Getting the Patient to Stay on Medications is Caregivers Biggest Dilemma

One of the most frustrating and difficult tasks for a caregiver of someone with schizophrenia is to help make sure that the medications prescribed by the physician are taken according to directions or sometimes even taken at all. Don’t be surprised if they completely refuse to take their medications, and there are, according to experienced family caregivers, several reasons why a loved one would be so resistant:

1. they may lack the needed understanding and insight into their illness;
2. they may not believe that they are ill, so medication is unnecessary;
3. some may believe that the medication is what’s causing their illness;
4. if your loved one is experiencing paranoia, they may think the medication is part of a plot to keep them from functioning;
5. they may be having unpleasant side effects as a result of the medication, and think that they feel better when they aren’t taking anything;
6. they may have to follow a very complicated medication regimen that involves taking several pills a day, and it may be too confusing to stick with it;
7. your loved one may begin to feel so good that they begin to forget to take their medication, or think that it’s not necessary anymore;
8. a loved one may even welcome the return of certain symptoms, like voices that say nice things, making them feel comforted and special, giving them incentive not to take their medication.

For obvious reasons, your loved one needs to take their medication as prescribed. When dealing with the initial dose of medication, it must be continuously monitored, so listen closely to your loved one’s complaints about any possible side effects. Do your best to empathize with any problems they may be experiencing from the medications.

Keep-in-mind that "bad" symptoms (hallucinations, voices, delusions) will not reappear immediately if a loved one should go off of their medication. Anti-psychotic drugs stay in the system between six weeks to three months. You do have some time to deal with the problem before their extreme symptoms return, however, after the three month mark, getting them back on a maintenance dosage may mean "starting over" at a higher maintenance level than before.

When a loved one balks at taking their medicine, explain to them that they may end up back in the hospital if the medication is not taken (this should not be a threat). Don’t be surprised if they don’t accept this warning, or if they actually want to return to the hospital.

One thing that might help is if other people in your family are on medication, you can make taking pills a positive, group event. Everyone takes their medication at the same time (even if it’s a vitamin pill). This will encourage your loved one to take their medicine regularly, and they won’t necessarily assume that they are being monitored if everyone else has to take their medication as well. If your loved one must take several pills, it can make the process much more difficult. Find out from their doctor if there is a simpler form in which your loved one can receive all their medications.

For those who keep forgetting to take oral medications, you can get them an attractive and easy-to-work weekly pill box. Be sure to never sneak pills into their food, even if paranoia doesn’t exist. If they are already experiencing paranoia, you will never be able to regain their trust again if you do this with their medication.

Oral vs Injectable Medication

More people go off oral medication than injectable medication. With an injectable, you know the person is receiving it, and that they can't spit it out or hide it under the tongue.

Discuss the pros and cons of switching from an oral to an injectable form with their doctor. Be advised that some medical professionals believe there is a "down" side to injections, because a loved one may experience possible feelings of humiliation, or a loss of control on their part. Injectable medication may have a different dosage schedule than an oral medication and may be given once a week or once every few weeks, depending upon the type of medication. Let your loved one know that you’re proud of the way they are handling the need for medication. Also, do your best to be calm and reasonable when getting them to take medication. If you push them too hard, you may make it more difficult for them to move toward greater independence. Realize that a period of learning through experience and adjustment is needed for both of you in order to get into some sort of regular routine.

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Through it all, your most important role is to encourage your loved one to stick with their treatment program. Treatment of schizophrenia isn’t just through medication alone, but will involve attending daily or regularly-scheduled medical appointments, and attending therapy or day programs as well. Remember that the time spent with mental health professionals on a week-to-week basis will be quite minimal when compared to the amount of time that your loved one will spend with you. This is why caregivers are usually in the best position to provide the everyday encouragement and support needed to help them stick with their treatment and help them on a successful road to rehabilitation.

Last updated: 02/06

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