Hello, my family member (20 years old) was finally diagnosed. His psychiatrist says he suffers from simple schizophrenia, that is, only the negative symptoms of schizophrenia predominate… do you think I should continue taking quetiapine? Because quetiapine supposedly blocks the mesolimbic pathway and my family does not have hallucinations… it is more possible that in that area they do not have dopamine, that is why they do not have energy, emotions, motivation, cognition, alogia (poverty of thought and speech) although in the cognition is the lack of dopamine in the mesocortical pathway… the psychiatrist suggested levodopa since it increases dopamine but he is not sure whether or not to remove quetiapine since it may be helping him in something or he needs it to rebalance the neurotransmitters (the levodopa only increases dopamine) what do you think?
Welcome to the forum @Miguel_Sanchez
In my son’s experience, initially, he was just experience the negative symptoms. At NAMI’s Family to Family class, they taught us that there are 3 phases of schizophrenia. The first stage is the Prodromal Phase. When my son was in the early stages he began to change by only showing a loss of abilities like energy, motivation, emotions, poverty of thought and speech for several years. When he moved on to the second phase, the Acute Phase, his active psychosis started appearing. He began having auditory hallucinations. He is 40 years old now and has possibly begun the third phase, Recovery Phase. In this phase we can hope that our family members will experience some lightening of their symptoms. Some family members have stated that it was like a fog lifting off their brain. Often in the recovery phase our family members are able to function with somewhat less help.
While some family members are on only one med, some family members are on several. I can understand the doctor’s reluctance to removed a working med - your family member is benefiting from the quetiapine, yes?
Hello @Miguel_Sanchez. I am wondering how long your family member has been on quetiapine and if it has helped him? Sometimes a person is on more than one medicine for schizophrenia.
My daughter’s doctor would not change her medicine because it worked for her, and is still working after 3 years.
Some thoughts as a person long in the recovery phase of SZA:
As @hope states there are phases to schizophrenia spectrum disorders. It’s possible your family member hasn’t yet reached an acute phase due to an early diagnosis and psychopharmalogic treatment, and may never will. The good news is early intervention is often associated with a better prognosis since positive symptoms are much more debilitating. The bad news is these symptoms may develop later in life, but may be blunted or suppressed by continued neuroleptic treatment. My acute phase was delayed until between 25 and 26 and I didn’t start neuroleptic treatment until late in my 26th year. This is later than typical, but within the realm of possibility for your family member.
Individual responses to medications and combinations of medications vary widely, but from my own experience and reports of many forum members—aside from improved cognitive function— negative symptoms tend to stubbornly persist in response to drug-based treatments. The drug Clozapine is a notable exception, but in the US it’s often reserved for difficult cases due to liability and blood testing cost associated with rare side effects. There’s always great hope as new atypical neuroleptics become available that they will better address negative symptoms, but most reports and my practical experience rarely bear out the marketing hype.
Certainly a rising tide of improved cognition may lift many boats, but I feel I gained more traction with negative symptoms with psychosocial activities (employment and social clubs) and talk therapies. I don’t have direct experience with cognitive behavioral therapy (CBT), but from many accounts, especially from Europe where it’s a more prevalent adjunct treatment, it can be helpful. Talk therapies aren’t a common form of treatment in the US for various reasons, notably positive symptoms and poor cognition of more complex forms of schizophrenia interferes with understanding and tolerance of the methodologies by clients. But in simple schizophrenia these impediments are largely absent, so goal-directed talk therapies may be better tolerated and in my opinion worth a try as an adjunct to medication(s).
Speaking of medication, I’m a bit puzzled by you getting into the weeds about technical aspects of prescribed medications. More typically psychiatrists offer advice and make recommendations on medications, because they are highly trained and have experience with them and don’t ask family members to do their psychopharmacology for them. As @oldladyblue reports, multiple medications aren’t uncommon in treatment plans, as well as iterating through medications one by one until a better fit is found. From my experience psychiatrists tend to be conservative with changes once you are stable, but aren’t shy with recommendations if they think you can do better. If risks are involved with changing medications, they’ll overlap them during transitions and either discontinue or keep them depending on observed results. Everyone responds differently to medication and simple schizophrenia is an uncommon diagnosis, so I’m unsure if anyone can validate or direct choices any better than you or your doctor can. It’s an inexact science, so trial and error is more the norm than the exception. Good luck.