Try to get the meds in him - or let things run their course? Opinions wanted!

Family
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My son was in the hospital the beginning of Sept. He seemed better coming out, but the delusions were still there, and he quickly stopped taking his meds.

When he saw his regular pdoc, they gave him Vraylar to try. He took it for a week and stopped.
Then, they gave him Rexulti. He took 1 and stopped.

In the past few weeks, we’ve fought over it, but he took his Zyprexa for the most part, and when he wouldn’t want to take it, I managed to give it to him another way. It’s helped him sleep, and helped him from being agitated & angry, but that’s about it. The paranoia & delusions are still there, some days worse than others, but always there.

We went back to the pdoc today. Last time, he wouldn’t talk about his delusions - would only say “it’s complicated”.
Today, he rambled on, then said he knew it sounded crazy, but it was true.

So, the doctor gave us Latuda, which he wouldn’t even agree to take in the office.

Now, I’m torn between 3 possible options, and I don’t even know if any but the last would work - so, what would you do?

Option 1
I might be able to get him to take the meds with his supplements by just not making a big deal about it and hope he doesn’t realize it since it’s a new pill. I’ve done this before, but only with stuff he’d taken before. I feel very torn about doing it with a new med, but I’m kind of desperate here.

I also worry that this is the wrong thing because I can’t ever tell him I did that, and he won’t connect taking his meds with getting better - if he gets well enough to get his insight back.

Option 2
I can try bribing him to take the meds - or cutting off stuff I already do for him until he takes them. This might work, but it will result in a big power struggle & constant arguments. I’m thinking I’d cut way back instead of cutting off.

Option 3
I can just let him stop taking the meds and let him learn the hard way that they are what’s standing between him & the hospital. That means I have to give up my massive control issues and trust the system. Both would be very hard for me, and hard on him, but am I only prolonging what’s going to happen anyway? Am I holding him back from getting some real help if he could get into a good hospital program? Or, would the constant revolving door be our future?

And, what do you guys think about this military stuff? He’s obviously sick right now, and people can see it. Maybe I should take him by the recruiter office like I’m supporting him and let them tell him no way?

Of course, if they were crazy enough to let him sign up, I’d raise holy h*ll with someone, but still …

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Would Option 3 result in creating a dangerous setting for either your son, yourself, or anyone else? I did reach a point of saying, there is only so much control I can have in this relationship.

My son has lived in assisted living setting where meds administration was done by staff. They could not MAKE him take it, but when he was non-compliant on his own, in those settings he always remained compliant.

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Option 2 is not good, it’ll only end up with him controlling you and resenting you for trying to control him. Option 3; I wouldn’t let a loved one fall into that if I know I could prevent it, so I’d go with Option 1. Maybe you can give it to him in a smoothie or something that he likes to drink. Once he has mental clarity, eventually you could tell him what you did and that he needs the medications and hopefully he’ll understand why it was necessary at the time. What military stuff?

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It never has before - not physically dangerous anyway. Of course, the decompensation is harmful.
And it takes a mental toll on me, but I’ll toughen up.

But at this point, I’m doing all the fighting myself, and while I’m not ready to give up yet, I’m pondering the rightness and wrongness of my actions. Not morally right or wrong, because I’d literally kill someone if it meant he’d never be psychotic again, but am I hurting him more than I’m helping in the long run.

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My son who hates authority, does not like to follow rules, figured out exactly how many times a year he could not participate in gym class and still pass with the lowest D possible, has decided that he should join the military.

Even if he gains insight, telling him will not go over well. I’m going to have to hope he gains insight, just a peak into things, then I can try to convince him to “start” taking it.

Plus, it means I’d never, ever be able to get away with it again.

