My mom has been diagnosed with paranoid schizophrenia since before I was born. She was, mostly stable, on old school Thorazine and usually antidepressant/mood stabilizer. Around three years ago, her long term psychiatrist died and it has been hell since then. She experienced a slight mental break overseas in 2017 and I had to fly over to get her. When I brought her back, she voluntarily checked herself into the hospital and they stabilized her on 1.5mg of risperdal and a mood stabalizer.
Unfortunately, I didn’t fully engage with her care and after linking her to a psychiatrist, I was hands off. Fast forward to fall of 2019 and she is once again experiencing a full psychotic break overseas. Somehow I got her back to the states again and had her involuntarily committed(I found out she was not taking her meds for over a year). Unfortunately this time, the medication(2mg risperdal then 4mg risperdal) was not working. Her delusions and aggressive behaviors would not stabilize. She stayed in the hospital until February and was released on the condition of attending groups. The groups did not go well and she was eventually discharged in March right before covid hit. Fast forward to July, and her condition was rapidly getting worse. I had to fight with her to take her medication and then I realized she wasn’t really taking them. It was a mess.
I had her involuntarily committed again until late August. She was released with the IOC program and was started on the invega shot, daily risperdal, plus tripital(mood stabilizer). The mood stabilizer was the godsend medication. She is finally not aggressive, but unfortunately; her psychosis is still very active. She thinks I’m a clone and not her real son,etc. I don’t believe the risperdal does anything for her anymore, and she just received her second invega shot. The doctor wants the invega to work since there is a three month version of the drug. At this point, I just miss my mom and wish she was back to reality. Her mood is better because of the mood stabilizer but her psychosis is still very active. Any advice on medication?
Not easy. Meds for SMI sometimes are trial and error. But there a combo out there that works for her. NAMI is starting a family to family course this October. You should look into it. Also their support groups are very good. You can find strength in shared experiences.
My personal experience with risperidal was not good and I’m confused why the psychiatrist would continue it if it’s not working, because there’s overlap with the Invega. Perhaps he/she is overlapping and then discontinuing after the Invega takes hold.
Given her history, a long term injectable makes sense. Since there’s a mood stability need, I’d be inclined to consider the newer antipsychotics often prescribed to people with bipolar disorders. I have zero experience with injectable medication and my recollection is injectable forms tend to lag in newer medications. I believe there’s injectable forms of Abilify, but not Vraylar and Latuda. There’s injectable Xyprexa, but I wouldn’t recommend it because of weight gain and other issues. There’s also injectable old-school Haldol which would be closest to what worked for her in the past. Injectable risperidal wouldn’t make much sense if pill form isn’t working.
My guess is the doctor is hoping that Invega Trinza (the quarterly injectable) will work for her. The protocol is get stable on the Invega Sustaina version and then follow with Trina if it works out. And I’d expect if not then the doctor will try these others.
Best of luck, I know it’s distressing dealing with the psychosis symptoms while the doctor is figuring things out and she’s adjusting to the medications, but her progress with the mood stabilizer is encouraging.
Disclaimer: While I am a part-time caregiver of my brother and father with SMI, I was diagnosed with SZA over thirty years ago. I’m an advocate of appropriate drug treatments for SMI, but I feel they are incomplete treatments and additional CBT, supportive talk and psychosocial therapies are helpful where feasible. Any drug advice is from personal experience or research and not a substitute for qualified Psychiatric care.
I am thankful to live in an area that takes mental illness seriously. I did have to really emphasize the part that she is a danger to herself even if she isn’t suicidal. I fought until she got discharged with a program that is “working”(IOC).
So this is month 5 with INVEGA 234, Risperdal 1mg, and they doubled her mood stabilizer to 600mg of tripital. Her psychosis is still very active and very little improvement. At this point, I think I am going to push to try and change it to abilify. I may do one more month of Invega to see if at 6 months it kicks in fully but since it is so similar to risperdal, I am not optimistic. The doctor is concerned that abilify is too weak to work for her but he is concerned that clorazipin is too much considering her age. Frustrating but at least I have a team I am working with now.
Sorry to hear you are disappointed with her progress. While there isn’t a quarterly injection of Abilify, there is a monthly one. Abilify is often prescribed to people with mood disorders and mixed diagnoses like SZA as I have. It’s also prescribed to people with dementia and as an add-on to antidepressants, so it might be more appropriate in her case. Haldol is also an option and it’s one of the few traditional old-school antipsychotics still prescribed because it is potent in resistant psychosis, but to my knowledge it has little antidepressant or mood stabilizing effect.
Best of luck. I agree Abilify seems a logical next step. Beyond that I would consider Haldol before Closapine.