Posted by SLS on September 12, 2009, at 12:35:14
In reply to Re: Suggestions re: Someone Who Refuses Medications » SLS, posted by 49er on September 12, 2009, at 8:58:19
I don't think either one of us is crazy. I think we both want the same thing - healthy and happy people.
I agree with you that the discontinuation of antipsychotics not be abrupt, but, rather, tapered. This is to help prevent the rebound psychosis that I alluded to in my previous post, and that speaks to your justified concerns. There are studies indicating that there is a supersensitivity of dopamine receptors that develops with chronic use of antipsychotics that facilitates this type of reaction. I don't know what the percentage is of people who react this way, but it seems to be a small minority. Not unrelated to this phenomenon, is the medication break-through that occurs, despite continued neuroleptic treatment. This is also thought to occur in some cases as the result of the development of supersensitivity. However, it can be the result of an increase in psychosocial stressors. Unfortunately, there are a few people who become resistant to subsequent attempts at treatment with antipsychotics. Again, it is theorized that this is the result of the development of dopamine supersensitivities.
It is the theory of an induction of dopamine receptor supersensitivity from chronic exposure to antipsychotics that becomes the thread that links withdrawal psychosis, medication breakthrough, and subsequent treatment resistance. However, these things are relatively uncommon. The decision to treat or not treat becomes a balancing act between functionality and the risk of drug-related adverse events.
I don't think it serves any further for the two of us to remark on the competency of a person in the midst of a psychotic or delusional schizophrenic episode. It is almost like we are talking about two different illnesses. People with more severe cases of schizophrenia can remain unreactive to questioning, let alone be relied upon to come to well deliberated decisions relating to the management of their welfare. The type of person you describe is functional enough to at least comprehend the question.
I do not think that the people in the medical profession have conspired to produce protocols of treatment that they know are detrimental to the health of people with schizophrenia. As one would expect, there are consensuses arrived at through investigation and deliberation. Sometimes, they actually get it right.