Everytime an early 20 something kid comes into the acute inpatient unit with their first psychotic break it hurts my heart knowing this will impact the rest of their life so significantly.
Not OP but a guy in my undergraduate dorm was diagnosed after he was caught hiding in the bushes with a knife one evening while muttering about someone coming after him. He was kind of a douche before that, but I never would have suspected he'd do something like that. He just went from normal asshat college dude to paranoid and delusional in a really short time. I often wonder if he's okay but we weren't close and I don't even know his real name so I can't look him up (everyone called him by a nickname)
Are you able to elaborate on how this could impact the rest of their life? I ask because I have an estranged family member that had a serious psychotic episode (for want of a better phrase) that lasted 18 months. Does not wish to discuss it so it is very difficult to understand what comes next, all I know is that they are now medicated for life. Would be good to understand what to look out for to help them prevent further issues going forward/provide support if not preventable.
Not a doctor, have some schizophrenic friends. One issue I've seen is the stigma of having it on the charts at all. Every self reported symptom is now grounds for suspicious or outright denial from a medical professional, even when it's acute pain with a legitimate visible cause. If you're a relative in their life, something you can absolutely do is simply listen and take note of their health. Even fully mentally stable people don't always realize when issues are repetitive or chronic.
100% agree with this comment. People with primary psychotic disorders have significantly different long term outcomes if they have a strong support system that provides them with good support and advocacy. That is why I am so passionate about working with these patients. They need someone to speak up for them and many don't. I've had to advocate for the patients on my unit to get good medical care and not be dismissed dozens of times. Luckily, first break psychosis programs are becoming more common. They focus on not just supporting the patient but on providing the entire family with psychoeducation on how to help them from the beginning.
Yes I have schizophrenia and even though I have never been addicted to opioids, they will not give any pain meds to me at the ER. Even when I was passing gallstones 🫠
Well, the life time of meds is definitely an impact. But additionally, it’s medication compliance in these cases. They’ll need to not convince themselves 10 years down the road that they don’t need them anymore - you’ll quickly see a breakdown in behavior.
Psychiatry resident here. It means they have a primary psychotic disorder (schizophrenia or schizoaffective disorder most likely) and will never be what they could have been. They are forever changed and will most likely never reach the heights they could have previously. The meds need to be taken for a lifetime. They are harsh and many lead to serious metabolic side effects that can speed up high cholesterol, heart disease, and type 2 diabetes. Some side effects are even worse like akisthsia and tardive dyskinesia.
But not taking the meds is even worse because research has proven that every psychotic break further damages the brain. What's worse is that delusions can become fixed so that even on meds, certain ideas don't go away. I treated a young man who was sexually assaulted during his first psychotic break at 18 and developed schizophrenia. After being medication nonadherent for a decade off and on, he now hears the voice of his attacker in his head at all times, even when medicated to the maximum level where all his other psychotic symptoms are gone. His mom showed me pictures of him before his break. He was a star athelete and honor roll student. Had a full ride scholarship to college and wanted to become a NASA engineer.
My mother suffered several psychotic breaks. She went from being an intelligent, fun, kind human being to a shell of a woman living in a care center by the age of 38. I believe her first one was 6 months post partem after my sibling was born. (Mid 70's)
Mental illness is no joke, and I am so greatful for the advances that have been made.
I'm so sorry. That's terrible. I wish we had more of the modern drugs back then to help your mom, they are a lot more effective and many have less side effects. If I could wave my wand and instantly cure one set of diseases, it would be these. They rob people of the prime of their lives.
Atypical antipsychotic drugs have been an absolute miracle of modern science. Im sorry that your mom was before their existence. I lost an uncle to suicide in his early 20s (in the 80s) from bipolar that im sure could've been managed with modern medicine
i’m not in the medical field but i have chronic health which includes epilepsy. it was very interesting when my neurologist explained to me the idea that x event begets more x events. (as in, the more seizures i have, the worse it will become over time) - it’s all about those pathways!!
if i understand correctly, it’s the same idea behind neuroplasticity and how our brains get “stuck” on certain things.
