So, in the end, she gave you permission. Don’t feel bad. I feel for you. The decision is hard, so is the ongoing problem.
My daughter, 33, was forcibly admitted 4 times: 3 times because she called the police on us, and once because I called the police on her. She still won’t take medication outside of the hospital, and still has no insight. The first three medications didn’t help her much, the 4th medication must have been a long acting injection, and it helped her to totally recover, for 6 weeks, until it wore off.
If your sister stays on medicine after her release, that is THE best thing you can hope for. Even if she doesn’t agree she has psychosis, perhaps she can agree to stay on it for anxiety, or ability to work better. Some reason that she will agree with is what your family should work for. Medicine can always be changed to help improve her outcome IF she will stay on continued treatment.
Good luck and don’t feel guilty about any of your decisions to help her.
There has not been any improvement since her treatment started 10 days ago. She still believes that we mix sleeping pills in her food and now she thinks that her room mate in the hospital is also spying on her.
The only positive thing happened has that she has started talking to our mother nicely, like there were no issues between them. But I think she is doing that because she wants to get out early.
She is currently on aripiprazole 30mg and the doctors say that it takes 3 weeks minimum to show effect on psychosis. But the problem is giving her the medicine in the long term. We can only afford to keep her in the facility for a 3-4 weeks more and once she is discharged, I don’t have any hope that she will take the medication orally at home the way she is taking them in the hospital. We wanted to adopt the long acting depot injections treatment in the long term but unfortunately in India, depot injections are not available for aripiprazole. Also after discussing with a few doctors, we came to know that aripiprazole is not a very efficient drug and has less probability of reducing the symptoms as compared to other anti psychotics.
Therefore, we are thinking of adding olanzapine with her medications and tapering off apiprazole as olanzapine is easily available in India in tbe Long acting depot injections form. Although side effects of aripiprazole are much less as compared to olanzapine, but effectiveness of the latter is much better. Also, currently we need to focus on her psychosis rather than the side effects of the drug (which are reversible).
PS: Still she currently has no insight about her disease and blames me for ruining her career.
Hi Pizza. Since your sister has anosognosia (and a history of med non-compliance?), I really hope you all can get her started on injectables before she leaves the hospital. I’d really fight for that. You can make that a “criteria” for taking her home. That’s what we did. If I recall, the hospital staff need about a week to test the oral version of the med before they can start the injectable version. Good luck.
Is Risperdal (risperidone) available in injection form there? That is another one that can be started orally, is more effective than apiprazole, and the shots last two weeks.
You need not feel bad about your decision to have her admitted to the hospital…you did the right thing! She will be angry for a time until the meds start to take affect and then she will be willing to talk to you. Whenever I had my husband commited, he was always mad and would get over it when the meds started working. Also, her interaction with your mother, as you described, may very well be correct; she might be putting on a show for the hospital staff so she can be released early, but hopefully with your input, they will see through it. Make sure you tell them everything including your sister not wanting to socialize with you; the more truth you tell, the more they can help her. Good Luck!
Another 30-day injectable is Invega Sustenna (paliperidone palmitate). There is also a 3-month version but I have only known of one person who had been on that and I don’t know why, but the 3-month did not go well. We have seen dramatic good results with Invega. Unfortunately, a person who has anosognosia will likely not stay on meds, whether oral, daily, or monthly. Ours did not. However, (I am learning… I have been advised by several sources including that of a professional care manager), and as someone mentioned in these posts, you can establish criteria for coming home (and for continuing to stay at home). But you have to be prepared to stand firm with the consequences that you have outlined. @Pizza, you absolutely are doing the right thing! I so admire your focus and care for your sister at your young age. You mentioned finding things that your sister can agree with you on. That is the LEAP approach used by Dr. Amador! Unfortunately, time and persistance using an approach like LEAP (Listen, Empathize, Agree, Partner) may be the only thing we have to help overcome anosognosia. We are in the L/E stages with ours right now with our son who has been in the hospital for 2 months, primarily for catatonia but he also has disappeared twice just prior to that and has had many other hospitalizations at his young age. He is close to being discharged from the hospital and supposedly agreed to outpatient ECT (he has been accepting that while continuing to refuse other med), but based on a visit with him today, I don’t yet see visible signs that he is really any better than he was before and I believe he has no intention to continue outpatient ECT. He can’t come home if he is not doing SOMETHING to help himself. He may end up at a homeless shelter. We have been advised that going there may actually help him realize his need for help and to become medication compliant in the long run. We know several people where this has actually occurred with success. It is a hard thing to even think about, let alone to do. We don’t know yet what will happen.
Hi Hope4us. Has your son been hospitalized for 2 months, and yet he is still refusing meds? If so, I’m shocked that the treatment team hasn’t moved forward with a civil hearing to force meds, especially since he has such a history of noncompliance. This lack of progress must be so upsetting for you.
If you do have to draw that horribly frightening line in the sand and say no to your son coming home, I wish you the best of luck. It’s terrible that we have to make these hard decisions. It shouldn’t have to be this way.
Thank you @Day-by-Day. In the state where we live, even with guardianship, meds/treatment cannot be forced unless the person is of “imminent danger to himself or others”. It seems this can sometimes be a little bit “gray” once you get into the medical facility, but still generally stands. I found this to also be true in another state where our son was “wandering” and eventually hospitalized for 6 weeks (in that state, the word “imminent” was not a requirement).