Consequences of Stopping Medication in Schizophrenia: Family Guidance and Support

What are the consequences of patients with schizophrenia discontinuing their medication? How should one respond to the auditory hallucinations and delusions experienced by a loved one with schizophrenia?

Hello Director Ding.
Thank you for taking the time to answer my questions amidst your busy schedule.
My brother has been diagnosed with schizophrenia and has been receiving treatment and medication for several decades.
Over the years, with the help of several doctors and adjustments to his medication, we have noticed that his condition has gradually stabilized.
In daily life, aside from certain special situations or conversations, we can sense his discomfort and difficulties; generally, outsiders would not perceive him as a mental health patient, though they might notice that his reactions and logic are somewhat sluggish.

However, this has led our family to feel increasingly pleased with his progress year after year, which has also caused us to underestimate the fact that he is a long-term chronic patient.
My brother now helps with some household tasks, but due to his medication, he has difficulty waking up in the mornings.
He has decided to stop taking one of his nighttime medications on his own, which has allowed him to wake up earlier and not feel as drowsy.
Unfortunately, neither he nor my family understands that discontinuing medication without a doctor's consent is very dangerous.

After he had been off the medication for about 4-5 months, his behavior and emotional responses began to change, and he started experiencing auditory hallucinations and delusions, which worsened over time, prompting our family to seek medical help.
The doctor reminded us that this particular medication is very important for him.
Fortunately, my brother has been self-aware and cooperative in resuming his medication, and he has been relatively stable over the past few days (he has been back on the medication for about five days).
However, he is still experiencing auditory hallucinations and delusions, particularly directed at family members, which is concerning since previously, these episodes were mostly directed at strangers whom he did not see daily.

I would like to ask the director:
1.
How should we respond to the auditory hallucinations and delusions of a relative with schizophrenia? (Explaining that these are not real does not work, as he does not accept it and feels that I do not believe him, but I also cannot go along with his delusions.)
2.
My brother has resumed taking the same medication, but he had been off it for about 4-5 months.
Will this have an impact on the medication's effectiveness? (I am worried that all the progress made in recent years may be undone.)
3.
Can we look at some online resources together to enhance his self-awareness of his condition?
Thank you once again for your response.
Thank you.

Z, 30~39 year old female. Ask Date: 2015/08/15

Dr. Ding Shuyan reply Psychiatry

Hello, as you mentioned in your letter, discussing the reality of hallucinations or delusions with individuals experiencing mental illness often presents a dilemma between providing a sense of reality and fostering distrust in relationships.
Although family members are the ones who care the most and have been with them the longest, sometimes their trust in medical professionals' expertise surpasses that of their loved ones.
You can encourage them to ask their doctor for assistance next time.
As family members, we can focus on discussing how to cope with the distress caused by hallucinations and delusions, such as redirecting attention and planning activities.
Additionally, reviewing the positive correlation between medication adherence and the reduction of hallucinations and delusions together is beneficial.
Discontinuing medication can lead to symptom exacerbation, and resuming the original medication may not achieve the same effectiveness.
This is a characteristic of the illness; the more episodes one experiences, the worse the condition may become.
However, many individuals find that after reducing or stopping medication, they can still benefit from the same treatment upon resuming it.
If they have difficulty getting out of bed in the morning, they can discuss with their doctor the possibility of taking some medications earlier at dinner or switching medications.
As the condition progresses, some medications can be reduced, while others may not be suitable for reduction yet, which requires discussion with the physician.
Exploring online resources together can also be a good approach.
I have noticed that more and more people tend to trust online information, sometimes even more than what their doctors say.
The issue is to carefully select the sources of online information, as there are also those that advise against medication and medical consultation, emphasizing religious or alternative therapies, and proponents of such views can be quite persuasive.
From the perspective of a psychiatrist, I support exploring various options, but at the very least, one should not casually abandon conventional medical treatment.
Wishing you all the best.
Sincerely, Dr.
Ding Shuo-Yan.

Reply Date: 2015/08/15

More Info

Dear [Name],
Thank you for your thoughtful questions regarding the management of schizophrenia, particularly in the context of your brother's experience with medication. It’s commendable that you are seeking guidance on how to support him effectively. Schizophrenia is a complex and chronic mental health condition that requires careful management, and medication plays a crucial role in stabilizing symptoms and preventing relapses.

