Family and Caregiver Schizophrenia Discussion Forum

Command Hallucinations continue to torment my son

He is on the highest dose of clozapine augmented with a high dose of ziprasidone and still the command hallucinations continue to torment him. He has insight and is medication compliant. The voices want him to go into the mental hospital but I am not sure he would be admitted. Also I hate to mess up his medications and might have to start over or perhaps they will not keep track of his severe constipation and he would become impacted or septic. Besides the holidays are never a good time to go to the short-staffed crisis unit. His psychiatrist suggested trying ECT but he is not really wanting to try it and I am not sure it works unless there is a mood component. Also, I worry about stopping his clonazepam just so seizures can be induced. He did try 4 sessions of rTMS but he did not want to continue since there was no reduction of symptoms and it was experimental and not covered by insurance. I really don’t think there is a treatment that will reduce the auditory command hallucinations but even when I think he is calm and doing relatively well, he is saying he wants to go to a locked facility to be safe and stop their torment. I suggested listening to music or books with headphones but the voices don’t like that and made him throw the headphones away. Sometimes the TV will distract him for a while. He needs to take medication every few hours throughout the day. It is upsetting to me that although I have tried just about everything and to me he seems so much better than he was, still it isn’t enough and I don’t know what else to do. Dropping him off at a crisis unit is not going to fix anything and will leave me with him even more de-stabilized when they release him in a few days, if they even admit him at all. If I don’t take him, he will find a way to get there himself. Also, there is a lifetime limit of mental health hospitalizations on medicare so I hate to waste them.
If anybody has any ideas or encouragement, it would be appreciated.

His age and state you live?

A daily fiber laxative is a must for my SZs

When their medication resistant, about all you can do is learn to live with it,

My daughter had round six of ECT yesterday, round seven Monday then release…

He is 30 years old and we live in Central Florida.

Doctor prescribed lactulose, he tried linzess, he takes stool softener and fiber and one of his delusions after doing religious ritual blessings is to eat 10 plums. He also drinks multiple glasses of water with blessings. He walks around the neighborhood 6 to 7 miles a day because the voices force him to do that… Usually we end up with enema and stimulant laxative to get him going. All the meds he takes including cogentin cause this problem.

Please let me know if ECT helps at all. A lady on my online support group said her 50+ year old daughter had 2 weeks of ECT previously with no improvement and currently there does not seem to be any mood component so I do not hold out much hope for relief from that procedure. I truly hope it helps your daughter.

Believe me he was much, much worse when the big psychotic break happened over 2 years ago, but still even if he is unable to live a productive life, I just want him to be able to stay calm and content. For a number of years he was able to successfully function and work and when he decided to go cold turkey off his meds he lost insight, was very delusional and psychotic for a long time and after multiple hospitalizations he finally regained insight and became compliant but still he is not able to get back to a functional level. Sometimes he wants to live on his own and work again but either the illness or the med side effects cause him not to have a good memory or concentration. I am very lucky I have been able to work closely with his psychiatrist. When I am unable to be his caretaker anymore, I would like him to live in an affordable long term residential program.

Well, like all the meds, some work for some… We have tried every med available and they only help a little…

Yes we have tried just about every antipsychotic there is, including amisulpride. Clozapine has been the best for him but still not enough even with augmentation of ziprasidone. Without the medication, we are unable to live with him. Some medications actually made him worse such as abilify (extreme mania and dystonia) and even invega sustenna (extreme anxiety). I think an XR or LAI version of clozapine might be helpful but I guess nobody will ever come out with that. Most people take clozapine all at night, but my son takes 200mg every 3-4 hours throughout the day. He also augments with ashwaghanda for anxiety and a small dose of clomipramine for OCD at night since he does not want to increase his clonazepam,