Family and Caregiver Schizophrenia Discussion Forum

Normalizing medication

It appears likely that my son who was hospitalized after a suicide attempt will be released tomorrow. He has engaged a public defender to petition for his release and the social worker told me this morning that she thought it likely that the decision would fall in his favor because he is so lucid and says all the right things. He has been on Abilify for one week and I know to my very depths that he needs to stay on medication and stay connected to psychiatric care. I have read Dr. Amador’s book and watched his videos and am wrapping my head around how to get someone to take medication when they do not believe they need it.

I had a thought and I was wondering if perhaps someone here had tried a similar method. I take a few supplements and am on hormone replacement therapy. I am thinking to put these “medications” on public view in the kitchen in order to normalize their use. Has anyone tried something similar? And how HAVE you handled the taking of medication if your loved one is staying with you? Do you check the bottle? Do you watch them take it? This is completely new territory for me and it is actually too bad in a way that my entire family prides themselves on not needing medication (even my parents who are well into their eighties are medication free.) Any thoughts would be much appreciated.

(On a side note, I apologize that I feel ill equipped to respond to other people’s posts here. There are several that have come through today that tear at my heart, but I am afraid to contribute because I don’t want to mislead someone. Perhaps I just need to say I am so sorry. I find myself saying that a lot these days.)

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I’d see if long term injectable medications are an option. I believe there is an injectable version of Abilify. It simplifies matters. There are only a few AP medications that aren’t in injectable form, but they are rare ones like Clozapine and Geodon and such. If you want to model managing medications, I’d recommend not making a huge deal about it. Just matter-a-factly set up one of those weekly pill organizers in a public location and load it up on a specific schedule. If asked about it, I say it helps you keep track and remember medications. Similarly I would display a calendar and cards for doctor and other appointments. Abilify has a very long effective half-life once you are titrated up, so it’s more forgiving. Setting up meds in a public place like the kitchen and ritualizing taking meds with meals or offering them in a small cup with water is an approach I’ve seen with family members and it mirrors how things are typically done in mental wards.

I know I would wonder if I forgot my medication in my early days, and be concerned about taking a double dose or be anxious I missed a dose. I would sometimes count my pills to check, so I could have used an organizer back then. Dr. Amador’s methods take time to master. I’d focus more on building trust rather than trying to force any particular agenda at first. Work on listening and reflective listening, then branch out to empathizing as you understand his situation better. Agreeing and planning tend to wait until very strategic moments after you’ve built rapport.

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I feel like there was a time when I thought I didn’t need meds and I was threatened with being kicked out of the house so I ended up staying on meds. After I was stable again, I preferred being on meds. I’ve never been so psychotic that I lost all ability to reason. I went out during the day and had weird thoughts, then would always come home before dark and my parents at the time didn’t see the urgency in getting on meds unfortunately. But it is urgent. Funny as it may be to vow quitting meds, your functioning degenerates with each episode and for most people it never comes back so they become more and more like a zombie after they stabilize. In other words, negative symptoms will keep getting worse due to psychosis. I guess your other choice is to let the person live with psychosis if they really don’t want to be sane again. Somehow talking to the doctor usually leads to some hypnotic desire to keep up meds. Some people really don’t want meds. You could try an injection. Just want to point out there’s a big difference between someone who gets treated early and someone who is psychotic for a very long time (or forever).

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Wow! Thank you so much Maggotbrane and Tukey! So much useful information for me. I am buying a pill organizer today and I love the idea of putting those appointments up on a calendar as you suggest Maggotbrane. “Work on listening and reflective listening”. So useful for me to hear that, because I think in inexperienced hands even an excellent system like LEAP could turn into manipulation and I know that is not going to win this game. Your point about going on and off Tukey is well taken and so important I am sure. Unfortunately for us, my son, at 26, has never been on medication although he has been suffering for ten years. I really feel like this is our big chance and I am so focused on playing my cards right. The information you have both given me here is so, so valuable to me and I thank from the bottom of my heart for taking the time to share.

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If someone doesn’t think they are mentally ill, then logically they won’t want to take medicine, so the first step I think is for the person to acknowledge they have a mental illness.

My son doesn’t think he is mentally ill although he’s been hospitalized 3 times in 10 months, hears voices constantly and has been diagnosed by 2 psychiatrists as having schizophrenia, one telling me yesterday he’s 100% certain of the diagnosis.

I wonder if having them take a Psychosis Test would help them see they have a problem?

I respectfully disagree and so does Dr. Amador. Acknowledging a mental illness does very little unless you commit to medication or other treatments, and taking and continuing medication does not require acknowledging having a mental illness. It can help motivate in people with insight, but with people with anosognosia it’s often unobtainable, so you need to look for other motivators or coping mechanisms.

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Yes, I put my Levothyroxine right out on the counter, take it right in front of him and always tell my son that I need to balance myself just as he does. As for medication and my house, it it absolutely mandatory and he has to take it. It was a HUGE struggle for a very long time and there were many times when he would pretend that he took it, but he did not - they become very good at hiding this and he learned this in the hospital from peers. We fought quite a bit, but I never gave in - my son would be dead without medication, so I fight the medication fight with all of my might! If we were having a rough day with him taking his meds, I would call supportive influences and have them gently, sometimes not so gently remind him how well he is doing on his meds - not in the hospital or a treatment program and living in the community with me and this definitely helped. I still watch him take his meds and count them occasionally, but this has definitely become more relaxed now. It has now become such a routine that he takes by himself, with some gentle reminders every now and then from me. Sadly, he does state that when he gets his own place he won’t be needing meds because of course, he’s not sick, sigh! I’ve provided him a very nice life and he enjoys his lifestyle and wants to maintain living with me, so that’s a WIN! Jump on here whenever, we are non judgmental and have all been through the ringer - some are just starting out and some have been digging at this for years and are super strong - you’ll get both sides, but lived experience is so much more powerful than any book smarts. Welcome to the 1%, sigh! My son was hospitalized 13 times within 2 years before I demanded Clozapine and guess what, not 1 hospital stay in 3 years now - did I just say that? WOW, that is HUGE progress! Best of luck! Xo :purple_heart: @Steadfast

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Oh, and he’s going on a trip to NY in June and he already asked me if he’s going to have enough medication, HUGE gains my way! @Steadfast

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@Maggotbrane You’re right, I posted this before starting to re-read Amador’s book yesterday from the beginning.

