Why schizophrenics dont take medication

Give the person options about what to do if he or she wants to stop taking medicines. Talk with his or her health professional about what the options are. Make changes in the medicine routine only after consulting with the health professional.

And keep records about these changes and their effects. Ask how the person is doing with the medicine treatment. Say, "How many pills do you have left? Take any complaints seriously and see whether there is anything that you can do to help or that can be done differently. Help plan for relapses even if your family member continues to take the medicines as prescribed. Relapses are part of the illness. Accept the fact that some people will not take medicine as they should even with a lot of support.

Do not tie your concern and caring to whether your loved one takes the medicines. My son has been diagnosed with schizophrenia. However, when he starts feeling better he won't take his medicine, which is risperidone, and it is very difficult for us to get him to take it when he is not feeling well. He is a bright young man who has lost his job many times because of this illness. Are there any new findings for this illness? Can you explain what part of the brain is affected? Mental Health Expert Dr.

I am sorry to hear about your son. For many years I ran an inpatient team in a big psychiatric hospital, and the story you tell was the bane of my existence. A young person like your son would come in to the emergency room wildly psychotic.

We would hospitalize him, give him a medicine like risperidone -- often against his will in the beginning -- and he would do remarkably better. Home he'd go, with all our follow-up plans in place, only to return a month or so later wildly psychotic all over again because he'd stopped taking his medicine. When we think about schizophrenia, we tend to envision the flashier symptoms and behaviors such as hearing voices, shouting at the empty sky while pushing an overflowing shopping cart or believing that one is God or the devil.

I had another patient who was convinced he had died years before and someone had stolen his body. Because he saw his body lying in a coffin in a church once. In fact, while colorful, these types of symptoms are not the worst part of schizophrenia. Much worse is the fact that many people with the illness lose all insight into their situation.

They believe their delusions so thoroughly, or are so thoroughly confused in general, that they can't see that something is wrong. And even when they recover, they often do not gain insight into what happened. This lack of insight is itself a symptom of schizophrenia, and it is one of the worst.

Many studies show that, other things being equal, a patient who recognizes that he is ill and complies with treatment will do much better over the years than someone without insight, who thinks he is normal and doesn't need treatment. There are probably two reasons why having enough insight to comply with treatment improves outcomes. A majority of patients were male The patient mean age was Flowchart of early treatment discontinuation.

Values are the summary of reasons for discontinuation from all 4 studies. Poor Response was based on "Lack of Efficacy. In order to objectively examine the association between poor clinical outcome and treatment discontinuation independently of the checklist used at patient departure, PANSS total scores at each assessment were compared between patients who completed the study and those who discontinued early.

There was no significant difference in baseline PANSS total scores between the patients who completed and those who discontinued treatment Visitwise PANSS total scores between patients who completed the study and those who discontinued early. Values are means across all treatments and studies. In view of these results, it was of interest to determine if early response predicted study completion.

Symptom improvement from baseline to 2 weeks as measured by mean change in PANSS total score was significantly predictive of study completion regression coefficient estimate 0. In contrast to patients who discontinued due to poor response or symptom worsening, patients who discontinued due to medication intolerability showed improvement in PANSS total scores comparable to study completers, suggesting that adverse events do not interfere with symptom response but do prevent an otherwise effective treatment.

Visitwise PANSS total scores between patients who completed the study and those who discontinued early due to various reasons. This group of patients reported prior hospitalization significantly more frequently than all other patients In addition, these patients were significantly more often Caucasian when compared with all other patients Other baseline characteristics were similar between patients who discontinued due to poor response or symptom worsening and the rest of the study population.

Baseline characteristics of patients who discontinued due to poor response or symptom worsening. Discontinuation due to poor response was further characterized to determine whether the patient or physician concluded that symptom response was not adequate for medication continuation. In order to emphasize the role of patients in the decision to discontinue, discontinuation due to patient perception of poor response in the following analyses was defined as discontinuation due to patient perception of poor response lack of efficacy either alone or in consensus with physician conclusion.

Physician perception was based on physician perception of poor response alone. Patient and physician perception of efficacy. Discontinuation due to poor response by perception. Patient perception was based on discontinuation by patient perception of poor response either alone or in consensus with physician perception. Physician perception was based on physician conclusion alone.

Visitwise PANSS total scores between patients who discontinued early due to poor response by patient perception and those by physician perception. Physician perception Phy per , Patient perception Pt per. Premature treatment discontinuation was very common in these 4 schizophrenia clinical trials.

Patients who discontinued early from the study due to poor response or symptom worsening had a slower initial rate of improvement and less improvement overall compared to those patients who completed the study. In contrast, patients who discontinued due to medication intolerability were showing symptom improvement comparable to study completers up until discontinuation. Discontinuation due to poor response was overwhelmingly linked to patient perception of response compared to physician observation alone.

Discontinuation due to patient perception of poor response appeared to occur particularly early in the treatment course. The substantial rate of premature discontinuation from these studies likely reflects the great challenge of treatment adherence in the clinical treatment of patients with schizophrenia. Both the present study and other analyses of clinical trials likely underestimate the true incidence and likely the associated burden of antipsychotic nonadherence in the long-term course of therapy since the studies are time-limited, and treatment of schizophrenia is a life-long consideration.

Perhaps the most interesting and important result of our analysis is that treatment discontinuation due to inadequate control of psychiatric symptoms appeared 3 times as likely as discontinuation due to medication intolerability.