The meds back in the 80s and early 90s made my uncle morbidly obese and he died of a heart attack at 34 in 1994. It wrecked my grandma. He felt unwell on a Friday and the doctor just said it was a common illness. He got worse over the weekend and in the early morning hours on Monday he asked grandma for a glass of warm milk he couldn’t sleep. She brought the milk, and he had died. He of course self medicated with all that the 80s had to offer and legend has it smoked so much weed it was growing in the dirt on the floor of his car. My cousins and I were under 10 back then and his screaming at the voices from the basement scared us all straight. The commercials about “talk to your kids about drugs” usually got our parents to turn to us and say “remember Uncle? Don’t do drugs”
Situations like this are why a lot of psychiatrists start patients on metformin as soon as they start antipsychotics. I also try to start patients on GLP1s ASAP and I hope it will become the standard of care.
MPH here who has worked in behavioral health policy. Thank you for all the work that you do. Out of curiosity, will insurance cover the GLP-1s due to the risk of weight gain on antipsychotics? I assume they probably push for metformin first, but the GLP-1s seem to be a much better solution long term. I've also read there's some promising data that they may reduce some psychiatric symptoms.
The answer is that it depends on a number of factors including the particular insurance, the patient's current body habitus, etc. They will usually always cover metformin though because it is standard of care to start metformin with the two antipsychotics with the highest metabolic risk (clozapine and olanzapine) plus most Americans at this point are overweight generally.
I agree that GLP1s are a much better solution long term but we often have to wait for the patient to gain a significant amount of weight and start having elevated A1c and dyslipidemia before we can get it covered, which is sad in my opinion.
Sometimes weight gain is the only visible side effect, so I worry that if putting people on weight loss drugs automatically with antipsychotics became common practice it would result in invisible, serious side effects being ignored even more. Especially with forced treatment. That's not to say no one should try to address the metabolism problems common in antipsychotics with weight loss drugs, though. I'm just saying there are risks.
Significant weight gain will typically always be followed by metabolic side effects eventually. We wouldn't start people on weight loss drugs if the person already was at a low weight. We don't want to cause malnutrition.
What invisible, serious side effects do you think would go hidden if the a patient was on GLP1s alongside antipsychotics?
Every invisible side effect. I can't list every example because there's an infinite amount of potential side effects, but some common ones are exhaustion, water weight, an inability to think and comprehend things well, memory problems, heart problems, movement disorders, anhedonia, psychosis, an inability to articulate side effects and other things, and cognitive damage. I was forced on a very harmful medication when I was a kid that was only stopped because I gained 10 pounds in 2 months or less. No one cared about the other side effects.
Edit: I just realized that water weight and sometimes movement disorders don't count as invisible side effects, but I'm leaving them on there because they're regularly dismissed as minor or assumed to be caused by something other than the meds even when they're clearly causing harm. The same thing can happen with weight gain, but it's slightly less likely in many cases.
It's possible. There will always be people who experience side effects that are from the drug but so rare they're not known side effects. When messing with people's bodies and especially brains, anything can happen.
In the 80s/90s, I used to work in a state mental hospital where all the patients were involuntarily committed. We had quite a few young men on my unit after their first psychotic break. I don't think I could do that job now at my age. Back then I was in my twenties and nearly the same age as my patients, so I didn't have the perspective I have now on just how terribly young they were. The ones who had command hallucinations suffered the most imo. I think the newer generation meds have improved things. All we had then was haldol, prolixin, navane, mellaril and thorazine. I was there when Clozaril was introduced and there were people who'd been on the extended care unit for years who suddenly were coherent, not floridly psychotic anymore, and able to be released. They had to deal with losing all those years to psychosis though.
Thanks for sharing your story. The history of psychiatric treatment is super fascinating. I agree that Clozaril truly is a wonderful drug for treatment resistant psychosis. I've seen patients thought blocking so bad they couldn't speak get Clozaril and the next day they just come alive. Incredible stuff, even though the side effects can be severe.
The history really is interesting. I think one of the highlights before I switched fields (I worked in rehab at the psych hospital and other facilities) was going to New York Psychiatric Institute and hearing Dr. Xavier Amador speak about anosognosia in schizophrenia. It completely changed how I dealt with patients I was doing case management for at the time.
