1. In an active psychotic state, non-compliance is fueled by paranoia – which dictates that medication is some form of poison or mind control. Why take poison, or something that will manipulate the mind?
2. Another piece of the schizophrenic’s thought puzzle is that medication has curative powers. Medication is supposed to “fix” the problem isn’t it? Numbers 1 and 2 are of course, influenced by poor reality testing which in turn leads to illogical conclusions.
3. Antipsychotics are fraught with side effects. This is true, and there is nothing irrational or illogical about giving up on medication that causes weight gain, marked sedation, type – II diabetes, the potential for rising levels of cholesterol and triglycerides and movement disorders. Non-compliance due to side effects I can understand, these medications are just plain awful for the most part.

Regardless of the reasons, the risks of antipsychotic non-compliance have to be addressed. Continued relapse to active psychotic features is a recipe for potentially serious consequences for both the schizophrenic and his/her family. This is why it is so important to get the family involved in treatment. Family members are our de-facto healthcare specialists and are the clinician’s first line of defense against symptom re-emergence. Those closest to the affected individual should be made aware of the therapeutic benefits of medication as well as the adverse effects. Consistently, family members prove to be the clinician’s most reliable ally when it comes to challenging the schizophrenic’s irrational beliefs regarding medication and increasing medication compliance. Use them!

• Approximately 85 percent of older adults with schizophrenia live in communities with support, 13 percent reside in nursing homes, one percent in state or county hospitals and 0.5 percent in veterans hospitals.
• Positive symptoms (delusions, hallucinations, disorganization) improve with age. Negative symptoms (apathy, anhedonia, avolition) also improve with age. Cognitive symptoms (incoherence, loose associations, informational processing impairment) worsen with age.
• Quality of life in adults with major mental illness such as schizophrenia is lower than in unimpaired controls, but differences are small. Quality of life in major mental illness subjects is higher than in those with chronic pain.
• Psychosocial functional capacity is highly variable among people with schizophrenia. Functioning is dependent upon environmental circumstances (the better the environmental living conditions the higher the level of functioning), support system strength, opportunities for daily stimulation and the extent to which the schizophrenic is stigmatized.
• There is evidence of better functional outcomes with schizophrenics living in under-developed countries where family support systems are strong and well integrated, and roles of family members are simpler.
• Ten national and international studies spanning a period of 20-30 years indicate that recovery is possible for at least 50 percent of people with schizophrenia.

A new study suggests that fish oil may also be a possible deterrent to schizophrenia. One theory supporting this hypothesis is that those with schizophrenia don’t process fatty acids properly, leading to damaged brain cells. Omega-3 fatty acids in fish oil could possibly help brain cells to repair and subsequently stabilize.

Researchers are starting a large international study in eight cities with the goal of replicating their findings. These findings appear in this month’s Archives of General Psychiatry.