Is It Time to Change Schizophrenia Treatments?

Why They May Need an Adjustment

Even if your loved one’s treatment has been effective, circumstances may arise that necessitate changing medications or dosages, or incorporating an additional type of treatment.

These include:

Their condition gets worse. ““While most individuals with schizophrenia improve with treatment, there are times when the condition can worsen,” says Chicago-based psychologist Elizabeth Lombardo, PhD.

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 the University of Texas Southwestern Medical Center. Major events and changes, such as the death of a loved one, can be triggers. Other triggers include drugs and alcohol, stress, and disruptions to their 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 an additional psychiatric condition, it could trigger issues that necessitate 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 experience new or intensified side effects from their medication. Its effectiveness can diminish over time, or they might stop taking it, exacerbating their condition.

Behavior Changes to Watch For

According to Brittany Webb, LMSW, a therapist at Birmingham Maple Clinic in Troy, MI, if you notice changes in your loved one’s typical behavior or mood, it might be an indication that they need a treatment adjustment. These changes can occur gradually or suddenly.

Here’s what to look for:

• • • They become withdrawn, antisocial, or isolated.
    • They exhibit increased symptoms, such as paranoia, hallucinations, and unusual behavior.
    • They talk to themselves, laugh, or act up.
    • They get angry for no reason.
    • Their appetite, eating, or sleep patterns change.
    • They become less attentive to grooming, personal hygiene, or their attire.
    • Their personality or mood seems flat.
    • They have mood swings.
    • They seem depressed.
    • They express suicidal or homicidal thoughts.

“It may be hard to tell if they’ve stopped or cut down on the medication,” says Tamminga. Monitor your loved one to ensure they are taking their medication as prescribed.

If they are not following the medication regimen correctly or if you observe worsening side effects, it may be necessary to adjust their treatment.

What to Do if There’s a Change

If you notice any deviations from their usual behavior, consult their doctor. Even if you lack legal authorization for the doctor to discuss your loved one’s health with you, you can still provide relevant information to the doctor. Call the office, or leave a message through an online patient portal.

Their doctor might adjust or change their medication, suggest cognitive or behavioral therapy, or provide supportive counseling. They may also connect your loved one with community resources.

As you seek help, approach your loved one with care.

“It’s crucial for caregivers not to argue or confront a loved one when they show signs of deterioration,” Webb advises. Avoid using language that might seem shaming or blaming. Create a supportive environment while arranging for the necessary help.

“Help them stay calm and offer them unconditional love,” says Lombardo. Reassure them that your concern is due to the illness, not a reflection of their character, and that it’s the disease, not them personally, that isn’t responding well to treatment.

What to Do if It’s Urgent

If you notice a significant increase in symptoms or if your loved one is experiencing a psychotic episode, contact their treatment team right away.

“Providers often have emergency, after-hours, or crisis hotlines available,” says Webb.

If your loved one is in crisis and poses a risk to themselves or others, seek emergency services immediately. Many cities offer mental health crisis intervention services as an alternative to 911. However, don’t hesitate to call 911 if necessary. You can also take your loved one to a hospital emergency room and request a psychiatric evaluation.

Provide the emergency department with as much information as possible, including:

• A list of medications your loved one is taking
• 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 extends to their entire treatment team.

Ensure that your loved one receives consistent care from a team familiar with their medical history and dedicated to following through with recommendations.

This team might include a psychiatrist, mental health therapist, and primary care physician, along with support from case managers and care coordinators.

“Community mental health agencies often offer comprehensive services in one location to help manage outpatient care,” says Webb.

Finding the right providers can be challenging, as some doctors may not accept patients with psychosis.

“You may need to put in significant effort to find a qualified professional,” Tamminga advises. “Stay persistent.”