Posted by: drhaisook on: June 20, 2006
Because this article was initially written as an educational aid on schizophrenia, not as a place for people to tell their psychological problems, commenting has been closed.
If you wish to discuss your medical problems with me and with other users, head to Dr Haisook’s Medical Forums, the rightful place for such.
I appreciate your understanding.
By: Dr W
Many readers have read my post from last Fall about the fact that reality is only relative, and that the term “normal” is a flawed concept. With that in mind, I’m going to tell you about one of my patients. Before continuing, please read the list at the top of the page about HIPAA compliance. There is no information shared here that could possibly identify this patient. The patient would not recognize it himself if he read it.
Some background info on the patient:
Mr. X is a young man newly diagnosed with paranoid schizophrenia. He had his first psychotic break a few years back, and after speaking with his family, he had prodromal symptoms for a couple of years prior to the first psychotic break. When I began seeing him, he had become convinced that no one, other than himself, could kill him, because many had tried without success.
He reported multiple incidents in which he’d been injected with something while shopping, and he’d also had a dream which he’d come to believe was a premonition in which he would die, by his own hand. He also very frequently spoke of a government conspiracy to kill him. The patient became more and more ill, and soon, he began to hear and see things which nobody else could (hallucinations, according to prevailing social and cultural norms where we are). This patient was in danger of harming himself, and potentially harming others. I ordered him hospitalized, which he did not believe he needed–they rarely are able to see this. Ultimately, though, he cooperated and was able to be released.
It took some time to build rapport with this young man, which is a common problem with people who have schizophrenia. I avoided using the term in sessions with him because I knew that knowledge of his diagnosis would likely bring him down emotionally. So, when he would enquire as to his diagnosis, I would simply say, “you have a problem with perceptions, and we can treat you with medications and some psychotherapy.” He would often ask “am I crazy?,” to which I always responded with “absolutely not.”
He agreed to take a medication, one of the atypical antipsychotics, which have been available for the last several years only (<10 years), which have been thought to be safer than the older antipsychotics, commonly known as “neuroleptics.” At any rate, close monitoring is mandatory for patients requiring this type of medication.
I also set about to involve him in psychotherapy. At first, I tried referring him to a psychologist in the community who I know does good work, and who has experience with helping those afflicted with schizophrenia. However, the patient refused to go. His explanation to me was “I dunno.” When I asked his sister, though, she told me that he wouldn’t talk to anyone about his illness except me. However flattering that may be, it didn’t bode well for the patient.
The whole purpose of psychotherapy in this patient (as with most diagnosed with schizophrenia) was to keep him functioning in society. He needed to work; he needed to continue to maintain his lifestyle, which would not be possible if he were to be awarded disability. I’m talking about social recovery, a concept in psychiatry in which the patient may have some symptoms, but these are very greatly overshadowed by continued ability to work, maintain relationships and lifestyles, etc.
This particular patient didn’t even want disability–he wanted to work! I supported him in his effort to return to work. After returning to work, he continued to come to the office every month, and he continued to do well. He thrived socially, reestablished many of his old friendships, and maintained contact with his family.
The patient discontinued his medications when my year in the outpatient clinic was over. I had worried this might happen, and told the new resident coming to the clinic that this patient may have trouble with “the transition.” This proved disastrous to the patient, actually, because he would not talk to anyone about his illness except me. I wish somebody would have called me; maybe I could have intervened in some way. Thankfully, though, this patient did end up in the hospital before he harmed himself or anyone else. It was a close one–ALL BECAUSE HE STOPPED TAKING HIS MEDICINE. This is common theme in psychiatry.
What was even more fortunate, however, was that I happened to be working in the psychiatric facility when Mr. X arrived. I took him as a patient since I knew him well. His thought process was disorganized, clearly he was hallucinating, and he refused to sleep because he believed that if he did, the world would come to an end. He’d been told this by “someone.” After several days, and several hours of just sitting and talking with him, he was able to be stabilized.
After the hospitalization, I made special arrangements in order to be able to see him in the clinic. He has done very well on his medicines, and he shows up at the office, faithfully, every two weeks. We talk about whatever is on his mind, and he tells me about side effects of medicines, and we discuss the options for alleviating them. I let him decide what to do about the side effects, within reason, though. He has told me several times that he does not want to change his medicine because he doesn’t “want to get sick again.” Like the last time, he has re-connected with his friends and family, but unlike the last time, he has no job to return to. He has decided to attend college after a few months of rest, which I think is a GREAT idea.
Now, I’m getting ready to move away, and of course I am extremely worried about this patient. I have two other patients with very similar stories that I also worry about a great deal. All three of these patients have the same diagnoses and take atypical antipsychotics, they have moderately similar backgrounds, and all three have done very well since they started medication, and stayed on medication.
