How to help a friend

therealstacy · Dec 20, 2021, 07:19 PM

My friend has schizoaffective disorder. She does not take meds regularly because of side effects, which I can understand because the side effects can be horrific. She's tried a lot of different meds.

She talks a lot about her paranoid symptoms for hours at a time very quickly. It's dizzying. I feel really sad for her. I want so much to help, but listening for hours to her paranoid thoughts is not helping.

What can I do? Encouraging her to take her meds, doesn't do any good.

sarahsweets · Dec 22, 2021, 08:16 AM

Hey @therealstacy:
I am sorry to be blunt but if she isnt taking medication to manage her disease you can not help her. Schizophrenia is one of the mental illnesses that almost always requires medication. For patients that are non-compliant or forgetful there are monthly injectibles of antipsychotics that can be given in a doctors office.

Quote:

Schizophrenia requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. In some cases, hospitalization may be needed.

A psychiatrist experienced in treating schizophrenia usually guides treatment. The treatment team also may include a psychologist, social worker, psychiatric nurse and possibly a case manager to coordinate care. The full-team approach may be available in clinics with expertise in schizophrenia treatment.

Medications
Medications are the cornerstone of schizophrenia treatment, and antipsychotic medications are the most commonly prescribed drugs. They're thought to control symptoms by affecting the brain neurotransmitter dopamine.

The goal of treatment with antipsychotic medications is to effectively manage signs and symptoms at the lowest possible dose. The psychiatrist may try different drugs, different doses or combinations over time to achieve the desired result. Other medications also may help, such as antidepressants or anti-anxiety drugs. It can take several weeks to notice an improvement in symptoms.

Because medications for schizophrenia can cause serious side effects, people with schizophrenia may be reluctant to take them. Willingness to cooperate with treatment may affect drug choice. For example, someone who is resistant to taking medication consistently may need to be given injections instead of taking a pill.

Ask your doctor about the benefits and side effects of any medication that's prescribed.

Second-generation antipsychotics
These newer, second-generation medications are generally preferred because they pose a lower risk of serious side effects than do first-generation antipsychotics. Second-generation antipsychotics include:

Aripiprazole (Abilify)
Asenapine (Saphris)
Brexpiprazole (Rexulti)
Cariprazine (Vraylar)
Clozapine (Clozaril, Versacloz)
Iloperidone (Fanapt)
Lurasidone (Latuda)
Olanzapine (Zyprexa)
Paliperidone (Invega)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Ziprasidone (Geodon)
First-generation antipsychotics
These first-generation antipsychotics have frequent and potentially significant neurological side effects, including the possibility of developing a movement disorder (tardive dyskinesia) that may or may not be reversible. First-generation antipsychotics include:

Chlorpromazine
Fluphenazine
Haloperidol
Perphenazine
These antipsychotics are often cheaper than second-generation antipsychotics, especially the generic versions, which can be an important consideration when long-term treatment is necessary.

Long-acting injectable antipsychotics
Some antipsychotics may be given as an intramuscular or subcutaneous injection. They are usually given every two to four weeks, depending on the medication. Ask your doctor about more information on injectable medications. This may be an option if someone has a preference for fewer pills and may help with adherence.

Common medications that are available as an injection include:

Aripiprazole (Abilify Maintena, Aristada)
Fluphenazine decanoate
Haloperidol decanoate
Paliperidone (Invega Sustenna, Invega Trinza)
Risperidone (Risperdal Consta, Perseris)
Psychosocial interventions
Once psychosis recedes, in addition to continuing on medication, psychological and social (psychosocial) interventions are important. These may include:

Individual therapy. Psychotherapy may help to normalize thought patterns. Also, learning to cope with stress and identify early warning signs of relapse can help people with schizophrenia manage their illness.
Social skills training. This focuses on improving communication and social interactions and improving the ability to participate in daily activities.
Family therapy. This provides support and education to families dealing with schizophrenia.
Vocational rehabilitation and supported employment. This focuses on helping people with schizophrenia prepare for, find and keep jobs.
Most individuals with schizophrenia require some form of daily living support. Many communities have programs to help people with schizophrenia with jobs, housing, self-help groups and crisis situations. A case manager or someone on the treatment team can help find resources. With appropriate treatment, most people with schizophrenia can manage their illness.

