How to handle a schizophrenic patient?

Hi doctor,

My sister is suffering from auditory hallucination and two years back she was diagnosed to have schizophrenia (paranoid). Earlier, she regularly took medicine. But now she is not taking medicine because of side effects. She is unmarried and working in a private company. She does not feel any hallucination in her office, but when she reaches home, she hears somebody calling her by her name again and again. When it goes beyond her tolerance capacity, she becomes quite violent and says that she will kill that person.

She is suffering from chronic suppurativa otitis media (CSOM) from the age of 4 and had undergone right mastoidectomy. She was almost deaf till that time and started hearing actual voices from four years of age. Later, she said that she was not comfortable hearing these sounds since it was too loud for her. Then she started complaining that a person is repeating her name. It was diagnosed as auditory hallucination and schizophrenia. Earlier, she took tablets Risperidone 1 mg, Parkin 2 mg and Escitalopram 5 mg. Our mother is also suffering from schizophrenia, but she is medicine compliant. She is maintaining it by taking regular medicine. How to handle my sister? Please guide us.

Hi doctor,

I forgot to give my sister tablet Parkin 2 mg for three days, though I am regularly giving Risperidone 2 mg in her food as she is not medicine compliant. She has shown great improvement after a period of three weeks. Now, she is not having auditory hallucinations and is behaving well. But she feels drowsy. As she has to work in her office and tasks given to her require alertness, I have not increased her dosage to 3 mg. Can I keep her on Risperidone 2 mg alone without giving Parkin? Can I give her a multivitamin? Please suggest.

Hi doctor,

I am regularly giving my sister tablets 2 mg Risperidone and Pacitane 2 mg. Though she has shown some improvement in her symptoms, these days I am finding that she doubts a lot. Recently we have employed a domestic help in our house, who works for an hour only. My sister keeps a close watch on what the maid is doing. My sister doubts the maid of stealing household things and money. My sister gets annoyed when she does not find anything in the house and doubts the maid of stealing that thing. She gets relaxed when she finds that thing. If not, then she blames the maid and requests us to expel the maid.

She tells me that she knows that the maid may not steal, but doubts keep coming in her mind. She requests us to sit in the room where the locker is kept until the maid goes out after finishing her work. I do not understand how to handle her doubting attitude. She complains that she does not feel active and enthusiastic as she used to feel earlier. It has been a month now and I am regularly giving her medicines by mixing it in her food as she is not medicine compliant. Earlier you suggested giving Risnia liquid by mixing it in her food. I want to know how I can avail this medicine since it is not a over-the-counter medicine. Please help.

Hi doctor,

Thank you for the reply.

My sister has suspiciousness. She doubts a lot. I feel that she is unaware of her behavior when she gets angry and speaks harshly continuously. She does not regret or confess to the way she behaves or what she speaks to someone. It appeals to me that my sister is unaware of her behavior, and she feels that she is right. She has no distress.

Hi doctor,

I am giving my sister Risperidone LS (combination of Risperidone 2 mg and Pacitane 2 mg) regularly. Though her symptoms of hallucinations and unwanted agitation because of suspiciousness have improved, she is suffering from depression. She told me a few days ago, that she is not feeling enthusiastic about doing any work. She does not enjoy daily activities, which she used to enjoy earlier when she was not on medicines. She is not able to laugh in her office when her colleagues laugh on some matter. Today, she is weeping and looking tired and sad. She told me that she is feeling the same for the past five days and that today it is out of control. Should I give her an antidepressant? I know she has poor insight into her disease, and she is not compliant with medicine because of its side effects. Can these side effects be lowered? Please help.

Hi doctor,

I am giving my sister tablets 2 mg Risperidone and 2 mg Pacitane for about three months. For about two to three weeks, she started complaining of depressive symptoms like a lack of willpower, enthusiasm, hopelessness, and helplessness. She was neither enjoying her job nor any tasks at home. She told me that she is enjoying nothing and want to quit her job because of such depressive feelings. But she does not have any problem in her office. I started giving her the tablet Escitalopram 10 mg. She is highly impatient and intolerant to bear the side effects of the tablet Risperidone 2 mg. She says that either she needs relief from these depressive symptoms, or she wants to die. She does not know that she is on tablet Risperidone 2 mg medication as she is non-compliant with medicines.

But she easily agreed and started taking the tablet Escitalopram (a drug prescribed earlier for depressive symptoms). She is taking it for two weeks but is not satisfied since she is having no improvement in her schizoaffective symptoms. Considering her intolerance, I have lowered the dosage of the tablet Risperidone to 1 mg. This has shown improvement in her depressive symptoms, but I fear that it may bring hallucinations back. Please suggest what I should do. Is there any other medicine that is tolerable when the dose is hiked and has less unpleasing side effects?