Dr. W
© Copyright, “Dr. W” 2006
Dr. H:
Schizophrenia, any form, is rare, actually. Incidence is only 1%. The reason I have so many patients with this illness is because I “specialize” in what is labeled SPMI (severely and persistently mentally ill). My practice now is made up of approximately 50% of such patients. When I move into my new position in August, 100% of my patients will be those considered “SPMI.” (I only use these labels for simplicity sake–I hate labels, actually.)
Antipsychotic therapy usually is not enough in the acute phase. Antipsychotics, along with emotional support (supportive therapy), in the maintenance and remission phases, are usually all that are required. Occasionally, an antidepressant is also indicated, if the patient has what we call a “post-psychotic depression,” (*311). This is not the same as Major Depressive D/O (*296.xx). In the acute phase, which usually means they are hospitalized, they often require the antipsychotic, and a benzodiazepine, or another medication that will help them sleep and/or relax. The last thing you want is for such a patient to be stressed.
Don’t get me wrong about the sedative, though! We do NOT drug them into zombies! That is a thing of the past. We want them to be out of bed, alert, and as functional as possible, even in the hospital. Sometimes, especially in the first few days of hospitalization, they are too psychotic to really participate in therapeutic activities, though, so they are simply given the opportunity to rest, if they like, or talk to psychiatric nurses, or wander the halls–just as long as they don’t get stressed.
Psychotherapy which is more insightful than supportive, e.g., psychodynamic, insight-oriented, etc., is not indicated in any phase of a psychotic disturbance. It can do more damage because it forces the patient to confront/challenge their delusions, which most often causes a sudden collapse of the ego. This is not a good thing to do to someone with this diagnosis. The goal of medication and therapy is to first stabilize them so you can talk to them, then emotionally support them and encourage them to be as functional as can be reasonably expected, depending upon their individual problems/stressors/strengths. Then, you can achieve social recovery, like the patient above.
*296.xx and 311 are DSM-IV-TR codes, if you didn’t know
Dr. W
After reading your article I thought of giving a comment about Schizophrenia and to share it with other readers. Schizophrenia is a psychiatric diagnosis that describes a mental disorder characterized by impairments in the perception or expression of reality and by significant social or occupational dysfunction. Schizophrenia has been found that patients suffering from schizophrenia at times hear voices which are not heard by others.
Hi,
I know you probably won’t respond to this because you will not have enough information, but I will try to give a short summary of years of pain and upset.
My mother and father went through a horrible divorce when I was 14, followed with custody battles, etc. We were an upper middle class family, torn apart. My mother has been convinced that my dad is gay and there is a gay network in the United States where they all help eachother with their dirty deeds (aka him getting custody of me as ordered by the courts). She is convinced he paid someone to knock on her apartment door at night on the anniversary of the day the courts granted him custody (she was in Pittsburgh, we are in Milwaukee).
Basically, she has all these delusions she has held on to years and she will not stop bringing them up. She will fill my phone with messages and call minute after minute. She refuses she has a problem and refuses to go see any therapists or seek help because she feels they are all against her and in the “network”.
Is this characteristic of paranoid schizophrenia? I am so frusterated. This is my mother, and I love her, but it is so difficult to communicate with her and she has poisoned my memories with her beliefs for so long that I have been very very angry with her. I need some answers. I don’t know where to turn anymore. I’m 20 years old and I don’t have the money or means to do anything. She does not have contact with ANY of her family, and she lives in her car.
Please help
I have paranoid schizophrenia and i just found a new psychiatrist and he acts like he doesn’t want to deal with me. I don’t think this man has alot of experience with schizophrenia. do you think it should matter to me if he has a lot of experience because he is a psychiatrist. Do I have to only go to a psychiatrist that specilaizes in the field.
Do you think it is possible for someone with schizophrenia to obtain a college degree while on medication. Do you know anyone who has done it?
Hi,
I wrote before about my undiagnosed mother who lives in her car.
To answer, I know she has a great deal of money from the divorce (almost 200k), but she refuses to find an apartment because she says everyone is against her. I personally think she is doing it to make people feel sorry for her, manipulation.
She also thinks medication is “evil”, even antibiotics.
I read all these messages and posts and stories about people with loved ones who are mentally ill and get help, but I know for a fact there is no way to get help for my mother. She is convinced there is nothing wrong with her, and actually turns it back on me and says I’m the one with a problem. My mother is very smart and manipualtive. She is constantly threatening suicide and threatening to never talk to me again when I don’t meet her demands (which I used to do when I was younger but don’t do anymore).
Basically I have no hope. I have never heard her be vulnerable about herself. In her mind, she is a saint of some sorts, almost like a martyr. She believes she is suffering at the hand at everyone else and all people are evil for the things they do to her (i.e. tell her she needs help, doesn’t agree with something she says).
Even if she did go to a psychotherapist, keep in mind that she is extremely intelligent. I don’t know how professionals diagnose these disorders, but trust me, she would make it sound like there was nothing wrong with her.