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He will not be allowed into the military, so don’t worry about it. I went to a military school; if you have debilitating mental illness, if you’ve had a history of epilepsy, if you’re missing a limb, or if your eyesight is bad they do not let you in. They can only work if they’re doing engineering or perhaps as a medic or nurse, but not in the field. You also have to pass a fitness test. You go even have to climb mountains, travel miles through grass fields in any type of weather, and carry equipment with your bag on it. They take you to a secret location. No phone, no family contact. They’ll get the letters you send them after they get back. If he cannot pass a fitness test as you say, there’s no chance of getting in and he can’t be over a certain BMI. They inspect every part of your health in there.

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BMI would not be a problem - he’s thin as a rail since he quit taking his meds.

Even without trying to exercise, he’s always been very fit, except for when those meds packed the pounds on him.
I’m sure he’d have some other issues, but strength and weight would not be the problems.

I have no doubt that they would reject him, so I’m not worried there. No mother wants to see your child feel disappointed or rejected no matter how old they are. And, who knows what delusion would replace this one, or what reason he’d come up with that someone is just trying to keep him out.

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Doesn’t matter, he can’t get in. You can’t carry nor purchase a firearm either if you have an active mental illness. I know how it feels like because I’ve had epilepsy and not only did I have to leave to be placed in Hospital-Homebound, but I also lost my driver’s permit before I could even get it after my passing my test.

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I’m so sorry about your epilepsy. I’ve heard you have to prove you haven’t had a seizure in so many months to get your license back here.

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Yeah, but some states take years and you also need a neurologist to sign some papers to allow you to drive. If you take medication, you get time limits.

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Do you take meds for your epilepsy?

We have a bunch of dogs, but our favorite one has epilepsy. It started when he was 3/4 years old, and he sometimes goes months without one. Then, he’ll have them once every month or two, then it’ll be a long stretch again. When he does have them, they’re usually cluster seizures.

He’s borderline for medication because he doesn’t have them more than once a month for the most part, and for dogs, they consider them under control at 1/month. Our old vet retired, and this new one wouldn’t even talk about trying to wean him off in a year or so - so I filled the prescription, then chose not to medicate him.

I will if I have to, of course, but it seems like the meds would be worse than the epilepsy unless he starts having seizures more often. Hmmmm - sounds like psych meds, huh?

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I hadn’t had one in over a year, but I still need to wait until the neurologist can sign the papers. Ha, yeah, and I’m very sorry to hear that. :sweat: I used to be on Ativan and Gapabentin, but I stopped taking if about 6 months ago.

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They wanted to put our dog on phenobarbitol - so take it to not get seizures, but if you stop taking it, even tapering, it can induce seizures.

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Oh, I wasn’t aware of that. Those are the only two I’ve ever been on, unless it was medication-induced, then they would give me Benadryl and an IV to get it out of my system.

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I think anything you take for seizures can induce them if you stop taking them suddenly.

I know Gabapentin has that in the warnings, and so do most of the benzos, but if I remember correctly, phenobarbitol is famous for doing it even on a taper.

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Yeah, same with psychiatric medications, you have to decrease the dosage slowly.

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Om, I failed completely by trying Option 3. Hospital is heaven compared to jail.

I think you need to involve local crisis workers, build up his file. That way if he starts in on any type of severe episode, call them immediately.

This is how that conversation might go:

My adult son who has schizophrenia and experiences many symptoms each day refuses to take the medication prescribed to him. What should I do?

[Whatever their answer is, do it.]

What are the signs that I need to get him into the hospital?

How do I do that?

I’m extremely concerned for his well-being since he has stopped taking medication. Is there any doctor or agency in town that helps people who are severely ill, but unwilling to take medication?

And then, whatever questions they ask you, lay it out. Follow their recommendations. I had the chance to have my family member escorted to the ER (though this does not usually result in hospitalization) and since I didn’t want him to be mad at me and he had calmed down, I didn’t. I have no other advice except, if your son becomes debilitatingly ill, get him to the hospital and leave him there until he is court ordered to take medicine. He can come home when he is court ordered to take meds or otherwise engage in effective medical treatment.

