Why do many people with schizophrenia stop taking medication?

Schizophrenia is a complex disorder, which generates serious difficulties and a high level of dysfunction and suffering for those who suffer from it and/or their environment. This alteration is considered chronic and requires continuous 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 drug treatment prescribed over time. Why do many people with schizophrenia stop taking medication? Throughout this article we will see some of the most frequent reasons for this.

• Related article: "Types of antipsychotics (or neuroleptics)"

Schizophrenia: a disorder considered chronic

Schizophrenia is a psychotic mental disorder whose diagnosis requires the presence for at least six months of symptoms such as such as hallucinations, delusions, speech disturbances (with at least one of these three present) along with other disturbances such as restlessness motorboat,

catatonia, alogia or impoverishment of thought, affective flattening or abulia.

The suffering of this disorder supposes a great alteration in the day to day of the person, affecting all or almost all vital areas such as personal interaction, the couple, work, studies or the 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 rather as part of their reality, but in general it supposes 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 dealing with a chronic disorder for which there is currently no cure, with treatment focusing on symptom control. Said treatment, in order to maintain the stability of the patient, requires to be continued throughout the life of the subject. 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 great attention is generally paid to making clear the need for continued treatment, a great deal of percentage of people with schizophrenia decide to stop taking the medication or do not adhere to the guidelines indicated by the doctors. In fact, various studies indicate that less than half follow these medical guidelines as directed (some by default, others by excess). It is estimated that among the people who quit, 25% do so during the first ten days, half a year and 75% after two years. Because? Below we indicate a series of reasons why pharmacological therapy is frequently abandoned.

1. Not aware of illness

One of the reasons that can lead a person with schizophrenia to not take the medication, especially in the initial phases after diagnosis, is the lack of awareness regarding its disorder. Not knowing what they have or not having the ability to recognize the existence of alterations (for example, patients with cognitive impairment) does not consider the possibility or need to consume drugs.

These patients can take the medication at a given moment by inertia or by initial medical prescription, but end up giving it up considering 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 assume. It is not uncommon for a denial of the diagnosis and a deep rejection of the idea of ​​taking medication or treatment to appear in the initial moments, as if doing so meant accepting that one had that disease. This can cause people diagnosed with this disorder to refuse to start taking medication or, even if they have started to do so, suddenly decide to stop taking it. As in the previous case, this It is especially frequent in the first moments after diagnosis.

3. Alterations produced by the disorder itself

In some patients, the disorder itself can cause abandonment of medication. For example, a paranoid subject may begin to view taking medication as evidence that he is trying to be poisoned or externally controlled and react aversively to it. Although the effects of the medication would initially alleviate the 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 caused such rejection.

• Related article: "The 15 types of hallucinations (and their possible causes)"

4. ballast

Another of the possible reasons 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 said idea and causing them to end up leaving the medication. Also there may be reactance or even fear of the idea of ​​depending on taking pills the rest of his life.

• Related article: "Psychological reactance: what is it and what are its effects?"

5. Side effects

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. And it is that 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 appearance of motor problems such as the appearance of akathisia or motor restlessness, dyskinesias, uncontrollable movement or even type tremors parkinsonian. Sometimes antiparkinsonian drugs are added to the medication to be taken precisely for this reason. They can also generate sexual symptoms, such as gynecomastia, galactorrhea (expulsion of milk from the breasts regardless of gender), amenorrhea or erectile dysfunction. Dizziness, gastrointestinal disturbances, tachycardia and other disturbances such as elevated blood glucose levels (facilitating the onset of diabetes) may also appear. In some cases, even more dangerous problems can 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 their medication. And it is that 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 can bring the symptoms of schizophrenia under control, many patients report having trouble concentrating or functioning mentally, as well as becoming fatigued 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 medicines work the same in all cases, and there is even the possibility that some drugs do not show effectiveness in the treatment of some cases or that the subject is resistant to they. Although the procedure to follow would be to modify the dose or the drug, some patients may feel hopeless and abandon the treatment.

7. stable improvement

One reason some people stop taking medication, both in schizophrenia and other disorders (for example, it is common in depression or bipolar disorder), the more or less stable absence of obvious symptoms for a relatively long period of time 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, the symptoms usually end up reappearing 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 life of the person and in their environment. It is necessary to use a continuous treatment over time. It is essential for professionals who treat patients with this disorder carry out psychoeducation for the patient and his environment, explaining its functioning, the need to take medication and present a high adherence to treatment, the risks of not doing so and giving space to the expression of fears, doubts, thoughts, feelings and questions.

If a drug was not effective or had 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 use or actual forgetfulness of doses and the need to take the medication), and including some preparations such as paliperidone palmitate that can be injected monthly (or in some cases even quarterly basis).

This is not an obstacle to continue researching new drugs and alternatives that make it possible to deal with this disorder in a less aversive way. In fact, it was this concern that generated the exploration and investigation that led to the emergence of atypical antipsychotics or second generation, as well as numerous advances that are applied today.