It's a mixed bag.
He's not paranoid, I don't have any signs that he's hallucinating or hearing anything, but his delusions are going in full force.
The shot is not lasting him a month, and his appetite and sleep both drop as he hits the 3-week mark.
Last time, he was on a 117 mg injection and it dropped hard & fast on him at just under 3 weeks and he ended back in the hospital on the day he was scheduled for his next injection. He kept asking to go, then didn't want to be there, so they did the hold. They put him on 9 mg/day oral for nearly a week before giving him a 156 mg shot & bumping up the oral to 12 mg/day.
When he came out, he'd take the pills for a few days, then didn't want to take them anymore & his outpatient pdoc agreed. That was 8 days ago, and the delusions have slowly increased as his sleep has slowly decreased.
To make sure he doesn't go back to the hospital, they are going to probably give him his shot tomorrow instead of waiting for Monday, and maybe it will work. He's not getting sick as fast as he did on the 117 mg shot.
My opinion is that he will either need 156 mg every 21 days or he'll need to go up to the 234 mg shot. And, maybe he'll even need that more than every 28 days.
When he came out of the hospital from the first injections (234 mg followed by 156 mg 5 days later along with 6 mg orally), he came home with random delusional comments, then it gradually went away and we had about 2 weeks that were great. So, I know it can work for him.
If it was up to me, I'd give him a 234 mg shot tomorrow.
So, the good since I've complained so much - he's not angry, we're not constantly arguing about his meds, he's not paranoid, he's fairly pleasant to be around, he bathes and changes his clothes - it could be much worse. I'm prepared for the gradual improvements over 6 months that people talk about, but I don't see how that's going to happen with monthly setbacks. I'm going to watch for that once I think they have him at the right dosage.
I do think he's the exception. Most people do well on the 117 mg shot & many do well on less. He just seems to need the max of everything. We've even went above the recommended dosages on things a lot of times.