Why do many people with schizophrenia stop taking their medication?

Patients with this diagnosis have a high probability of not following treatment.

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 disorder is considered chronic and requires continuous and permanent treatment, medication is essential to keep the patient's symptoms under control and to keep the subject stable and without and keep the subject stable and free of psychotic outbreaks.

However, many people with schizophrenia However, many people with schizophrenia fail to comply with the prescribed pharmacological treatment over time. Why do many people with schizophrenia stop taking their medication? Throughout this article we will look at some of the most common reasons for this.

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 hallucinations, delusions, speech disturbances (at least one of these three being present) along with other disturbances such as motor restlessness, catatonia, alogia or impoverishment of thought, affective flattening or abulia.

Suffering from this disorder means a great alteration in the person's daily life, affecting all or almost all vital areas such as personal interaction, the couple, 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 in general it means suffering for a large part of those who suffer from it. suffering both for most of the sufferers and for their families..

It is a disorder that can present very different courses depending on the person and the type of symptomatology presented. However, it is a chronic disorder for which there is currently no cure, and treatment is focused on symptom control. Such treatment, in order to maintain the patient's stability, needs to be continued throughout the subject's life. To a large extent, part of the well-being that can be achieved depends on the use of these drugs..

Reasons for people with schizophrenia to stop taking medication

Although great care is generally taken to make clear the need for continued treatment, a large percentage of people with schizophrenia decide to stop taking their medication or do not adhere to the guidelines prescribed by their doctors. In fact, different studies indicate that less than half follow these medical guidelines as indicated (some by default, some by excess). (some by default, others by excess). It is estimated that 25% of those who drop out do so within the first ten days, half after one year and 75% after two years. Why? The following are some of the reasons why drug therapy is frequently abandoned.

1. Lack of awareness of the disease

One of the reasons that may lead a person with schizophrenia not to take medication, especially in the early stages after diagnosis, is the lack of awareness of their disorder. Not knowing what they have or not being able to recognize the existence of disturbances (e.g., patients with cognitive impairment) leads to not considering the possibility or necessity of taking medication.

These patients may take the medication at a given moment due to inertia or initial medical prescription, but end up abandoning it when they consider that its use makes no sense.

2. Panic or flight reaction to the diagnosis

Being diagnosed with a mental disorder, especially one considered chronic such as schizophrenia, is very hard and difficult to accept. It is not rare that in the initial moments there appears a denial of the diagnosis and a deep rejection to the idea of being medicated or treated, as if to do it supposed to accept that one has this disease. This can cause people diagnosed with this disorder to refuse to start taking medication or, although they have started to do so, they suddenly decide to stop. As in the previous case, this is especially is especially frequent in the first moments after diagnosis..

3. Alterations produced by the disorder itself

In some patients, the disorder itself may lead to withdrawal from taking medication. For example, a paranoid subject may begin to see taking medication as evidence that he or she is trying to be poisoned or externally controlled and react aversively to it. While the effects of medication would in principle alleviate psychotic symptoms, the acquisition of tolerance or lack of effectiveness of a medication in a particular case may may lead to the appearance of hallucinatory symptomatology that would generate such rejection.

4. Reactance

Another of the possible reasons why someone may stop taking medication is their reactivity to the idea of being obliged to take it. This can occur in patients who are initially forced to take the medication or in people who are repulsed by the idea of having to take something for life, reacting with aversion to the idea and causing them to end up abandoning the medication. Also or even fear to the idea of depending on taking pills for the rest of their life. for the rest of their lives.

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. Many of the antipsychotics and drugs used can cause serious discomfort to those who use them, especially when we are talking about the classic neuroleptics. Some of the most common side effects are drowsiness and sedation, together 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 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 sex), 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 diminished capacities

Although it is part of the aforementioned side effects, this element has been separated due to its high prevalence among patients who decide to stop taking medication. One of the reasons why more people stop taking medication is the sedation that many of these drugs produce, which in turn has repercussions in a large number of vital domains.

Although the drug may have the symptoms of schizophrenia under control, many patients report having problems concentrating or performing mentally, as well as fatigue and drowsiness for much of the day.. A decrease in creativity, energy and desire to do things has also been reported. This can lead to disturbances in family life, leisure or work.

6. Lack of effectiveness

Not all drugs work the same in all cases, and there is even the possibility that some drugs may not be effective in the treatment of some cases or that the subject may be resistant to them. 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

A reason for some people to stop medication, both in schizophrenia and in other disorders (e.g., it is common in depression or bipolar disorder), is the more or less stable absence of overt symptomatology over a relatively long period of time. The subject may think that he or she has already overcome the problem and that it is no longer necessary to take the medication, having already been cured with the previous medication. Unfortunately, the symptoms usually end up reappearing with 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 the sufferer if it is not treated, both in the life of the person and in his or her environment. It is necessary to use a continuous treatment over time. It is essential for professionals who treat patients with this disorder to psychoeducation for the patient and his or her environmentIt is essential for professionals treating patients with this disorder to provide psychoeducation for the patient and their environment, explaining how the disorder works, the need for medication and the risks of not adhering to treatment, and giving space for the expression of fears, doubts, thoughts, feelings and questions.

If a drug is ineffective or has very serious side effects, it is possible to look for different alternatives and substances that can help the patient. 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 preclude further research into new drugs and alternatives for dealing with this disorder in a less aversive manner. 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.