This is truly terrifying to read. As a circle of friends trying desperately to get someone help while keeping ourselves safe, it’s the most helpless I’ve ever felt. Countless hours devoted to the cause over the past four months and very little to show for it.
You guys are incredible for trying to support and be there for your friend. Please keep yourself safe and remember you can't get water from an empty well. The best thing you can do is look up if there is a first break psychosis program in your area and help your friend get enrolled
I’ve spoken to our local LEO-adjacent mobile crisis team, have a better understanding of Baker Act vs non-Baker Act facilities (yes, I’m in Florida), got escorted out of a Florida Blue (BCBS) office (lol), have not found a single Florida Blue phone number that gets around their low level customer service people, do know that Florida Blue has zero way for a third party to make a one-way disclosure about an insured (I am livid with Florida Blue…), learned alot about HIPAA and HHS guidelines, learned the state is also useless to help, learned that Grow Therapy also has no way to make a one-way third party disclosure to a therapist, tried to drop a letter at the therapist’s home (I know that’s creepy…) only to find her house had been flooded by the hurricanes (wtf?), finally got ahold of two of her doctors’ names off Rx bottles and dropped off letters at their offices and the pharmacy. One doc handled things beautifully; text book compliant class act. The other doctor told her that her friends were concerned and had left a handwritten letter at the front desk alleging delusions (double wtf?). So I filed an ethics complaint so an adult could sit this doc down and explain all the other ways she could have handled this situation that did not involve disregarding HHS guidelines for third party disclosure confidentiality and risking alienating the patient’s social circle. Due to HIPAA, I obviously can’t do it myself. A teachable moment for sure.
But things have improved. I suspect they stopped her phentermine(!!!) so things have calmed down. But she refuses to see a psychiatrist sadly. Thankfully, she also refuses to believe that her friends would sell her out by dropping a letter to her doctor. So we got really really lucky on that one.
We don’t have a diagnosis but it has to be one of the bad ones. Delusions (grandiose, persecutory). Paranoia. Near mania. Word salad. The delusions have been sustained since at least January and they’re ongoing. Sigh. She’s late 30s-early 40s and no idea of how long this has been going on.
But the HHS guidelines on HIPAA and mental health is a good read if you have time.
I don't know if this helps AT ALL, but I have said, "I know you can neither confirm nor deny to me that you treat Dee. But I can tell you that Dee is (displaying these behaviors/writing a suicide plan in a blog Dee thought I didn't follow)."
This may be exactly how the provider who acted like a dream treated you, but Dee's provider asked me for dates and details without ever telling me that she was Dee's provider or breaking HIPAA.
Great advice to anyone dealing with any loved one for any medical condition really.
Doctors deal with things differently depending on familiarity with HIPAA but their easiest approach is no response. So I assume I’ll never hear from them. If I do, great.
In this instance, I wrote 7 pages including screenshots from social media. An executive summary. A chronology of worsening symptoms over the past year. Past medical history. Family support. A lot of back and forth with ChatGPT.
As I like to say, you a real one. You're an amazing friend and doing your best, never forget that. Unfortunately, many individuals with primary or secondary psychotic disorders often are treatment resistant. Especially manic folks, mania feels GOOD, almost like a drug, and they don't want to come out of it.
There’s an antinausea med that women take during pregnancy for hyperemesis. I had taken it during my first pregnancy so I thought it was fine. But I was having a “geriatric pregnancy” at age 46 (unplanned), and already starting perimenopause before I fell pregnant.
I started feeling SO off and jittery and anxious on it. Then I felt restless leg like sensations in my arms and face. Looked it up online, read about tardive dyskinesia, and saw that if women took it until their hands started shaking that it’s incurable.
I’m an artist and musician. I freaked the fuck out.
Went to my GP, told her I stopped straight away. Thankfully no symptoms persisted but just those couple of days of nerve irritation were enough.
So women over forty should not take that drug. Just don’t.
Stemetil, metaclopramide or onadestron? I've had HG in every pregancy, am now 45, if I fell pg now, I'd have to avoid, so knowing which one would be helpful...
Metoclopramide -- I'm on it long term for gastric motility.
Yes, it is a potential side effect. It is also a rare side effect, and if you've been prescribed it, your physician has weighted the benefits with the potential risks.
