Refusal to take medication

This is one of the most frustrating problems. It may be hard to understand why someone with schizophrenia would refuse to take medication when the necessity of doing so is so obvious to everyone else. Families have found that there are five main reasons why someone might refuse medication .

 * Your relative may lack insight about the illness. Not believing  that he or she is ill, he or she sees no reason to take medication. Or, some think that it is the medication that causes the illness. If the illness involves paranoia, your relative may view the medication as part of a plot to prevent him or her from functioning.

   * Your relative may be suffering from unpleasant side effects as a result of the medication and believe that it causes more problems than it solves.

   * Your relative may be on a complicated medication scheme that involves taking several pills a day. He or she may find the regimen too confusing, and may resent the constant reminders of illness.

   * Your relative may feel so well that he or she either forgets to take the medication, or thinks that it is not necessary any more.

   * Your relative may welcome the return of certain symptoms such as voices that say nice things and make him or her feel special.

People with schizophrenia need to take prescribed medication , and the following is a list of ideas and guidelines to help you with this difficult problem.

* Know that the initial medication dose must be continuously monitored. Therefore, you should always listen to your relative's complaints about side effects. Do your best to empathize with any distress about medications.

*Know that "bad" symptoms (usually symptoms such as hallucinations and delusions ) will not reappear immediately upon discontinuation of medication. Anti-psychotic drugs stay in the system for six weeks to three months. This "grace" period gives you some time to deal with the problem. After three months, however, getting back to a maintenance dosage may mean "starting over" at a higher than maintenance level.

*Explain to your relative that he or she may end up back in the hospital if medication is not taken (this should not be a threat). Some will not accept warnings, and still others may not mind returning to the hospital.

*If other people in your family are on medication, turn pill taking into a ritual. Everyone takes his or her medication at the same time (even if it is a vitamin pill).

*It is easier to take one pill a day than six. Talk to the doctor about the form in which your relative is receiving medication.

* For people who keep forgetting to take oral medication, the use of a weekly pill box can be an effective tool.

*Never sneak pills into food. If paranoia exists, this will increase it. Trust will never be built up.

*More people go off oral medication than injectable medication. With injectable, you are sure the person is getting it. He or she can't spit it out, hide it under the tongue, etc. Discuss the pros and cons of switching medications with the doctor. (Health care professionals note that there is a "down" side to injections: possible feelings of humiliation, loss of control, and the potential for build-up of medication over time.)

*Injectable medication is given once a week or once every few weeks, depending on the type of neuroleptic. Consider arranging a "treat" built around going for the medication - seeing a movie, going for lunch, etc. Let your relative know that you are proud of the way in which he or she is handling the need for medication.

*Do your best to be calm and reasonable about getting your relative to take medication. If you press too hard, you may make it more difficult for your relative to move to greater independence. A period of learning through experience may be necessary.

Text from:
SCHIZOPHRENIA, A Handbook for Families ,
Published be Health Canada in co-operation with
the Schizophrenia Society of Canada

On the web:
www.hc-sc.gc.ca/hppb/mentalhealth/pubs/schizophrenia/index.html