Ask the Expert

It’s very important to note that treatments for schizophrenia vary from person to person based on individual symptoms. However, there are certain instances when it’s time to change treatments.

Even with their current medication regimen, a person may still have positive symptoms such as hallucinations and delusions and/or negative symptoms such as lack of motivation and social withdrawal. They may have intolerable side effects that affect their quality of life. They may not stick to their medication regimens due to side effects or difficulty in maintaining the schedule.

Another indicator to make the change occurs when a person begins to have functional decline, increased hospitalizations, and/or impairment in their life activities.

Schizophrenia is a condition requiring long-term medication management. A person living with the condition will benefit from treatments that help them manage their symptoms and prevent chances of relapse.

The expected duration of treatment is based on the severity of an individual’s condition, outcomes of treatment, and their psychiatric medication history. It’s very important to have frequent appointments with healthcare professionals to discuss the continued benefits and potential risks of treatment.

Schizophrenia worsens when we notice an increase in positive symptoms, negative symptoms, or both.

With positive symptoms, a person would experience increased hallucinations, delusions, or disorganized thoughts and speech, or all of these.

Regarding negative symptoms, we would notice an increase in social withdrawal and apathy. It would be important to monitor for negligence in personal hygiene, erratic behaviors, and inability to maintain daily activities.

It’s vital for a person with the condition to follow up with their healthcare professional when they notice worsening symptoms. Getting collateral information from family members or caregivers can help the healthcare professional formulate a treatment plan.

If a person has been taking medications as prescribed, and symptoms haven’t improved, we would examine whether there are any other co-occurring disorders, such as substance use or mood disorders. These may affect the treatment. We may consider increasing the dose of the current medication or adding mood stabilizers such as valproic acid, lamotrigine, or both.

For treatment-resistant schizophrenia, switching to clozapine can be an option for providers. However, this would require frequent blood monitoring to ensure there isn’t a severe decrease in white blood cells. The healthcare professional can order a pharmacogenetic test to check how the person metabolizes medications and whether they have the proper drug targets.

However, these tests don’t determine the best medication but give probabilities of effectiveness or potential side effects to guide antipsychotic treatment options.

Positive symptoms such as hallucinations and delusions can get intense over time without proper management. Negative symptoms such as emotional blunting, apathy, lack of motivation, and social withdrawal may worsen with age.

A person may experience functional declines in their ability to work and maintain relationships. This can potentially lead to social and economic consequences such as unemployment, homelessness, incarceration, and isolation. Some may choose to self-medicate with drugs and alcohol to help alleviate the symptoms of untreated schizophrenia.

There’s a new treatment called Cobenfy, which activates specific muscarinic receptors in the brain related to schizophrenia symptoms.

You can speak with your psychiatric professional about new treatments and ask whether there are drug samples you can try before getting a prescription. Clinical trials are investigating new treatments to help provide relief for those living with schizophrenia.

Yes, the person’s psychiatric professional can recommend switching to a long-acting injectable (LAI). Many medication options are available.

LAIs can be given every 2 weeks, once a month, every 3 months, and even every 6 months. The injection frequency will depend on the brand the doctor chooses. Some common LAIs are:

Dr. Ifeanyi Olele is a board certified psychiatrist and Fellow of the American Psychiatric Association, serving the Washington D.C. Metro area. He leads a private clinical practice and specializes in transcranial magnetic stimulation for treatment-resistant depression and obsessive-compulsive disorder. Dr. Olele is passionate about advocating for mental health, mentoring, and supporting underserved communities.