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I was not suggesting jail when going with option 3 - just letting it play out until hospitalization is something that is obviously required.

I know you would do anything to get your son better, but you will not be able to do it alone.

On a side note, I’m kind of surprised at how quickly the pdoc has changed his medications. Usually they want a longer trial before deciding to try something new.

I hope you can find some ways to take a break from all your worries over the weekend. Since you say your son doesn’t put himself or others in danger, it could do you some good to just let the craziness be for a few hours. I was told once - there is no law against being crazy. I know it saddens you, but you need to step back and re-establish some sanity in your own head.

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I have been fortunate that my son is medicine compliant, which is a rarety…but if it were me I would start with option 1, only because I believe getting my son stable supercedes everything else. I also believe that you can’t apply logic and reason to an illogical and unreasonable illness like sz. The condition that causes sz patients to believe they are not ill, (anosognosia) or do not need medicine is not an easy one to reverse…so I would not be concerned about my son connecting the medicine to his wellness until has been a stable for a good long while…In my own experience I had to report all of the affects of medications to my son’s doctor for him because he was unable to talk about them but accurate reporting is critical to finding the correct meds. If I had to use option one which I think is the most effective choice you have listed…I would refrain from explaining it to my son until he has been lucid for a long while and then I would still refer to the medicine that is making him better as “the supplement”… since he is open to supplements. It may seem somewhat deceptive but I think it is justified to reach and maintain stability…before I was my son’s legal guardian I once spent a day trying to get my son to check into a hospital because he was so very ill…he was angry and hostile and then he said he was hungry and jokingly I said I’d buy him a cheeseburger if he’d sign himself in and to my surprise he said, “really?” And I said absolutely and he said OK then and signed himself in. (see? rational thinking doesn’t apply with sz) This is only my opinion based on my own experiences - everyone is different but I wish you and your son the best.

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Well, I’m going to go with option 1 as long as I can.

And, I decided to go back to Vraylar instead of try the Latuda he’s never had. I was seeing some improvement after a week on Vraylar, and both me & his dad have a sneaky suspicion that he stopped taking it because it was working.

He asked for the Vraylar in the dr’s office, took it on his own, even asked to up the dosage, then suddenly didn’t want it anymore.

His doctor is simply trying to keep his trust & find something that he will take because he had been fairly stable for 8 years - then stopped taking his meds (I think after they stopped working for him), and here we are.

By coincidence, his case worker finally called me back yesterday. We’re meeting with her next wednesday. She wants to get him worked over to the “intensive treatment unit” at our county mental health support center. They have a dedicated psychiatrist, they work with people who need meds but don’t have insight & don’t want to take them, they will do med management & even come to the house if we get to that point. They will also do injections either in the office or at home if we can get him to agree.

It will take some time & be very gradual because they only take Medicare, so they will also start the disability process.

I feel like I’m on a race against time - and I don’t know why. Everyone really is trying to help, which is shocking me a little, but somehow, I feel like it will all be too late.

I also told them how I was going to try to keep getting him to take the meds - she didn’t say anything one way or another. I guess they’ve heard everything.

And, I still don’t know that I can ever tell him I did this. He blames me so much for holding him back. He’s so nervous he can barely go in a store some times, but I’m the one who’s holding him hostage & won’t let him have a life. The current word is “stifling” - because I play dumb and don’t know all about his delusions, I only want to stifle him and hold him back.

I have to learn to not react to him so much, and remember that when he changes something, I have to change my strategy. I get so emotional about it, and mad, and guilty, that I think maybe I am just holding him back instead of keeping him safe.

At least I learned an important lesson about the hospital - never, ever, ever, ever try to persuade anyone to let him come home even one day early.

On a positive note, since I didn’t even try to get him to take his medicine yesterday, we did get along a little better. I asked him if he wanted his other pills last night, then just left them out - if he didn’t take them before he went to bed, he’ll probably take them this morning. It’s what he usually does.

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