1. Responding to Hallucinations and Delusions
When interacting with a loved one experiencing hallucinations or delusions, it’s important to approach the situation with empathy and understanding. Here are some strategies to consider:
- Validate Feelings: Acknowledge that your brother is experiencing something real to him, even if it is not based in reality. You might say, "I can see that this is really distressing for you."
- Avoid Confrontation: Arguing about the reality of his experiences can lead to increased agitation. Instead, focus on how he feels and offer support. For example, "I understand that you feel this way. How can I help you feel more comfortable right now?"
- Redirect the Conversation: If he becomes fixated on a delusion, gently steer the conversation towards a neutral topic or activity that he enjoys. This can help distract him from distressing thoughts.

- Encourage Professional Help: If his symptoms worsen, gently encourage him to speak with his psychiatrist or therapist. You might say, "It might help to talk to your doctor about what you’re experiencing."

2. Impact of Stopping Medication
Regarding the impact of stopping medication for 4-5 months, it is indeed concerning. When someone with schizophrenia stops taking their medication, they are at a higher risk for relapse, which can manifest as the return of hallucinations, delusions, and other symptoms. The effectiveness of the medication may also be influenced by the duration of non-compliance.
However, it’s important to note that if your brother has resumed his medication, it may take some time for the full therapeutic effects to return. The brain often needs time to readjust, and the dosage may need to be monitored and adjusted by his healthcare provider. Regular follow-ups with his psychiatrist are crucial to assess his response to the medication and make any necessary changes.

3. Increasing Self-Awareness
Encouraging your brother to learn more about his condition can be beneficial, but it should be approached delicately. Here are some suggestions:
- Choose Reliable Sources: If you decide to look at online resources together, ensure they are from reputable organizations, such as the National Alliance on Mental Illness (NAMI) or the American Psychiatric Association.
- Discuss What He’s Comfortable With: Ask him if he would be interested in learning more about schizophrenia and its treatment. If he is open to it, you can explore materials together.

- Promote Self-Advocacy: Encourage him to ask questions during his medical appointments and express any concerns he may have about his treatment. This can help him feel more in control of his health.

Conclusion
In summary, managing schizophrenia requires a collaborative approach between the patient, their family, and healthcare providers. It’s essential to maintain open lines of communication and provide support while respecting your brother’s autonomy. Encourage him to adhere to his medication regimen and seek professional help when needed. Your involvement and understanding can significantly impact his recovery journey.

Thank you for your commitment to supporting your brother. If you have further questions or concerns, don’t hesitate to reach out to his healthcare team for guidance.

Best regards,
Doctor Q&A Teams

Similar Q&A

Understanding Medication Management in Schizophrenia: Risks of Stopping Treatment

If a patient with schizophrenia (auditory hallucinations) stops their medication, it may lead to a relapse characterized by the re-emergence of symptoms such as hallucinations, delusions, and disorganized thinking. The severity and timing of the relapse can vary among individuals...

Dr. Chen Guangpeng reply Psychiatry
Dear Chen, I am glad to hear from you again. Unfortunately, it seems you are still at a standstill—hesitating over whether to take medication or to stop it. In fact, you have asked similar questions on November 19, 23, and 27, and I have done my best to respond to you. Perhaps i...

Navigating Treatment Challenges for Family Members with Schizophrenia

Hello Doctor, my mother is 56 years old. Her past medical history includes hypertension, and there is a family history of cancer. Her current condition started about a year ago with olfactory and visual hallucinations (smelling and seeing toxic gas from neighbors), a constant fee...

Dr. Li Guanying reply Psychiatry
From your letter, it is clear that you are experiencing discomfort and distress due to concerns about your family member's delusions and hallucinations, as well as the associated mental health symptoms. 1. Schizophrenia, like chronic conditions such as diabetes and hyperte...

Can Schizophrenia Patients Safely Stop Medication?

Hello, doctor. During acute episodes, after using medication to suppress the symptoms, I have been maintaining a low dose of Aripiprazole. However, as long as I am on medication, I am unable to work and return to my previous level of functioning. Only when I stop the medication c...

Dr. Huang Xiaoxian reply Psychiatry
Hello, thank you for your question. Schizophrenia is generally a chronic condition, and the illness itself can lead to functional decline. On the other hand, certain medications may also contribute to a perception of diminished functioning. It is advisable to seek a medical evalu...

Understanding and Managing Psychotic Disorders: A Personal Journey

I have been diagnosed with schizophrenia, but I feel very unhappy every day. I experience auditory hallucinations where I hear people cursing at me, and I can barely tolerate it because it’s so loud. I have had sleep issues since childhood. I am currently a senior in the vocation...

Dr. Tian Xinqiao reply Psychiatry
Hello, dear user: Thank you for your message. Individuals with schizophrenia often experience similar concerns, worrying about their condition and how others perceive them. The treatment of psychiatric symptoms can indeed affect one's work performance and social interactions...