Question

My brother 42 years old suffering from schizophrenia for last 19 years but condition is not improving after all efforts.

Dr.Saranya Devanathan · Accepted Answer

Dear lybrate-user,
Please understand schizophrenia so that you can make your brother live with dignity. Unless you write in detail about the symptoms at present and the efforts you and your parents have taken so far, it is difficult to reply. Most often people living with schizophrenia don't know that they are sick. So they don't co operate with treatment. Once the treatment is discontinued for any reason (no improvement, side effect, sleeping too much, putting on weight, can not afford, it is difficult to give him tablets, etc), relapses occur. After each relapse it becomes more difficult to treat. See below a general information in schizophrenia
Positive Symptoms
Hallucinations: Hearing voices when awake and alone.
Delusions: Strange and firm beliefs that is peculiar to the person. It remains in spite of obvious evidence to the contrary. Many who suffer from persecutory delusions are called “ paranoid”. They believe that they are being watched, spied upon or plotted against. Rural people may believe that relatives or in-laws through ‘poisoning’ or ‘yanthram’ have done black magic. Educated urban youth may believe that CBI or computer and electronic devices are observing them.
Thought Disorders: “Racing thoughts” come and go so rapidly that it is not possible to “catch” them. Because thinking is disorganised and fragmented, the person’s talk is often in coherent and illogical.
Altered sense of self: A blurring of the person’s feeling of whom he or she is. It may be a sensation of being bodiless, or non-existent as a person. He or she may not be able to tell where his or her body stops and the rest of the world begin. It may be as if the body is separated from the person.
Catatonic Behaviour: Some time the person may be staring at the infinity or horizon. He or she may remain in uncomfortable position for long hours without any purpose.
Agitation: Without any obvious reason, the person may be agitated and restless.
Negative Symptoms
Lack of motivation or apathy: There is no energy or interest in life. He may just be in bed for most of the time. He or she may be picking at food. It is often confused with laziness
Blunted feelings: The fine emotions are not sharp. He or she is unable to show or feel any love or affection. He or she may be very emotional but cannot express it outwardly
Depression: Schizophrenia changes one’s life. The future looks bleak. So they are helpless and feel hopeless. So they talk of suicide or attempt suicide
Social withdrawal: He or she feels relatively safe alone. They cannot show interest in socialising since they don’t have the resources. They are caught up with their own feelings even in other’s company
Alogia: Restrictions in the fluency and productivity of thought and speech
Avolition: Restrictions in the initiation of goal directed behaviour
Anhedonia: Lack of pleasure
Lack of spontaneity
Stereotyped thinking
Attentional impairment
Poor rapport
Treatment
Medical: We have not yet found a medicine without any side effect at all. Still we use for its benefit. It can effectively control positive symptoms. So he/she is amenable for counselling or occupation. The medicines we use are Major Tranquilizers or Neuroleptics. Before 2000, we were using typical drugs like Chlorpromazine, Trifluperazine, Thioridazine, Fluphenazine injections, Haloperidol, Pimozide, etc. All these tablets give neurological side effects in effective dose.
After 2000, we give Risperidone, Olanzepine, Clozepine, Ziprasidone, Quetiapine, and Aripiprazole. They cause weight increase, blood sugar elevation, cholesterol changes and changes in ECG.
Family members: They should understand the disease and try to give the tablets without missing. They should start or join self-help groups in order to share the experience. Otherwise they get burnt out which results in divorce, half way home admissions and hospital admissions.
Occupational Therapy: If the person is occupied, he/she needs less medicine. However others should not feel that by advising he/she would work. It is with consistent effort, we can sustain them in any job. We should keep on trying, even if he/she leaves the job.

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