Why Do Many People With Schizophrenia Stop Taking Medication?
Schizophrenia is a complex disorder that generates serious difficulties and a high level of dysfunction and suffering for those who suffer from it and/or those around them. This alteration is considered chronic and requires continued and permanent treatment. being the essential medication to keep the patient’s symptoms under control and keep the subject stable and without psychotic breaks.
However, There are many people with schizophrenia who do not comply with pharmacological treatment prescribed over time. Why do many people with schizophrenia stop taking medication? Throughout this article we are going to see some of the most frequent reasons for this.
Schizophrenia is a psychotic-type mental disorder whose diagnosis requires the presence for at least six months of symptoms such as hallucinations, delusions, speech disorders (with at least one of these three present) along with other disorders such as motor restlessness, catatonia, alogia or impoverishment of thought, emotional flattening or apathy.
Suffering from this disorder represents a great alteration in the person’s daily life, affecting all or almost all areas of life such as personal interaction, relationships, work, studies or leisure. It is possible that some of these subjects are not aware of the presence of alterations or that they do not consider them as such but as part of their reality, but generally it is suffering both for a large part of those who suffer from it and for their families
It is a disorder that can present very different courses depending on the person and the type of symptoms they present. However, we are facing a chronic disorder for which there is currently no cure, with treatment focusing on symptom control. Said treatment, in order to maintain the patient’s stability, requires being continued throughout the subject’s life. To a large degree, part of the well-being that can be enjoyed depends on the use of these drugs
Reasons that lead people with schizophrenia to stop taking medication
Although, as a general rule, great attention is paid to making clear the need for continued treatment, a large percentage of people with schizophrenia decide to stop taking medication or do not comply with the guidelines indicated by doctors. In fact, different studies indicate that Less than half follow these medical guidelines as indicated (some by default, others by excess). It is estimated that among the people who abandon, 25% do so during the first ten days, half after a year and 75% after two years. Because? Below we indicate a series of reasons why abandonment of pharmacological therapy is common.
One of the reasons that may lead a person with schizophrenia not to take medication, especially in the initial phases after diagnosis, is the lack of awareness regarding their disorder. Not knowing what they have or not having the capacity to recognize the existence of alterations (for example, patients with cognitive impairment) means that the possibility or need of taking drugs is not considered.
These patients may take the medication at a given time through inertia or by initial medical prescription, but end up abandoning it because they consider that its use does not make sense.
2. Panic or flight reaction to the diagnosis
Being diagnosed with a mental disorder, especially one considered chronic like schizophrenia, is something very hard and difficult to accept. It is not uncommon for in the initial moments to appear a denial of the diagnosis and a profound rejection of the idea of taking medication or treatment, as if doing so would mean accepting that one has that disease. This can cause people diagnosed with this disorder to refuse to start taking medication or, even if they have started taking it, to suddenly decide to stop. As in the previous case, this It is especially common in the first moments after diagnosis
3. Alterations produced by the disorder itself
In some patients, the disorder itself can cause them to stop taking medication. For example, a paranoid subject may begin to see the act of taking medication as evidence that he is trying to be poisoned or controlled externally and react aversively to it. Although the effects of the medication would in principle alleviate psychotic symptoms, the acquisition of tolerance or the lack of effectiveness of a medication in a specific case can cause hallucinatory symptoms to appear that generated said rejection.
4. Reactance
Another possible reason why someone may stop taking medication is their reactivity to the idea of being forced to take it. This can occur in patients who are initially forced to take the medication or in people who reject the idea of having to take something for life, reacting with aversion to this idea and causing them to end up abandoning the medication. Also there may be reactance or even fear at the idea of depending on taking pills the rest of his life.
The main and most frequent reason that leads a person with schizophrenia to stop taking medication is the existence of side effects caused by the medication. Many of the antipsychotics and drugs used can cause serious discomfort in those who use them, especially when we talk about classic neuroleptics. Some of the most common are drowsiness and sedation, along with weight gain
Among them we can find the emergence of motor problems such as the appearance of akathisia or motor restlessness, dyskinesias, uncontrollable movement or even parkinsonian-type tremors. Sometimes antiparkinsonians are added to the medication to be taken precisely for this reason. They can also cause sexual symptoms, such as gynecomastia, galactorrhea (expulsion of milk from the breasts regardless of sex), amenorrhea or erectile dysfunction. Dizziness, gastrointestinal alterations, tachycardia and other alterations such as an increase in blood glucose levels may also appear (facilitating the onset of diabetes). In some cases, even more dangerous problems may arise, such as neuroleptic malignant syndrome or agranulocytosis (which can be fatal).
6. Drowsiness and decreased abilities
Although it is part of the previously mentioned side effects, this element has been separated due to its high prevalence among patients who decide to stop taking medication. And one of the reasons why more people stop taking medication is the sedation that many of these drugs produce, which in turn generates repercussions in a large number of vital domains.
Although the drug may bring schizophrenia symptoms under control, many patients report having problems concentrating or performing mentally, as well as becoming tired and sleepy for much of the day A decrease in creativity, energy and the desire to do things has also been mentioned. This can generate alterations in family life, leisure or work.
6. Lack of effectiveness
Not all medications work the same in all cases, and there is even the possibility that some drugs are not effective in the treatment of some cases or that the subject is resistant to them. Although the next procedure would be to modify the dose or drug, some patients may feel hopeless and abandon treatment.
One reason why some people stop taking medication, both in schizophrenia and in other disorders (for example, it is common in depression or bipolar disorder), is the more or less stable absence of obvious symptoms for a relatively long period of time. The subject may think that he has already overcome the problem and that it is no longer necessary to take said medication, having already been cured with the previous medication. Unfortunately, symptoms often end up recurring over time or with the presence of stressors.
The importance of adherence to treatment
The reasons described above are multiple and, in many cases, understandable. However, schizophrenia is a disorder that generates great dysfunction in the life of those who suffer from it if it is not treated, both in the person’s life and in their environment. It is necessary to use continued treatment over time. It is essential for professionals who treat patients with this disorder. perform psychoeducation for the patient and his environment explaining how it works, the need to take medication and have a high adherence to treatment, the risks of not doing so and giving space to express fears, doubts, thoughts, feelings and questions.
If a drug is not effective or has very serious side effects It is possible to look for different alternatives and substances that can replace it Intramuscular depot presentations are also available, which means that many subjects do not have to take medication frequently (which would solve an aversion to frequent drug consumption or the actual forgetting of doses and the need to take the medication), and even some preparations such as paliperidone palmitate that can be injected monthly (or in some cases even quarterly).
This does not prevent us from continuing to research new drugs and alternatives that allow us to deal with this disorder in a less aversive way. In fact, it was this concern that generated the exploration and research that led to the emergence of atypical or second-generation antipsychotics, as well as numerous advances that are applied today.