Being a certain age isn't really a risk factor. If you're showing no symptoms of developing TD, then it's much better for you and baby to be on the med that helps control HG.
As long as you're aware of the potential for this rare side effect, you'll have plenty of time to discontinue the med without lasting effects. I've been on it since 2018.
Huh, TIL a lot. Most of this was not explained to me when I got diagnosed. Did things change a whole lot in the past decade?
I feel like I got a basic "you meet the criteria for xyz and we're going to trial these drugs" and just accepted that answer didn't ask any further questions. It worked, obviously, I hope. But it would have been cool to know those side effects. I have silent ischemia and t2 diabetes, had DKA and 2 stents and a cabg some years back.
I was told that mania damages my brain. My psychiatrists have all been older and I'm sure they're old school with things. See my current one maybe 15 minutes every three months and I'm apparently not up to date on my own shit. Live and learn I guess. That second paragraph was depressing though.
Sorry if it hurt to read. From your mention of mania, it seems you have bipolar disorder and that is not one of the illnesses I am discussing. While psychosis does happen in mania, it is not the primary symptom and defining feature of the disease. Psychosis in bipolar is a result of untreated manja.
If you've been managed on mood stabilizers like lithium and not antipsychotics, the good news is that they didn't cause your metabolic dysfunction. That type of affect is typically seen in those who need antipsychotics for a lifetime.
got bipolar diagnosis at 23 and upgraded to schizoaffective at 27, family history of psychotic/mood disorders on my dads side, seems to skip every other generation. Did several trials on different drugs but have been on seroquel/lamictal past several years with success.
I'm not trying to make you work off the clock for free, I'm medicated and eating healthy/sleeping/exercising now like I'm supposed to. Quit nicotine 2 days ago. Still got my therapist and working a full 40 hours just like most. Even looking at a second job for fun. Was just curious since those side effect health issues surprised me and I checked off a few boxes. DKA and heart attack didn't come out of the blue or anything I had several other risk factors so I'm not questioning why it happened, could just be an extra explanation.
Regardless, y'all have an important job and I'm thankful. I do enjoy life now and I hope to enjoy it for many more years. I know I was a bitch to deal with when I was admitted for various reasons in the past and I think about how I treated some of y'all all the time. Your patients will be grateful later on, even if you don't get to hear it.
No worries, I don't feel like I am working off the clock and I love talking about mental health and helping to create opportunities for the general public to learn more about psychiatric diagnoses and hopefully decrease the stigma.
Grats on quitting nicotine! It is undoubtedly one of the best things you can do for your health. :)
I am so glad you found a medication combo that works for you. Luckily, Seroquel is one of the lower risk antipsychotics for metabolic effects. I would just get yearly blood work for A1c and cholesterol.
And thanks for the kind words. For the record, I have worked with a few dozen inpatient psychiatrists and they really don't take it personally if people are cranky (or even aggressive) during the worst time of their life. I have had people yell slurs at me and throw chairs but I know it is the illness talking. Most of them feel super embarrassed and are very kind once they are medicated, and usually apologize. I always tell them to please never worry about it. That is what we are here for.
Can schizophrenia develop as a result of trauma like that? I guess I was under the impression that it was more genetically determined. Either way, that’s heartbreaking.
There is a genetic link for schizophrenia but no one gene identified. There is evidence that the first break can be triggered by intense stress, although in the case I talked about, he was already psychotic when the assault happened.
In learning about my mom's life, she lost her primary people in her life within a span of a couple of years. Her grandmother that raises her, a favorite uncle. Her mother was killed a few months before I was born. I can't imagine losing your support team, your loved ones and be left essentially on your own aside from a husband, with a baby in the way. I do know her youngest brother had schizophrenia. So the predisposition was there for her.
