Patient: Hello, Dr. Chiang! I happened to see your webpage on the internet today and I think you are a very professional and competent doctor. So, I have a question I would like to consult with you. I hope you can give me an answer in your busy schedule. My sister is 30 years old and has been suffering from schizophrenia (hallucinations) for 11 years. During her treatment, she has taken up to 12 tablets of clozapine, but still has symptoms (laughing for no reason). She had a relapse in the middle of the treatment and tried to commit suicide during the attack, so her family added the medication back as soon as she became ill. So, in 11 years, almost no break from Western medicine. She has also tried Chinese medicine, but the effect is not obvious. Moreover, she is now regurgitating Chinese medicine, probably because she has taken too much of it. She now takes clozapine, 5 tablets every night. Her condition is okay, she can take care of herself personally and can help her family with simple household chores, such as cleaning and cooking. Her thinking is relatively clear, but she is not willing to think about things. She moves slowly, for example, she has to eat for one hour for each meal, and she has to work for two hours when others can finish cleaning in one hour. She is more suspicious of people, and she will be more concerned when people talk unintentionally, and then she is not willing to speak out when she is angry, but she can adjust herself after one or two days. Also, she is always willing to laugh and mumble. My question is this: 1. Personally, I think it is better for a psychiatric patient to recover to this extent because she can take care of herself and her family and is not a threat to people. But the concern is that she still has some symptoms present, such as laughing and mumbling. Do you see any need to go to the hospital for treatment in this case? The treatment will definitely require another increase or adjustment of medication, which is more damaging to the body, and can you guarantee that there will be no after-effects after the treatment? Will it be better than the current situation? 2.Some people often advise my sister to practice Christianity, saying that it will be more psychologically peaceful and may be useful for her condition. But I always feel that this view is not very scientific, so I would like to hear your opinion. 3. Can my sister consider getting married and having children in her condition? I look forward to your reply, thank you! Nanjing Brain Hospital Psychiatric Department Jiang Xiaojun: Chinese medicine, qigong and religion are not suitable for people with mental disorders. It is difficult to treat 11 years of schizophrenia, but it is still possible to give it a try. The new drugs of recent years have little side effects and no significant damage to the human body with long-term application, so they can be used with confidence. Patients should marry under stable conditions and with the understanding of the other party, but the other party has to make a greater contribution. The issue of fertility is more complicated and can be consulted in person. Patient: Thank you for your answer above. Can I continue to ask you: 1. If the patient continues to take the current amount of medication (5 tablets of clozapine per night), will it definitely have an impact on the fetus if the patient has a baby? 2.If I go to the hospital for a medication change, what new medication should be changed according to your experience? 3. If the medication is adjusted, is it true that clozapine cannot be completely withdrawn and must be mixed with new medication in the future? Theoretically, any medication can harm the fetus, especially during the first trimester of pregnancy. So it is better to stop the medication during pregnancy. 2. If the medication is adjusted, quetiapine or aripiprazole seems to be more appropriate among the new drugs. 3.If the medication is adjusted, clozapine should not be completely withdrawn, and it is possible to keep 1 or 2 tablets daily to prevent the rebound of symptoms. Patient: Thank you very much for your reply. The society usually cares too little about psychiatric patients and even discriminates against them. For so many years, seeing my parents’ white hair and broken hearts, I am really anxious and heartbroken. We were at a loss because we could not meet a competent, professional and caring doctor. We had a lot of questions in our mind, and thanks to the patient response from Director Jiang, our family feels satisfied and grateful. In addition, we still have some questions about the first problem: 1. According to our observation of the patient for many years, if we stop the medicine, I am afraid that the disease will recur even in three days, not to mention three months. Is it possible to take less stimulating drugs temporarily during pregnancy or is there another way? (The family also knows that it is more difficult for a psychiatric patient to get married and have children, but the patient likes children and the family wants to satisfy her wishes as much as possible, so Director Jiang is really troubling you and giving you trouble. Nanjing Brain Hospital psychiatric department Jiang Xiaojun: I can’t write a lot here because I’m a slow typist, please understand. The problems you are experiencing are common to many schizophrenic patients. Due to the lack of adequate treatment after the onset of schizophrenia, the disease is prolonged for many years, and with the passage of time, there is less and less chance that the disease can be fully remitted, while patients face more and more problems with school, work and marriage and family, which are extremely difficult to solve. Therefore, when treating schizophrenia, it is important not to be satisfied with “getting by” and allowing psychiatric symptoms to persist for years. In your case, it may be possible to try new medications and treat them adequately. I’m not a big supporter of pregnancy and childbirth with medication. The cost of Quetiapine and Aripiprazole is about $500-600/month for the domestic variety, and $1500-2500/month for the imported drug. A good specialist he uses only 1-2 kinds of drugs at the same time in general, but the dosage will be larger and the time of high dose will be longer.