He says that insight does not have to mean you acknowledge you have a mental illness before you start taking meds. Acknowledgment of illness first, then taking drugs sounds logical to me, but as you point out, acknowledgement will not happen if a person has anosognosia.

So why would anyone take meds if they they think they’re being prescribed for an illness they don’t have? Amador gives the following reasons: 1) It might make the family member feel better (see Lilies’ post about her son going back on meds to “feel better”), e.g. suppress annoying voices and 2) please other people so they won’t land back in the hospital.

Can you think of any other motivators? I’m pretty sure my son will stop taking meds once he gets out of the hospital.

Well our story has taken a strange twist. The psychiatrist has diagnosed him with Major Depressive Disorder. I know that this is only part of the story. He certainly has severe depression, but there is a lot more to his history that apparently the psychiatrist has chosen to ignore (or does not know about). He prescribed aripiprazole (Abilify) and fluoxetine (Prozac) and although my son has not actually taken the medication at home yet (we cross that bridge in a few hours), he appears to be quite willing to do so. I think he can understand that he has been labelled with MDD by others because of his two suicide attempts in the past month, and therefore can also understand that taking medication is a logical step. Anyway, that is how I am reading it for the moment. Just the fact that he is getting psychiatric care after all of these years is a huge step.

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Sadly and from experience, I don’t hold a lot of trust in most psychiatrists’ ability - they’re playing guessing games w/ medications, educated guesses, but guesses none the less. I figured out my son’s diagnosis and proper medication by myself after years of ‘fighting’ incompetent psychs’. So, always keep researching, second guessing and continue fighting hard for your son! Unfortunately, there are times that I have to get loud and heated with his care, but it’s absolutely necessary for his safety and like that old saying, mama’s know best - is SO true! Awesome about the meds! Happy Friday!

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Hello great info, my love one is on Abilify injection monthly for about 3 months now and other AP meds. Not sure what the above means, thank you

Half life is a technical term about the decay of the levels of something. That is how much time has to pass until the levels are half of what you started with. As I recall for Abilify it’s about two weeks, whereas with most AP medications it’s usually not more than a day or two. So it’s more forgiving if you miss a dose or two, especially at higher dosages.

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@caregiver1 the paradox of this line of thinking is caregivers project logic (and often THEIR brand of logic) on others’ decision-making processes when by definition they believe their thinking to be faulty, flawed and in need of correcting. Similarly some confuse empathizing with “putting themselves in another persons place” i.e. what would I do/feel/think (with a “well-functioning” brain) if I were in this person’s position. That’s projection, not empathy. The point of all the listening and empathy is to learn THEIR internal logic and priorities, and work to motivate them within THEIR framework and find things you both agree on and plan from there. Your task within LEAP is NOT to get them to agree with you and come to YOUR way of thinking. You are looking more for pragmatic overlap, not full agreement.

For example, I started taking medication because I was concerned I’d lose my job if I didn’t, not because I thought it would make me feel good. I traded something I thought I wouldn’t like to avoid losing something I did. One LEAP practitioner on the forum’s daughter doesn’t acknowledge she has an illness, but takes medication because she believes if she does, she can continue to work which is important to her. Her reasoning might not make sense to you, me or even her, but that’s not important. Court assisted mental health treatment is based on the premise that people with mental health issues can make pragmatic decisions about medication injections in exchange for freedom v.s. incarceration even if they don’t understand or believe they have an illness. Amador also speaks to “bribery” as a motivator: money, food, shelter, freedoms, praise, acceptance, a better relationship with friends and family etc.

These are behavioral, emotional and habitual motivators, you need to get out of your head and throw notions of “objective logic” out the window. There are many behaviors we engage in regularly that don’t make much logical sense, advertising boards and salespeople and so on nurture and exploit them daily.

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Thank you for the explanation👍

I was also told injections last longer when given in the butt than in the arm. Would that be because it’s a larger muscle?

I have no experience with injectable medication, so I honestly don’t know. I would think this might vary with the medication and the delivery method used. I speculate that there’s some sort of suspension or encapsulation going on. I suggest you google the medication and look for studies. Most of the studies are posted online but it takes some wading through technical jargon to get to the punchlines.

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Yep that’s for sure!

Amador’s LEAP strategy encourages the person to take medication because in the past it has helped them achieve certain goals. This without needing to agree they have a “diagnosis”. So the focus on goals might be a best opening. But what do I know? I’ve read the books too!
And our daughter is missing - I can’t even have that conversation.

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My son is on Clozapine big dose 650 mg a day and still has hallucination and delusion . Some good days and some bad days . He is doing better . Able to finish undergraduate and is in law school . One day at a time . I was his conservator for 4 years and with Covid etc didn’t have a chance to reapply . I feel like that helped him to take meds and how you said no further admission after heavy dose clozapine . He is not free of symptoms . One day at a time . We did go Thru several years of I am not sick . We actually approached Dr. Amador and saw one of his therapist too . We made a big change of moving from east coast to west . Things are better for him and for me too . Knowing where he is etc . I am thankful for all the help and professionals who came into our life .

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