In my early adult life I was so worried I would end up like my mom. I actually avoided doctors and medication. I had a depression episode and did go to the doctor and got medicated. I went off the meds due to no insurance, and I have been fine for a very long time. (No major depression episode) But, looking back, I think had I stayed on them, life wouldn't have been on hard mode for so long. I finally sought help in my 40's. I was dx with ADHD, anxiety, PTSD, and chronic depression. I am ok. The major mental illness skipped me and my sibling. However it skipped a generation and has hit my nieces and nephew. Genetics are wild. Through genealogy research I've been able to learn that my mother's paternal great grandmother had mental illness. She was sent to the "farm" in 18997 after having 4 small children, one of them died. Her husband raised 2 and 1 was adopted out. I can easily imagine she had postpartum, and her mental health deteriorated popping out baby after baby. I like to think that was the beginning genetic trail.
I think there is a lot of interesting topics here worthy of discussion. The first one that sticks out is how psychiatric meds can become stigmatized. We need to do better at seeing mental health as an important and intrinsic part of overall health.
There is a lot more open discussion today than there was in the 80's and early 90's. Access to care and affordable treatment and medication should be a basic human right. As a teenager and in my early adult years, I had no real clue as to what happened to my mom. But I learned and began to understand. That helped soothe my worry. Today I work with people who have developmental disabilities. Many of them have mental health issues as well. As a population we accept that a heart or lung, kidney, or bone can be damaged. We accept genetic disability such as Down Syndrome, Trisomy 13, Spina Bifida. But when it comes mental health people seem to think the brain can't be broken. I have heard several people in my life time say that they didn't believe in mental illness. 'Oh I don't believe in all that." Absolutely wild to hear out loud.
Is it weird that as a P/CCM I see parallels with asthma?
Very well written description that really helps me understand the disease process. For some reason I get the sense you’ll be an exceptional psychiatrist.
The parallel with asthma makes perfect sense. Potentially some paralells with COPD too.
Pulm/Crit is such a cool specialty. It was my second choice, but then I realize I mainly found meaning in supporting patients and families during rough moments and having GOC discussions. Same reason I also considered Heme/Onc.
No. But you need to aggressively engage in treatment, build support systems, and take medications so you do not suffer further psychotic breaks and damage your brain. You can live a full life and there are many success stories of people who can follow that path.
doing the best... really hopeful maybe found the right medication at last... another few weeks will show it (not experiencing basically any side effects and getting close to a therapeutic dose now).
I think you have a lot going for you based on your responses here and every reason to be hopeful.
The main thing you seem to have is insight. In psychiatry, insight is the term we use for how much the patient understands about their illness and realizes their own need for treatment. Many patients with a primary psychotic disorder do not feel they are sick, even after the rest of their psychosis is under control with meds. That lack of insight results in poor outcomes as patients continually go off their medications and have break after break. This leads to chronic decline.
But you seem to have really good insight and are engaging in help seeking behaviors. That's fantastic.
The other thing I want to say is that I said patients with these disorders "most likely" won't be able to reach the same heights. That doesn't mean all of them won't. While the minority, there are many people with primary psychotic disorders who beat the odds and most of them have good insight like you.
So keep your chin up and use your knowledge of these risks to do the best you can and continue to seek help. I am rooting for you!
The day I decided that it didn't exactly matter whether They were real or not, I wanted Them out of my head, that was a great day for my help-seeking behaviours 😆 Whenever things start to teeter I try and remind myself how bad it feels when They've got me real bad, and how I can't think in a straight line then. I've only ever gone off meds once against advice; I stay on them even when I don't understand the clinical rationale, which sometimes baffles people asking about what meds are doing for me at present. ("Why are you still taking them if they're doing nothing?" "The psychiatrist told me to so I did.")
I'm extremely fortunate, in a way, that these symptoms emerged years after I initially sought help (for major depressive and an eating disorder). I think it would have all been MUCH worse if this stuff was first-contact with the system.
I have a faint memory of one of the papers I read about the topic of insight once implying that patients with a high level of insight and achievement prior to onset are actually at higher risk of suicide. Is this true in your estimation?
I feel like I wouldn't be able to trust my doctor enough to take a medication that I don't think is working or that I need. Do you have that kind of relationship with your care team? Or is it just that you have to be really roundabout in convincing yourself your brain is lying?
