[Medicine can’t stop! ] It’s just an Internet joke, but for many patients with chronic diseases, it’s not just a joke.
Schizophrenia patients are one of these patients with chronic diseases.
Symptoms have disappeared, can the medicine stop?
It is easy to understand that when people are ill, they have various uncomfortable symptoms and need to take medicine. Then when the disease is cured and the symptoms disappear, can the medicine stop?
For schizophrenic patients, the answer is no.
China’s Guidelines for the Prevention and Treatment of Schizophrenia (2nd Edition) once again emphasize the importance of long-term treatment of schizophrenia.
Among them, the guidelines mention the concept of [maintenance therapy], that is, after the symptoms of acute attack of schizophrenia are controlled, treatment still needs to be continued. In other words, schizophrenic patients still need continuous treatment when they are asymptomatic.
For patients with different conditions, the recommended time for maintenance treatment is different:
Patients with the first attack shall continue treatment for at least 2 years after the symptoms are completely controlled.
For patients with the first recurrence, maintenance treatment shall be carried out for at least 3-5 years.
For patients with recurrence twice or more, maintenance treatment should be at least 5 years.
You see, in fact, you don’t have to worry so much [once you take medicine, you have to take medicine for a lifetime]. If the patient’s condition is stable during the treatment stage, the medicine can still stop.
Why can’t you stop taking drugs?
In short, the most important reason is: withdrawal = relapse.
According to a number of clinical studies, the recurrence rate of schizophrenia patients within 2 years after drug withdrawal is > 90%, and worse, the existing medical methods make it impossible for doctors to predict who will be 90% of the recurrence and who will be the lucky 10%.
Each recurrence is a new injury to the patient’s brain, and the difficulty of treatment will increase accordingly.
Patients with multiple recurrences are likely to become refractory schizophrenia. After that, living a [normal life] has become a luxury.
Therefore, insisting on taking medicine is the most important factor to prevent recurrence. None of them is that the longer the insisting on taking medicine, the stronger the protective effect will be.
The second and second important reason is that many new generation of antipsychotic drugs have many benefits to patients.
In addition to positive and negative symptoms, schizophrenia patients also have cognitive symptoms.
Examples of cognitive symptoms include:
Compared with normal people, patients are more difficult to judge other people’s psychological intentions, that is to say, they are not sure whether the other person is kind or malicious.
Compared with before the disease, it is more difficult for patients to concentrate at work.
Attention problems are accompanied by the patient’s memory and ability to learn new knowledge and skills.
The improvement of cognitive function is very important, which helps to improve the quality of life of patients and makes them more competent for work, daily life and social intercourse.
However, there are always various specific difficulties in life, which make it difficult to take medicine. Here are some common problems.
I also know [the medicine cannot stop], but…
1. [I am not ill, why take medicine? ]
Almost all patients have such problems, which doctors call [lack of insight].
[Insight] is a psychiatric term, which refers to a patient’s ability to know his own disease. Patients with acute stage or incomplete recovery often have the problem of lack of insight, while a schizophrenic patient can realize that he is ill, and which previous behaviors, thoughts and feelings are the manifestation of the disease and the manifestation of good recovery of the disease.
As the patient’s family member, if the patient says so, then he cannot relent and indulge the patient not to take medicine-because this further shows that TA is really ill.
For patients with long-term residual insufficiency of insight, the options are:
- Dark medicine, i.e. Taking medicine to patients with dosage forms (such as oral liquid) that are convenient to mix in meals and drinking water; Using long-acting injections, there are currently long-acting injections on the market that are given once a month. It is much less difficult to send patients to the hospital once a month than to stare at patients every day. If the patient was willing to take medicine well before and suddenly said in recent days that he was not ill and refused to take it, then this is likely to be a manifestation of relapse, so send it to the hospital quickly.
2. [I don’t want to take all kinds of discomfort after taking the medicine]
This is also a common complaint.
Indeed, the current antipsychotic drugs have various side effects, the common ones are:
- Appetite increases and weight increases; Changes in blood sugar and blood lipid; Abnormal liver function; Sleepiness; Involuntary trembling of limbs, etc.
In case of these side effects, you should communicate with the doctor in time. You should not stop the medicine in a hurry, nor should you allow it to develop completely.
Generally speaking, doctors will provide the following countermeasures:
- Some side effects do not need to stop taking drugs and change dressings, and will slowly disappear with the extension of taking drugs. Some side effects can be eliminated by using auxiliary drugs, such as liver-protecting drugs and antifibrillation drugs. There are also some side effects that need to be overcome by patients themselves, such as controlling diet and increasing physical exercise. When the side effects are too large for the patient to tolerate, the doctor will actively reduce the dose or change the dressing.
3. [I am willing to take medicine, but it is hard to forget too much medicine]
4. [I am recovering quite well and am willing to take medicine, but I don’t want others to know that I am ill. Taking medicine during the day gives people the fear of discrimination]
These are all very practical difficulties.
The methods for reference are:
- When possible, let the doctor prescribe the medicine every day at night, so that it is convenient to take it and not easy to remember wrong, and others will not see the medicine when they come home from work. Set an alarm clock for your mobile phone to take medicine, or download a [Doctor Clove] App to remind them to take medicine. Buy a small medicine box, which is pre-packed with medicine for each meal every day.
In fact, the more recommended method is to use a long-acting injection and go to the hospital for an injection once a month. The rest of the day is easy. You don’t have to worry about forgetting to take the medicine or being seen by others when taking the medicine.
5. [I want to have a baby, can’t I take medicine? ]
For women of childbearing age, the trade-off between taking medicine and giving birth is very difficult.
During the pregnancy stage and the [confinement] stage, the endocrine factors of women are quite different from those of other periods. This change itself is easy to cause changes in mental state, and childbirth itself will increase the risk of recurrence. However, many antipsychotic drugs have a high teratogenic risk, which makes psychiatrists often timid.
However, it is also very irresponsible to stop taking drugs rashly [for the sake of children]: patients with acute attacks of schizophrenia are under high stress, and their behavioral disorders, refusal to eat and drink, etc. may even be more dangerous to the fetus than drugs.
Therefore, for female patients with strong reproductive needs, it is recommended to slowly try to stop taking drugs after sufficient and sufficient course of maintenance treatment. After pregnancy, close monitoring by obstetrics and gynecology and psychiatry is required.