Medication refusal

My step daughter has been living with me for a few months. Her mother has a restraining order and her father can’t deal with her. There have been about ten arrests over the last two years for violent incidents. Soon after she came to my house, she snapped, with the usual extreme abuse and property damage. I insisted on the PERT Team coming for her so she went to the psych ward instead of jail again. They sent her home with lithium and vistoril (sp?)which she was taking as a condition of remaining here. Now she has stopped the lithium but is staying on the vistoril. As I understand it, that helps with anxiety but the lithium is more for her episodes of uncontrollable rage, which are sudden and quite unpredictable. She did stab one guy (only a little, as she put it) so there is a degree of apprehension. She is 27 and my daughter is 13. They are very close, but the older sister does not discriminate when she has one of her bouts of all consuming paranoia. Without offering unauthorized medical advice, does anyone have any feedback in general and especially in regard to reluctance to continue meds?

Lithium is more typically prescribed for bipolar disorder rather than schizophrenia. It’s a mood stabilizer. While it can help with rage, it takes a while to take hold and there’s some risk of toxicity and regular blood tests are often recommended. Antipsychotics like Haldol are more typically prescribed in hospital settings for bipolar patients in acute states, and after it passes, lithium or depakote or other mood stabilizers are used for maintenance. Some newer generation atypical antipsychotics like Abilify or Vraylar are another form of maintenance.

As with Schizophrenia, people with Bipolar Disorder often have lack of insight into their disease. The technical term for it is Anasognosia. It’s difficult to convince sufferers that they are sick and need to continue medication as a result. With bipolar patients they often feel great or “high” during manic phases, and it can be challenging to convince them it’s a problem. Periodic injections of long lasting medications (typically antipsychotics) are one route to compliance. Another is a communication method called LEAP developed by Dr. Xavier Amador. The following video introduces the problem and the method:

Thank you very much for all of that. The Ted talk is a much better template for discussion than take your meds or get out.
At the moment she is rational. The concern is episodic where things spiral out no matter what. She was up late by herself when she lost it here the first time.