Hi doctor,

I would like to brush up on my sister's medical history once again here. Two years ago when she was diagnosed with schizophrenia, she was prescribed tablets Risperidone 1 mg, Parkin 2 mg, and 5 mg Escitalopram for a week and then it was increased to 2 mg Risperidone, Parkin 2 mg, and 5 mg Escitalopram for one month. At that time, she was feeling fine with 1 mg of Risperidone, but when it was hiked to 2 mg, she had the symptoms of drowsiness, forgetfulness, dry mouth, not being able to enjoy any work or any activity like watching her favorite program on television, listening to music, experiencing lack of willpower and having the urge to recover from all of this quickly. She was weeping and had thoughts of suicide mainly because of depression. She used to say that she wanted to quit taking the medicines since the side effects were intolerable for her.

She wants to work and enjoy everything. As a result, she quit taking medicine. Within a period of two to three weeks, hallucinations recurred making her feel uneasy. On my convincing her, she started taking medicines only till the hallucinations vanished. She again stopped the medicines saying that she was alright. At that time, she was unemployed at home. I convinced her a lot to stick to the treatment, but she was reluctant. I pressurized her to go for a job and not sit idly at home. She found a job and started working. She got busy with her job, and it reduced her hallucinations. When she was at home (jobless) she used to have hallucinations all day and at night. But when she started working, she used to have hallucinations only when she reached home and not in the office.

With your suggestion, I started giving her tablet of Risperidone 1 mg and Parkin 2 mg by mixing them in her food due to her poor compliance. I increased the dosage of tablet Risperidone to 2 mg and this time I did not give her tablet Escitalopram. After a period of two months, she started complaining about the side effects mentioned above. I started giving her tablet Escitalopram 10 mg to reduce her symptoms, but she did not recover. Conclusively it appears that the side effects of a hiked dose of tablet Risperidone are intolerable for her. Now when I have lowered the dosage of tablet Risperidone to 1 mg, and I am giving tablets Parkin 2 mg and Escitalopram 10 mg. She is feeling fine like she wants to be. Please suggest another medicine with the least side effects. My sister also has maxillary sinusitis and a middle ear infection (CSOM). She is having pus discharge from both ears since her childhood. Now she is 35 years old. She has left her ear treatment untreated and uses ear drops to control pus discharge. Does her ear condition add to her schizophrenia and medicine non-compliance? Please help.

Hi doctor,

Thank you for the reply.

My sister is suffering from chronic schizophrenia. She is having auditory hallucinations. She says that a person is continuously chasing her wherever she goes and calls her name loudly. She wonders how no person other than her could hear those voices which she can. Though she is performing well in her job, she gets irritated by these hallucinations. She is not at all medicine compliant. Earlier she was taking the medications, but she used to stop taking them when she got relieved of hallucinations.

She cannot take medicine on her own, as she has poor insight into the disease. Our mother is also suffering from chronic schizophrenia for many years, but she is medicine compliant. What can I do to treat my sister? I am her younger sister. I am married and not at home to take care of her and her treatment. As she was not compliant in taking her medicines, I used to mix the medicine in her food. My brother started to give her the medicines, but somehow, she identified it and stopped taking food (milk). My brother is unable to give her the medicine. Please suggest what we can do to treat her. Right now, she is not taking medicine and showing symptoms of suspiciousness, aggression, and hallucinations. Please help.

Hi doctor,

Thank you for the reply.

I have several questions in my mind. How can I avail this injection? How can I inject it into her body when she is against the treatment? Should it be given when she is sleeping or first by giving her anesthesia? Please tell me precisely how to use the injection and the way of injecting it into her body. Her condition can be severe if left untreated. She cannot accept that her illness is not a reality. At home, because of a busy schedule, no one is free to take better care of her though all of us love her and pray for her. She is a very talented, fun-loving, and friendly person. I would like to know about the current research that is being done to cure schizophrenia, which is a curse in disguise. Please help.

Hello doctor,

My sister is now on medicine Olanzapine 5mg as suggested by a psychiatrist. He suggested to stop giving the tablet Risperidone as she did not comply with it because of side effects. She is now taking the tablet Olanzapine 5 mg and is complying with it for lesser side effects. She is regularly taking her medicine because it is also curing her headaches due to maxillary sinusitis. Now she is not having auditory hallucinations and is doing well. But she becomes aggressive easily and talks authoritatively. Her suspicious nature has not yet gone. She accepts that tablet Risperidone used to lessen her aggression and doubtfulness, but she cannot comply with it.

She becomes fine when her doubts are cleared. She is not ready to increase the dosage of the table Olanzapine as it makes her sleepy and alters her abilities. The only matter of relaxation for me is that she is herself taking the tablet Olanzapine 5 mg regularly. What to do about her aggressive behavior? Please suggest.