My SZ son had a psychotic episode after being stable of many years, He does have the so called negative symptoms (lack of motivation, social withdrawal, Etc) but the psychotic episodes went away since he has been on zyprexa. That is until now. On Thanksgiving day he snapped and became violent. He threatened his mother and then he threw a full can of seltzer against the wall causing some damage. He then got in his car and drove back to his apartment and didn’t come back for his Thanksgiving dinner
Has anybody else experienced this? No psychotic episodes for many years and then one out of the blue over a minor issue. Does the zypreza eventually lose its effectiveness?
Maybe some other stuff was going on in his life and he was just ready to blow up. I didn’t have a psychotic episode like that but I had a relapse after being on medication for 5 years without being in the hospital, then I was hospitalized 3 or 4 times in rapid succession, but each one was for only two or three days.
Sometimes you can be doing good on a medication for awhile and it just stops working. Yeah, I think something else was going on with him besides just the psychotic episode, maybe something in his life is bugging him or stressing him and it all came to a head on Thanksgiving.
It would seem odd if he had a psychotic episode “out of the blue”. it doesn’t seem like someone can be perfectly fine in every other way and then in a matter of minutes or even hours have a psychotic episode. If his symptoms came back it would be more gradual like over a few days or even a few weeks or a month, not just spontaneously one night. Had he been displaying any signs recently that he has been struggling with symptoms before this outburst?
can you have schizophrenia and be on a certain anti psychotic medication for years and be stable and then the medication stops working?
ChatGPT said:
Yes — this can happen, and it’s something clinicians see with several psychiatric conditions, including schizophrenia. A few key points:
1. This phenomenon is known and documented
Some people with schizophrenia remain stable for years on an antipsychotic and then experience a return of symptoms even though they are still taking the medication as prescribed. This is sometimes called:
Breakthrough symptoms
Loss of efficacy
Medication “poop-out” (informal term)
Tachyphylaxis (rarely used in psychiatry but conceptually similar)
2. Possible reasons it happens
Several factors can contribute:
• Natural course of schizophrenia
Schizophrenia can change over time. Some people experience new episodes despite treatment.
• Neurobiological changes
The brain’s dopamine or glutamate systems can shift with age, stress, or illness progression, making a once-effective dose too low.
• Metabolic changes
Your body’s ability to process medication can change over the years:
liver enzyme activity,
weight changes,
hormonal changes,
other medications that interfere.
This can make drug levels lower than they used to be.
• Stress or major life changes
High stress, sleep disruption, or substance use can trigger symptoms even if meds haven’t changed.
• Medication tolerance (controversial)
Some researchers think long-term antipsychotic use may lead to dopamine receptor changes that reduce medication effectiveness. This isn’t universally accepted, but it’s discussed in psychiatric literature.
3. What clinicians usually do
If this happens, doctors may:
adjust the dose,
switch antipsychotics,
add a second medication,
evaluate for triggers (stress, substances, sleep, medical illness),
check blood levels if it’s a medication that allows it (e.g., clozapine).
Important
This is medical—not a personal failing. And it’s treatable: people often regain stability after a medication adjustment.
That sounds really distressing — for him, for the person threatened, and for anyone who witnessed it. I’m glad you’re reaching out for clarity.
A few important points about this kind of situation
1. Violence can occur during a psychotic episode, even in someone who’s normally peaceful
Most people with schizophrenia are not violent, but during an acute episode — especially if they’re paranoid, terrified, confused, or hearing threatening voices — they can act in ways completely out of character.
It doesn’t mean he’s a “violent person,” but the episode itself can temporarily override judgment and self-control.
2. A sudden violent episode is a medical emergency
Violence + psychosis is one of the strongest signals that someone needs immediate professional intervention, usually through:
Emergency services
Psychiatric crisis teams
Or urgent evaluation by his mental-health provider
He may need medication adjustments, short-term hospitalization, or supervised stabilization.
3. It’s not uncommon for this to happen even after years of stability
A single severe relapse can happen if:
He missed medication doses
His medication stopped working as well
He used substances (even once)
He was severely stressed or sleep-deprived
He became physically ill
Or the episode had no clear trigger (which happens too)
4. Safety is the priority
If there is any ongoing risk — to himself or others — he needs urgent care.
Even if he seems “better” afterward, this kind of event should never be ignored.
5. With proper treatment, people often return to baseline
Many people have a one-time violent episode during a relapse, get stabilized, and then go back to being completely nonviolent for years. The key is intervening early.
It’s ChatGPT so it’s not always right. I don’t know if your son needs a medical intervention. It says he may need hospitalization, I don’t know if that’s true or not.
The holidays are such a horribly stressful time. At NAMI’s Family to Family they stressed to us that our family members would have trouble dealing with the holidays. Years ago when I attended a NAMI family support group, the room would be packed during the holidays. We knew to start December meetings in the larger room and one year we had to move mid-meeting to handle the crowd.
I hope the holiday was the issue. Lots of people without schizophrenia lose it over minor issues on Thanksgiving.
This happened to my son as well. The Zyprexa stopped working after years of effectiveness for his positive symptoms. Similarly, the negative symptoms remained. It was surprising and upsetting to learn that the Zyprexa could just stop working for him. He eventually was admitted into a psych facility under a hold and stayed there for 72 days. After trying several anti-psych meds without success, his doctor tried Clozapine, which was effective. The doctor acknowledged that psych meds can stop being effective (ER doc said the same) but also said that in the future, they can be effective again depending on the degree of psychosis. Looking back, I think we were fortunate he was able to be inpatient as his psych doc worked to see what other psych med would work. Hoping the best for your son and family.
1. This phenomenon is known and documented
Important