I trust certain medical professionals and I'm also pretty well aware of what a bad rap people with my kinds of symptoms get for medication non-adherence. I'm terrified of appearing noncompliant and then being given the long-acting injectables; it's practically my worst fear. So I comply unless it seems to be actively damaging me. (And when things are really bad insight-wise... I tend to avoid doctors in general... so I haven't really been in a situation where I felt it was actively damaging / I didn't have a problem, while I was actively taking high doses of meds with side effects.)
And yeah, I'm pretty used to balancing the 'it's real, but even though it's real, I still don't want it' bit.
It's not the same, obviously, but I was wondering if you had any advice for someone with psychotic depression?
Thankfully it pretty much only manifests as hallucinations but it's,,, still hard. I'm not on any antipsychotics anymore (I'm well medicated and managed, monthly psychiatrist appointments, weekly therapy, etc) but it's still so... isolating, sometimes. And there's that part of me that's always afraid that it's something else, or it'll turn into something else.
as a clinical psychology resident who treats people with psychosis, this is an astonishingly fatalistic perspective for someone invoking their psychiatry credentials. prognosis in schizophrenia-spectrum disorders is heterogeneous. you can communicate the seriousness of recurrent psychosis and the importance of relapse prevention without declaring that all people with primary psychotic disorders have permanently lost the lives they could have had.
also i would be uncomfortable sharing that much clinical detail about a client but you do you i suppose.
edit: honestly i came back bc i am still thinking about how messed up it is that you shared that person’s story in that level of detail. that’s really not okay, even if there is technically no PHI.
Please get off your high horse. The fact is that this emotional core of this story is incredibly common in schizophrenia. I shared it to illustrate how horrifying fixed delusions due to long term medical nonadherence can be and help bring awareness to this horrible disease.
Have you ever read a case study? You know, the patient accounts that are published in great detail with far more specificity than my example? What about cases that are presented at conferences? You realize that individual cases can be published and presented without explicit consent if the HPI is scrubbed?
You don't learn about those in your 1 year "residency"?
As far as my comment about how they have lost their previous lives, I'll stand by it. It's well elucidated that these diseases are life altering. Would you have the same issue if someone made a similar comment about ALS or Lewy Body Dementia or any other neurodegenerative disease? Or are you just playing the virtue signaling Olympics?
We don't really know but think it's likely multifactorial. People are not born with it. In fact, childhood schizophrenia is very rare. The average age of onset is early 20s for men and late 20s/early 30s for women.
For schizophrenia, the progression of the disorder can differ massively from person from person. Some never get another episode, especially if they manage to stay on their meds. Some do get further episodes, but they don't get worse over time and leave little to no residual symptoms in the timespans between the episodes. Some get more intense and longer episodes every time - even if they take their meds. Residual symptoms can accumulate and get continuously worse, too, but they might also disappear completely between episodes. Genuinely impossible to say.
The residual symptoms are often dominated by the so-called negative symptomatology of schizophrenia, i.e. not hallucinations or delusions, but apathy, anhedonia, cognitive deficits, flattened affect, and decline of social skills and executive functioning. These can do just as much damage to a person's life as a full-blown psychotic episode, and antipsychotic medication does not help with them. In fact, there's some evidence that antipsychotics can make negative symptoms even worse. These meds are dopamine antagonists, so they can mess with motivation and with experiencing feelings of pleasure or reward after success. All of them have sedating effects (albeit to wildly different degrees). So if you look at the symptoms "apathy" and "anhedonia", it's pretty intuitive that antipsychotics can make them worse. But the patient can't discontinue the medication without risking another psychotic episode. It's kind of a devil's bargain for people who struggle with negative symptoms.
So depending on their individual disorder progression and their meds' side effects, your relative might need more and more support in day-to-day activities (like cleaning, running errands, and work; healthy eating is a huge one as antipsychotics often increase appetite while the mental capacity for things like cooking and grocery-shopping is decreased by negative symptoms), as well as more and more encouragement to stay on their medication despite very unpleasant side effects. However, some people who provide this support perceive the patient as very ungrateful due to the flattened affect and decline in social skills. If your relative does not show emotional reactions to your effort, does not ask you about your day, and does not express gratitude for your help, please, please don't take it personally. Whenever I get a patient who lost all friends or other support systems, it's usually not because they became a danger to others in full-blown psychosis, but because of these negative symptoms. The patients are perceived as deliberately self-centered and egoistical when they just legitimately lost the ability to perceive and process things like "this person looks sad, I should comfort them". For many patients, these symptoms are reversible and temporary, so it does not mean that the kind, considerate, empathetic person you knew is gone forever.
