, so why take it).
At that time, we weren't attentive enough to realize she actually has schizoaffective disorder! She hasn't taken Seroquel for almost three years, and during this time, she hasn't experienced hallucinations or delusions (she hadn't before either), but she felt more euphoric.
However, at the end of May this year, she had a severe episode, starting to have serious delusions, claiming I have cancer and that other teachers are conspiring against her (our family initially thought she was possessed and consulted many practitioners; eventually, one teacher was introduced by a colleague of mine, which made my sister resent me).
She is chaotic at home and refuses to take medication; we can only crush her pills and mix them into soup, but Seroquel cannot be crushed.
I finally sought help from her attending physician (but she refuses to see the doctor).
The doctor prescribed Risperidone drops, which we started giving her in soup from July 6.
It seems to only stabilize her mood, but her delusions remain severe.
Since the end of July, she has expressed a desire to take medication but still refuses to see a doctor (the medication bag cannot have the word "schizophrenia" on it).
On August 18, she started taking an additional Risperidone pill, along with Quetiapine, four Lorazepam, three Fluoxetine, two Entacapone, and 3cc of Risperidone drops, but it still doesn't seem to suppress her delusions or hallucinations; she often laughs to herself.
The doctor then increased the Risperidone dosage to two pills (4mg) starting September 1, but there hasn't been much change.

I would like to ask:
1.
Which medication has the strongest effect among Seroquel, Risperidone drops, and Risperidone?
2.
Is the effect of Risperidone drops better than the tablets?
3.
Given that she has been off medication for a long time and has relapsed, is it better to take Risperidone tablets or Seroquel? She didn't have delusions or hallucinations when she was on Seroquel before, but now they are very severe; I wonder if the medication is effective.

4.
How long does it typically take to assess the effectiveness of Risperidone tablets, or when does the effect usually start?
5.
If she takes her morning medication at 9 AM, she can't hold on for six or seven hours; around 2 to 3 PM, she starts looking for medication, saying, "I start to have chaotic thoughts, and I feel better when I take medication." However, her delusions remain severe, and she often claims she can communicate with spirits and that she has someone else's past lover in her stomach, along with other magical beliefs.
It seems the current medication only controls her mood but does not eliminate her delusions and hallucinations.

6.
If we consider sending her to a long-term care facility, I am unsure how to proceed, as our parents are getting older and cannot care for her anymore.
We may need to consider placement (but she refuses to see a doctor or undergo inpatient treatment).

Thank you, Doctor, for taking the time to read and respond.

Lo, 40~49 year old female. Ask Date: 2022/09/06

Dr. Lin Mianzhang reply Psychiatry

Hello:
1.
The efficacy of Seroquel (Quetiapine) is generally stronger than that of Risperdal (Risperidone), with Seroquel being an active metabolite of Risperdal.
Some studies suggest that its effects may be slightly better than those of Risperdal, but the difference is not significant.

2.
Since the main components are the same, there is no difference in therapeutic effect.

3.
Both medications are acceptable.
If Seroquel was effective previously, it is recommended to continue with Seroquel.
The lack of effectiveness may be due to a worsening condition, where the original dosage is insufficient to control symptoms.
In this case, consider increasing the dosage, adding other medications, or switching medications.

4.
Generally, effects can be observed within one to two weeks.

5.
The half-life of Seroquel and Risperdal is approximately one day, while the half-life of Invega (Paliperidone) is three days.
This means that after taking these medications, the concentration in the body will decrease to half after one day (for Seroquel and Risperdal) or three days (for Invega), assuming a single dose.
However, if taken regularly every day, the drug concentration will not fluctuate significantly.
Therefore, the changes in your sister's symptoms should not be related to changes in drug efficacy.

6.
It is recommended that you apply for a home visit from the local health center, where a public health nurse can assess your sister's condition at home.
If necessary, the public health nurse can arrange for a psychiatrist from a collaborating medical institution to evaluate her, determining if she meets the criteria for severe illness or requires involuntary hospitalization, in order to plan subsequent treatment (such as involuntary community treatment or hospitalization).

Take care! Wishing you peace and health!

Reply Date: 2022/09/06

More Info

Understanding medications for schizophrenia and related disorders can be quite complex, especially for families who are trying to support their loved ones. Your sister's situation, having been on psychiatric medications for many years, raises several important considerations regarding her treatment and the management of her symptoms.

1. Medication Efficacy: The medications you mentioned—思維佳 (Seroquel, Quetiapine), 理思必妥 (Risperidone), and 鋭思 (Risperidone)—are all antipsychotics used to treat schizophrenia and other psychotic disorders. Seroquel is often used for its sedative properties and can help with mood stabilization, while Risperidone is effective in reducing symptoms of psychosis, including delusions and hallucinations. In terms of potency, Risperidone is generally considered to have a stronger antipsychotic effect compared to Seroquel, especially in managing acute psychotic symptoms.

2. Formulation Differences: The liquid formulation of Risperidone (理思必妥滴劑) may be easier to administer, especially if your sister has difficulty swallowing pills. However, the efficacy between the liquid and tablet forms is typically similar, as they contain the same active ingredient. The choice between them often comes down to personal preference and ease of administration.

3. Reinitiating Treatment: Given that your sister has been off her medications for a significant period, it is crucial to approach her treatment with care. If she previously responded well to Seroquel without experiencing hallucinations or delusions, it may be worth considering reintroducing it, especially since her current symptoms are severe. However, this should be done under the guidance of a psychiatrist who can monitor her closely for any adverse effects or worsening of her condition.

4. Timing and Effectiveness: Antipsychotic medications like Risperidone can take several days to weeks to show their full effect. Typically, you might start to see some improvement in symptoms within the first week, but it can take longer for the full therapeutic effect to be realized. It's important to maintain consistent dosing and not to adjust the medication without consulting a healthcare provider.

5. Managing Symptoms: The fact that your sister feels the need to take her medication multiple times a day indicates that her current regimen may not be adequately controlling her symptoms. This could be a sign that her dosage needs adjustment or that a different medication may be more effective. Regular communication with her psychiatrist is essential to address these concerns.

6. Long-term Care Considerations: If your sister's condition continues to deteriorate and she refuses treatment, it may be necessary to consider long-term care options. This can be a difficult decision for families, especially when dealing with the stigma associated with mental illness. Involuntary treatment may be an option in some jurisdictions if she poses a danger to herself or others, but this process can be complex and often requires legal intervention.

7. Support for Families: It's important for families to seek support as well. Caring for someone with a severe mental illness can be overwhelming, and resources are available for family members to help them cope with the challenges they face. Support groups, counseling, and educational resources can provide valuable assistance.

In conclusion, managing schizophrenia and related disorders requires a comprehensive approach that includes medication, therapy, and support for both the patient and their family. Regular follow-ups with a psychiatrist are crucial to ensure that the treatment plan is effective and to make necessary adjustments based on the patient's response. Your concern for your sister's well-being is commendable, and seeking professional guidance is the best step forward in navigating her treatment.

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