Treatment for Schizophrenia

Which medicine to use?

To manage schizophrenia, doctors typically recommend antipsychotic medications. These medications target brain chemicals like dopamine and serotonin, which influence mood, movement, and emotional responses. Depending on the severity and nature of the symptoms, antipsychotics can be prescribed for either short-term relief during acute episodes or as a long-term solution to keep symptoms under control. In many cases, individuals with schizophrenia will need to continue their medication for life. Another option is a long-acting injectable antipsychotic (LAI), which is administered as a shot once or twice a month. Doctors determine the best medication based on factors such as:

Effectivness in managing symptoms
Cost considerations
Potential side effects
Accessibility of the medication
Dosage frequency

Antipsychotic medications are broadly categorized into older, first-generation antipsychotics and newer, second-generation antipsychotics.

The older medications, often referred to as "first-generation," "typical," or "conventional" antipsychotics, include:

Chlorpromazine
Fluphenazine
Haloperidol
Perphenazine

The newer medications, known as "second-generation" or "atypical" antipsychotics, are the most commonly prescribed today for treating psychosis. Examples include:

Asenapine
Lurasidone
Quetiapine
Ziprasidone
Risperidone

In some cases, doctors might also suggest additional medications like mood stabilizers or antidepressants, depending on the patient's specific symptoms.

Picture by:"Housed" license: "https://creativecommons.org/licenses/by-sa/3.0/"

Side effect:

Weight gain
Sexual problems
Drowsiness
Restlessness
Dry mouth
Constipation
Nausea
Blurred vision
Low blood pressure
Seizures
Low white blood cell count

Diary: Eli Ruth

I never thought I'd start writing a diary, but here I am. Dr. Bennet said it might help, keeping track of things... keeping track of me. I don't know if it'll work, but I guess I have to try something, right? They said writing it all down might make it easier to understand what's real and what's... not. And honestly, I'm just tired of feeling lost all the time.

You'll notice some of the dates in here have a “(C)” next to them. That's just my shorthand for “checkup.” It's when I have my appointments with Dr. Bennet, the man who prescribed me Risperda. These checkups are supposed to be... clinical, detached. I don't want them to get too personal because that's what Bennet wants — facts, not feelings. So I'll keep those entries more like notes for him. Everything else... everything else is for me.

If someone's reading this—don't. This isn't meant for you. It's just for me, to make sense of the noise in my head. Maybe, someday, this will all make sense. Or maybe it'll just be another reminder of how messy things have gotten.

09.29.2007

First appointment with Dr. Bennet today. Finally seeing a proper doctor. He gave me Risperda. Says it's supposed to help... the hallucinations, the paranoia. I really hope this works.

09.30.2007

I feel... happy? Like the fog is lifting a bit. Fewer voices, fewer things that aren't there. Maybe things really are getting better.

10.05.2007

Marie's birthday today! We played on the Wii—Wii Sports, Mario Party 8—the whole evening. I can't remember the last time I laughed so much. I barely slept afterward, but it was worth it. A day without shadows.

10.06.2007

I'm so tired today. Sure, I didn't sleep much yesterday, but it feels... different. Something's awake in my head, even though my body is exhausted. I hope this feeling passes.

10.10.2007

Cesar bullied me again, like he always does. But today was different. He made a fool of himself with a simple math problem, and I knew the answer. The teacher even backed me up. A small win.

10.13.2007 (C)

Checkup with Dr. Bennet. Told him the side effects are draining me. My head feels blank, like a canvas with nothing on it. No urge to draw. No urge to speak. He said that's normal. I refused his offer for mood stabilizers.

10.15.2007

It's like there's a knot in my mind. I can't draw. I stare at my sketchbook for hours and... nothing. No ideas, just emptiness. There used to be so much in my head. Why is it all gone now?

10.19.2007

I feel like I'm losing everything. Cesar's bullying is a daily torment, and I don't have my art to escape anymore. The only thing keeping me going is seeing Marie on the weekends. But what if that isn't enough?

10.25.2007

I stopped taking the meds. The illusions, the voices—they're back. But I feel alive again. I can draw, I have ideas... finally. But I need to be careful. My next appointment with Dr. Bennet is soon. He can't find out.

11.03.2007 (C)

Managed to convince Dr. Bennet that I'm still on the meds. He bought it. He thinks I'm doing fine.

11.12.2007

A classmate noticed me drawing today. His name's Jonas, and he seemed genuinely interested in my art. It surprised me... but it felt good, having someone besides Marie appreciate what I create.

11.16.2007

Jonas and I have been talking a lot about art this week. He wants to meet up to draw together soon. But I already have plans with Marie this weekend, so I promised him we'd do it next week.