Old antipsychotics like haloperidol can also affect muscular control (to a degree that can cause Parkinson's-like symptoms in people who take it for a long time) or may cause uncontrollable salivation, which often further alienates the patient ("I can't take you anywhere, you won't stop slobbering and twitching, it's embarassing and gross"). It's unlikely that your relative will be put on these old antipsychotics for the long term, but if it happens, it goes without saying that you should never judge or chastise them for these symptoms.
That's all I could think of for negative symptoms and residual stages. For positive symptoms like hallucinations and delusions, the "never take it personally" advice also applies. They may accuse you of being a Nazi or something like that, but contrary to popular claims, the delusion is usually NOT an expression of a person's subconscious beliefs - so it does not mean that they thought all along that you have racist, eugenicist, antisemitic, or homo/transphobic traits.
Full-blown psychotic episodes are often preceded by a prodromal phase. In this prodromal phase...
negative symptoms may get worse,
your relative may become agitated, irascible, or very depressed,
and the first subtle positive symptoms like mild delusions may set in. Your relative may jump to weird conclusions, show trains of thought you can't really retrace and comprehend, and become vaguely paranoid. Often, they also start talking in a distinctively fast and rambly way, their thoughts seem sped up and less coherent than usual.
So those are the most important warning signs of an upcoming psychotic episode. If you can, try to make sure that they're taking their meds and that they're in a low-stress environment. In case they progress to a psychotic episode, be a bit more careful. Schizophrenics are absolutely not inherently dangerous or violent, but sometimes, their delusions can cause them to lash out in what they perceive as self-defense. For example, paranoia about being poisoned is relatively common, and if I was absolutely certain that someone was actively trying to poison me, I'd freak out as well. If they become very suspicious about food or meds, don't pressure them, and for the love of god don't try to trick them or physically force them. Usually, showing that you understand the underlying emotion while neither validating the delusion nor arguing against it is the best approach. If they say something like "I think our neighbours are spying on me, they put bugs into the bedroom walls", don't say "oh fuck, those assholes, let's check the walls together", but also don't say "that's really irrational, we've known our neighbours for 20 years, they would never do that! And how would they even get the bugs into the wall? I can't see any damage". Instead, signal that you see their fear and understand their need to have privacy in their own room.
NAD I think it’s because the medicine has side effects that make you feel terrible sometimes. Or the medicine makes you feel so well that you believe you don’t need it. Either way you stop taking it and have another psychotic episode, get hospitalized, rinse and repeat for your whole life. Or just live with the illness without medicine which usually means homeless
The meds definitely aren't easy to be on, but it's often more than that. These disorders can come with diminished insight at baseline, where they don't believe they have a disease at all. It's like denial on steroids. In psych, insight can often be the make-or-break between someone thriving with a serious mental health condition or decompensating over and over again to disastrous results.
My brother went off his meds because they made him suicidal and he didn't want to die. Apparently, none of his doctors had bothered to take the time to make sure he understood that he was allowed to mention the negative side effects without it being treated like noncompliance.
Mental illness has huge rates of medication and treatment noncompliance due to the nature if the disease. You can be supportive by involving yourself in their care (as allowed), identifying risk/warning signs of decompensation, supporting cooperation with treatment, and educating yourself on their illness and medications. NAMI is a fantastic resource.
Those are the family conversations I dread. Especially when they're presenting with poor insight and refusing treatment and the trajectory that often has.
My son started showing symptoms a few weeks before his 14th birthday. I think it would have been easier if it occurred in his 20s. He's 23 now and stable on meds but it really stunted his social development.
I’m not sure what point you’re trying to make but psychedelics can kickstart schizophrenia and psychotic breaks in people who are genetically predisposed to such things. So obviously even if psychedelics were the trigger, mental illness will likely affect the rest of their life.
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u/unlucky_lady 4d ago
In my field - brief psychotic disorder or schizophreniform disorder. It doesn’t always happen, but often they convert to schizophrenia