Is It Time to Change Schizophrenia Treatments?

People with schizophrenia need treatment throughout their lives, and sometimes their needs change. If you notice a difference in the behavior of your loved one with schizophrenia, it may be time for a treatment adjustment.

Why They May Need an Adjustment

Even if your loved one’s treatment has been working well, things can happen that mean they need to change medications or dosages, or add another type of treatment.

These include:

Their condition gets worse. “While most people with schizophrenia get better with treatment, schizophrenia can sometimes get worse,” says psychologist Elizabeth Lombardo, PhD, who’s based in Chicago.

This may be triggered by an event or circumstance in their life.

“People with schizophrenia often deteriorate around sudden changes in their environment,” says Carol Tamminga, MD, chair of psychiatry at University of Texas Southwestern Medical Center. Major events and changes, like the death of a loved one, may be a trigger. Other triggers include drugs and alcohol, stress, and getting out of a regular routine.

Co-existing psychiatric illnesses may cause problems. It’s common for people with schizophrenia to have other psychiatric conditions too, like panic disorder, posttraumatic stress disorder, obsessive-compulsive disorder, depression, or substance abuse. If your loved one has another psychiatric condition, it may trigger a problem that needs to be addressed with a treatment adjustment.

They may have trouble with their medication. It’s common for people with schizophrenia to need a change in medication. They may develop new or more intense side effects from their medication. It can become less effective over time. Or they might stop taking it, which makes their condition worse.

Behavior Changes to Watch For

Your loved one may need a treatment change if you notice differences in their usual behavior or mood, says Brittany Webb, LMSW, a therapist at Birmingham Maple Clinic in Troy, MI. These changes might be gradual or sudden.

Here’s what to look for:

  • They become withdrawn, antisocial, or isolated.
  • They have more symptoms, like paranoia, hallucinations, and bizarre behavior.
  • They talk to themselves, laugh, or act up.
  • They get angry for no reason.
  • Their appetite, eating, or sleep patterns change.
  • They pay less attention to grooming, hygiene, or how they dress.
  • Their personality or mood seems flat.
  • They have mood swings.
  • They seem depressed.
  • They express suicidal or homicidal thoughts.

These things may also happen if your loved one stops taking their medication, which is common with schizophrenia. Antipsychotic drugs often have unpleasant side effects that affect their mood, thoughts, and body. People may stop taking their medication to avoid these side effects.

“It may be hard to tell if they’ve stopped or cut down on the medication,” says Tamminga. Try to observe your loved one to see if they take their medicine as directed.

If they’re not taking their medication properly or if you notice side effects getting worse, they may need a treatment change.

What to Do if There’s a Change

If you see a change from the norm, talk to their doctor. Even if you don’t have legal permission for the doctor to discuss your loved one’s health with you, you can give information to the doctor. Call the office, or leave a message through an online patient portal.

Their doctor may increase or change your loved one’s medication. They may recommend cognitive or behavioral therapy and supportive counseling. They may connect the person with schizophrenia to community resources.

While you get help, approach your loved one gently.

“It’s important that a caregiver not argue or try to dispute with a loved one when they’re showing signs of getting worse,” Webb says. Avoid language that comes off as shaming or blaming. Provide a supportive environment while you get them the help they need.

“Help them stay calm and offer them unconditional love,” Lombardo says. Let them know you’re concerned. Reassure them that it’s the disease, not them, that’s not responding well to treatment.

What to Do if It’s Urgent

If you see a major increase in symptoms or your loved one is having a psychotic episode, contact their treatment team immediately.

“Providers often have an emergency, after-hours, or crisis line that can be reached,” Webb says.

If they’re in crisis and are a danger to themselves or others, seek emergency services. Many cities have alternatives to 911 that can put you in touch with someone trained in mental health issues. But call 911 if you need to. You can also take your loved one to a hospital emergency room and request a psychiatric evaluation.

Share as much information as you can with the emergency department. Give them details like:

  • A list of medications the person with schizophrenia takes
  • Any vitamins or supplements they take
  • Allergies
  • History of recent or past substance abuse
  • History of symptoms, including when they started
  • Recent stressful events or changes in their environment

Find the Right Care

When a loved one has schizophrenia, they need a support network. It starts with their primary caregiver, and includes their treatment team.

Do your best to make sure your loved one gets regular care with a treatment team that knows their history and follows through with recommendations.

You might need a psychiatrist, mental health therapist, and primary care physician. You may also get support from case managers and care coordinators.

“Community mental health agencies often provide wraparound services in one place that can assist in managing outpatient care,” Webb says.

It’s not always easy to find the right providers. Some doctors don’t take patients with psychosis.

“You may have to work hard to get a capable person to see them,” Tamminga says. “Keep at it.”

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