11.23.2007

It was all a joke. Another prank to humiliate me. Cesar paid Jonas to pretend he was interested in my art, just to mock me later for being gullible. I should've known. I can't trust anyone. No one. There are eyes everywhere, watching, judging. Marie called—wants to meet tomorrow. Said it's important. I agreed and locked myself in my room, under my blanket, crying.

11.24.2007 (C)

I couldn't hide how anxious I was today. Dr. Bennet is starting to get suspicious. He didn't say much, just gave me some mood stabilizers and said he'd wait till the next checkup. I won't take them. Afterward, I met up with Marie. She told me she has a boyfriend now. I smiled and said I was happy for her, but the voices wouldn't stop... they're too loud.

11.25.2007

I decided to skip school this week. Just staying home. Marie called, worried. She wanted to know if I was okay. But before I could tell her anything, her boyfriend Mark interrupted. She apologized, said I could tell her next week. I wonder if there will even be a next week.

11.30.2007

I had a dream. There was a figure — an angel, maybe a god. It spoke about justice and how it is everyone's responsibility to maintain it. Its final words echoed in my mind: “No justice, no sin.” What does that mean? I don't know. But it's haunting me.

Dr. Bennet's Notes

09.29.2007 - Checkup 0

Patient Name: Eli Ruth

Diagnosis: Schizophrenia (initial presentation)

Medication: Risperda 2mg, daily

Notes:

First meeting with the patient. Eli Ruth, 15-year-old male, shows early signs of schizophrenia: auditory hallucinations, paranoia, and mild delusional thoughts. Patient was visibly tense—kept looking around the room as if expecting something to appear. Although hesitant, he spoke coherently, though it often took effort to get a direct answer. Mentioned anxiety about losing "creative inspiration," specifically regarding his artwork. I instructed him on the importance of routine and adherence to medication. Offered mood stabilizers as a secondary option, which he declined, preferring to “keep things simple.”

Observations:

Eli fits the typical early-onset pattern, with clear discomfort in a clinical setting. His tendency to hesitate when speaking suggests self-consciousness or reluctance to discuss symptoms. Mentioned art frequently—likely a fixation tied to his paranoid thoughts, but not clinically relevant at this stage.

Conclusion:

Risperda prescribed to manage core symptoms. Patient advised to return in two weeks for a follow-up. Mood stabilizers are not required unless further symptoms develop.

10.13.2007 - Checkup 1

Patient Name: Eli Ruth

Diagnosis: Schizophrenia (early-stage, exacerbated symptoms)

Medication: Risperda 2mg, daily

Notes:

Patient appeared slightly anxious, mentioning fatigue and feeling "empty." Reports a lack of motivation, particularly in creative outlets. This is consistent with known side effects of Risperda. Patient refused mood stabilizers when offered again, citing concerns about feeling "numb." Maintained eye contact sporadically and spoke in a low, even tone. No overt signs of psychotic episodes during the visit, and he remained compliant with the current dosage.

Observations:

His emotional flatness aligns with expected side effects of medication. Mild agitation was noted when discussing his art—a possible emotional crutch. As long as his cognitive functions remain intact, no need to intervene further.

Conclusion:

No changes to medication regimen. Patient remains within manageable bounds. Next checkup scheduled in three weeks.

11.3.2007 - Checkup 2

Patient Name: Eli Ruth

Diagnosis: Schizophrenia

Medication: Risperda 2mg, daily

Notes:

Patient appeared calm, reported adherence to the medication. Claims symptoms have improved—less paranoia and fewer hallucinations. However, his affect remained somewhat flat, consistent with the known impact of Risperda. Refused mood stabilizers again, unsurprisingly. No psychotic symptoms were present during the session, though anxiety was noticeable when personal topics were mentioned.

Observations:

Patient is compliant and lucid; no further probing into his emotional state is necessary. His discomfort with discussing personal issues isn't clinically significant as long as his primary symptoms are under control. The current dosage of Risperda remains effective.

Conclusion:

Continue with the current medication. His emotional concerns are outside the primary scope of treatment. Will reassess at the next checkup.

11.24.2007 - Checkup 3

Patient Name: Eli Ruth

Diagnosis: Schizophrenia

Medication: Risperda 2mg (Non-compliance suspected)

Notes:

Patient displayed visible agitation—fidgeting and avoiding eye contact. Claims adherence to medication, but his symptoms suggest otherwise. Attributed to stress? Avoided discussing any home life details, especially when pressed about social interactions. I offered mood stabilizers again, knowing they'd be refused, which they were. Increasing signs of distrust in his demeanor, though his speech remained clear.

Observations:

Elevated irritability, though he contained any significant outbursts. Symptoms indicate possible non-compliance, but there's no need to force the issue as long as he remains coherent. The paranoid elements are notable but manageable.

Conclusion:

Continue monitoring for compliance. No intervention necessary unless Eli's behavior deteriorates further. Next session should provide clarity on medication adherence.