This was an unexpected finding of this systematic study since adverse events are a commonly cited reason for medication nonadherence [ 5 , 9 ]. Clinician experience with the older typical antipsychotics may be partially responsible for the perception of medication intolerability being a more common reason for antipsychotic treatment discontinuation.

Other studies of patient attitudes toward antipsychotic treatment adherence suggest that adverse events may be important for patient attitudes toward antipsychotic adherence in particular with typical antipsychotics [ 20 ]. The transition of treatment of patients with schizophrenia and related disorders from typical to atypical agents over the past 10—15 years may have resulted in a decrease in the incidence of discontinuation due to adverse events relative to poor efficacy.

Using an objective rating scale PANSS , patients who discontinued had less improvement compared to study completers, suggesting that this patient group has a real deficit in medication response. However, even patients who discontinued achieved response to a certain extent, suggesting that there is a critical level of response needed to keep patients on treatment.

Although the notion that a substantial delay in antipsychotic response is common in the field of psychiatry [ 21 ], Agid et al. In addition, antipsychotic response within the first week of treatment has been reported to predict response after 6 weeks, at least for haloperidol [ 23 ]. The present study expands upon these findings by suggesting that early response also predicts treatment continuation.

Therefore, patient perception of efficacy early on in treatment may be a major contributor to engagement in treatment and adherence to the treatment plan. One possible explanation for the inadequate treatment response of patients who discontinued treatment early due to poor response or symptom worsening may be that they are intrinsically less responsive to treatment. For some patients, treatment resistance may represent an intrinsic part of the schizophrenic illness, at least with current antipsychotic medications [ 24 ].

The current study provides limited data to address this possibility. In support of this hypothesis, patients who discontinued treatment early due to poor response or symptom worsening reported prior hospitalization significantly more than all other patients. Treatment-resistant patients often require extensive periods of hospitalization, and older studies commonly used frequent hospitalization as an indicator of treatment resistance, although this may not be accurate in all cases [ 25 ].

On the other hand, other baseline characteristics that might be associated with treatment resistance, such as duration of illness and baseline illness severity, were similar between patients who discontinued due to poor response or symptom worsening and the rest of the study population.

Standardized criteria for treatment resistance have been more recently described [ 26 , 27 ]. Further studies using defined criteria for treatment resistance are needed to better determine if patients who discontinue treatment due to poor response or symptom worsening are truly treatment resistant.

Alternatively, these patients may discontinue early because of a suboptimal early treatment response and perceived lack of efficacy, and may possibly benefit from an early, active clinician-initiated attempt to bolster engagement in order to maintain treatment adherence. Interestingly, patients who discontinued due to medication intolerability were showing symptom improvement comparable to study completers prior to their discontinuation.

It should be noted that some of the adverse events were not considered severe; nonetheless, they were costly to patients by derailing patients from the potential benefit of the treatment. Had these patients continued their treatment to study completion, they would have likely had a clinically successful treatment. Therefore, adverse events should be viewed as a significant barrier to treatment efficacy and must be addressed on an individual patient basis.

Weight gain is a potential adverse event of atypical antipsychotic treatment that has been cited by patients as highly distressing [ 28 ] and has been proposed to be a factor in medication nonadherence [ 3 ]. However, weight gain has rarely been directly investigated as a factor in medication discontinuation or adherence.

In the present studies, weight gain was infrequently reported as a reason for discontinuation 3 patients; 0. However, weight gain in more naturalistic treatment settings may be a more important factor in patient adherence to medication than reported here for clinical trials. Consistent with this notion, in the CATIE trial, which was designed to have several "real-world" features in order to make the results more generalizable, there was a higher rate of treatment discontinuation due to weight gain than reported here [ 14 ].

In addition to the deficit in treatment response as measured by PANSS scores, there was also a subjective component to the poor response reported by some patients. While patient perception of poor response was responsible for treatment discontinuation much more frequently than physician perception of poor response, patients who discontinued due to patient perception of poor response and patients who discontinued due to physician perception of poor response had similar PANSS scores, highlighting a subjective aspect of patient perception of treatment effectiveness.

This suggests that patients are aware of whether they are getting better and may not be as willing as physicians to allow more time for symptom improvement if they perceive early in treatment that their symptom response is less than optimal.

These results are consistent with the health belief model that suggests a patient's likelihood of adhering to prescribed medication is a product of an implicit and subjective assessment of the relative costs and benefits of adherence in relation to personal goals and constraints [ 3 , 9 , 11 ]. These results highlight the importance of active engagement of the patient early in treatment, with a clear understanding of the patient's expectations and treatment goals.

A limitation of the present analysis is that the reasons for discontinuation on the checklist used to categorize discontinuation in the 4 clinical trials may have not optimally captured the primary reason for discontinuation in all cases. For instance, a relatively high number of patients discontinued due to "personal conflicts," which included a variety of specific reasons and were not analyzed in this study.

Categorizing all of these reasons as personal conflicts may have prevented the identification of additional barriers to medication adherence and may mask an underlying patient concern regarding efficacy, tolerability, or novel reasons that caused patients to lack the motivation to continue. Finally, discontinuation due to physician perception of response may have been underrepresented since physician versus patient perception was only captured in regards to poor symptom response and was not assessed in regards to symptom worsening psychiatric adverse events.

Although discontinuation due to psychiatric adverse events was ultimately a physician decision, it cannot be concluded that patients did not play a role in this decision.

Therefore, discontinuation due to symptom worsening was not considered in the analysis of discontinuation due to patient and physician perception of response. An additional limitation of the present study is that it is based on clinical trials that may not reflect more naturalistic patient treatment settings.