Hospitalization
During crisis periods or times of severe symptoms, hospitalization may be necessary to ensure safety, proper nutrition, adequate sleep and basic hygiene.

Electroconvulsive therapy
For adults with schizophrenia who do not respond to drug therapy, electroconvulsive therapy (ECT) may be considered. ECT may be helpful for someone who also has depression.

Quote:

Originally Posted by therealstacy

My friend has schizoaffective disorder. She does not take meds regularly because of side effects, which I can understand because the side effects can be horrific. She's tried a lot of different meds.

She talks a lot about her paranoid symptoms for hours at a time very quickly. It's dizzying. I feel really sad for her. I want so much to help, but listening for hours to her paranoid thoughts is not helping.

What can I do? Encouraging her to take her meds, doesn't do any good.

I am not one of those people who think only meds work for mental health. But depression and bipolar are very different from schizophrenia.
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therealstacy · Dec 22, 2021, 09:20 AM

I see that there's nothing I can do. And I understand that bipolar and depression are different from schizophrenia. I don't know why that statement was included in this conversation.

Victoria'smom · Dec 23, 2021, 01:04 AM

Is she in therapy? Is she willing to do therapy? Would she let you go with her. There's injections that can be given 4x a year. Medicine doesn't have to have horrible side effects. See if she can get genetic testing to see what meds work the best. If she does the injection you may want to drive her. Because it's scary especially when paranoid.

As for the paranoid thoughts ask her what you can do. Validate that it must be scary

therealstacy · Dec 26, 2021, 12:18 PM

I've talked to her about the importance of therapy combined with meds. I'll ask her if she's tried injectibles.

Not sure if she can afford genetic testing but that's a good idea.

I like that idea too of validating her thoughts. I'll draw a boundary at a certain number of minutes that we can talk over the phone otherwise she'll want to be on the phone for hours. I know she's lonely. I am too but I don't want to listen to her ramblings incessantly when it does no good.

SlumberKitty · Dec 27, 2021, 03:19 PM

It's admirable that you want to help your friend. Side effects of meds can be terrible. Plus sometimes when people feel better then they think they don't need their meds anymore which can complicate matters.

I am schizoaffective and I am pretty much med complaint (I sometimes forget a day here or there but mostly I am on top of it) and even then managing the illness and the meds can be a bit of a nightmare and I'm high functioning. I can't imagine what it is like for someone who is more debilitated by the disease than I am.

I think it's good to set boundaries for yourself so that you can be protected from some of the paranoia, etc, as it seems to also maybe have a detrimental effect on you? You can only really be there for someone when you take good care of you.

I think it is important to not give into the delusions though because that can make them fuel for more. When someone I trusts tells me it is a delusion then I am more likely to see it as a delusion but if that person is trying to placate me and goes along with it, then I am scared that it is real and I get more delusional or paranoid. That is just my experience though so your mileage may vary.

Also maybe there is a PHP or IOP program your friend can attend? I was able to do an IOP program which means intensive outpatient program through my insurance at no cost to me. I can also do a PHP (partial hospitalization program) for no cost but I do have pretty good insurance which I pay through the nose for. They might be able to teach your friend some skills in dealing with the illness.

I have never been on injectables so I can't speak to them but if your friend is not med compliant that seems like a good way to go but still body integrity is important even to people who are mentally ill so be prepared to hear that she doesn't want to do that. I can understand because it means not having control over yourself. But in an IOP or PHP they might have tools to help her see that she needs to be on meds consistently.

Try to take good care of you!

HUGS Kit

Fuzzybear · Mar 28, 2022, 04:35 PM

Good post. I'm wondering if she's in therapy too.

Quote:

Originally Posted by Miguel'smom

Is she in therapy? Is she willing to do therapy? Would she let you go with her. There's injections that can be given 4x a year. Medicine doesn't have to have horrible side effects. See if she can get genetic testing to see what meds work the best. If she does the injection you may want to drive her. Because it's scary especially when paranoid.

As for the paranoid thoughts ask her what you can do. Validate that it must be scary

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