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Submitted by himanshu0801 on 29 March 2017

I know someone who was diagnosed with schezophrenia about 6 years back. He has been on reducing dosage of medication as the doctor started seeing improving results.
There have been a couple of instances where the patient stopped medication, but the family was able to talk him out.
Now since past 6 months he is strongly adament that medication is not required as he never had any issues, to an extent that he blames his family for fraudulent diagnosis and medication. He had started showing signs of relapse with delayed responses and distraction during conversations. Patient is in Delhi now!

What is the best way through this?

Persons with mental illness refusing medication is a common problem. In this case, the patient was cooperating but at some stage when he was on maintenance dosage, he started refusing to take medicines. The refusal to take medicine post recovery is uncommon. The patient must be persuaded, convinced or counselled to take medicines. If this does not help, covert medication, which is quite prevalent, should be resorted to. It may not be ethical to do so and is not approved by human right activists, but it could be resorted to in patient's interest. Forced medication should be the last recourse. Monthly injection instead of daily medication twice/thrice a day might be more acceptable option to such difficult patients For treating schizophrenia, now Invega sustenance injection is available in the Indian market. This is given once in a month and the attending psychiatrist can be consulted about it. But under any circumstances, medicines must be administered to prevent aggravation.

himanshu0801

Thu, 03/30/2017 - 10:47

Thank you Amrit for your response. Is there anyone in Delhi that I can refer to the family to meet and work on the next steps - any renowned organisation/psychiatrist?

Mangala R

Thu, 03/30/2017 - 23:37

A recovering person with schizophrenia refusing medication can be the very first sign of relapse. If convincing him doesn't work, the caregiver may contact the treating psychiatrist at the earliest with or without the client. When there is a refusal to take medication, there is a possibility he may refuse to see the doctor too. Sometimes a telephone conversation between the doctor and the person can help too. There may be a genuine reason sometimes for refusal of medication like side effects interfering with his work/functioning etc. If those issues can be addressed and remedies suggested, he might accept to restart medication. Forced medication for a short period may help to prevent a full blown relapse but cannot be the primary option. An injectable long acting preparation can be considered to avoid similar situations recurring.

himanshu0801

Fri, 03/31/2017 - 09:38

Yes, the reason that the patient gave for not taking medication was side effects. Specifically, making him drowsy and sleep which was impacting his usual life style. Rightly pointed out, he is adamant that he does not need a doctor.
Should we look for a new psychiatrist as the patient's primary psychiatrist is in a different city and now he is in a different City?

Delhi has some of the best psychiatrists in the country. You may go to Psychiatry Dept. of AIIMS, IHBAS Shahdara, VIMHANS, Psychiatry Dept. of Sitaram Bhartiya Hospital etc. There are also very good psychiatrists doing private practice. Consulting a psychiatrist located in another station creates practical problems and is an unnecessary stress for the patient. There are good NGOs working foe mentally ill and their families. You may contact Rita Seth of
Sambandh (9810723245) or Rajeshwari Iyer of Roshni (9871256572).

Atypical medicines have fewer and mild side effects. If side effects is a major issue, psychiatrist be requested to change the medicines. Sleep inducing medicines should be taken post dinner to avoid drowsiness during the day.

Mangala R

Mon, 04/03/2017 - 17:04

Changing the treating doctor may not be the best thing to do when there is a possible relapse, The family can get in touch with the doctor and take his advice. The dosage of medicines can be changed and time of administration altered to minimize side effects If the client is still very keen on seeing a different consultant, it can be considered.
Hope this helps.