I don’t know what to do. Sometimes people tell me I should just pretend like she’s dead. THe mother I knew when I was very very young isn’t there anymore. I feel like I need to cut her out of my life for my own sanity. But I just can’t do that.
Help
I hope this is the right place for this inquiry.
This year my daughter was diagnosed with schizophrenia. She had been living with her common law husband for about three years. We really don’t know when she started showing signs of her problem since we saw her for such short periods of time that any odd behaviour was usually rationalized. Since we have had her home we realized as does she that rather than trying to get her help her so called partner was using her deteriorating state to his advantage. He kicked her out of their apt. shortly after she was diagnosed. In fact it was a friend who convinced her to go to the hospital where they admitted her . Any way enough of that I really wanted to know if anyone has had to deal with outstanding debts, seems things were in her name and since she worked sporadically he paid or was to have paid the bills but didn’t. If anyone can give us advise about this I’d appreciate it because we are just going through a traffic case over him driving her car without insurance and she was charged. I would like to know what to do if anything else pops up.
Our girl is doing not so bad these days. She is in control of her meds and takes them as she should. Her behaviour is a good indication having experienced her in hospital before her medication was regulated. She seems to know the consequences of not taking it. It just breaks my heart when I think of the state she was when we found her on the street and brought her home.
Thank you for your response. I guess we are the luck ones to be able to have our child safe. It is not all easy going but I can see more and more of the daughter we raised showing through. Her support network has been terrific so far. Thanks again for the advise.
Dear Dr. W,
I was just browsing the net searching for “paranoia” and “schizophrenia” and stumbled on your site. I am grateful for you for reading and hopefully, responding.
I have been a schizophrenic for the last 20 years. I have just had another breakdown two months ago. The last one was six years ago. When it happened, I just quit my job. I began feeling persecuted. I went to a doctor I had known earlier. He scared me about joblessness, being on the streets and so on. So after a month, I went back to my job (as a medical transcriptionist). I just couldn’t cope and left again. My maintenance drug is risperidone 2 mg q.h.s. But now I am also on citalopram, clonazepam,lorazepam. As the doctor I went to was not really interested in my feelings, and more on getting me back to my job, I stopped seeing him and went to another facility. Here they listened to me for an hour. They added trihexyphenyl hydrochloride but didn’t counsel me or anything. I am due to go back in another week.
About myself, I am 41, male, single, both parents deceased, college dropout but with good language skills. I know it is foolish to say that “they” are all after me, but I am convinced that something somewhere is not right. In this most recent breakdown, whose onset was due to a heavy workload at the office, the first thing I noticed was my thoughts going awry, and memories, old, coming up from the bottom. The meds made me feel good. But I am still wary. I refused to go with the family on a trip. I want to make trips but feel so paranoid that I drop the idea. I do not want to meet relatives. I meet friends very rarely. I am afraid of going back to the office. I am afraid of working from home, because I fear that “they” will shut off the power, and cut my internet connection, both of which are essential to working from home.
So now I am not too paranoid, but I am not living life to the full. Just last week, I turned down an offer to go out and see a movie. I have this feeling of being watched. So I am just surviving. How can I be convinced that “they” are not after me? I am scared of crossing the road, afraid of being knocked down. Could you just help me out a bit? Thanks.
Looking forward to hearing from you,
Yours sincerely,
Ganesh B
Hi,
I have a similar case with my mother as Shopie’s.
My parents too are torn apart but not divorced. My mother feels that my dad is a womenizer and he sleeps with all the neighbourhood women and servents at our home. She belives this so deeply that she belives that every one in the family (Dad’s family)encourages him to do so, and they want him to divorce her. She feels every one around her is plotting and scheming against her including her own mother and myself.
She was taken to a docter few years back and she was asked to take medicines. I started staying with my mother only recently. I understand that her problems aggravete when dad is around. And recently dad took retirement and has been staying home , now for almost one year. In this one year, her paranoia have aggravated to uncontrallable and unbearable limits. Though dad now stays in our farm house, the problem is only getting worse. She feels that he is plotting against her sitting there. She shouts at our neighbours and at everyone she is suspicious of.
Recently i took her to a doctor and he said that she is paranoid. He asked her to be admitted to a hospital as she is showing hisitance to take medicines regularly. But due to social problems, my family hesitates to do so. My grand mother is trying to make her take medicines, but its very difficult.
Is there anyway we can make them take medicines at home itself. Please hepl
Ashwini
Dear Dr. W,
Thanks a million. I was eager to hear from you, and your letter really helped me out. I am keeping that appointment tomorrow.
Again thanks doc,
Ganesh B
Thanks Dr. Haisook. Ganesh B
Dear Dr. W,
I think the medical system just sucks. My doctor is anxious to get me to go to work whether I am paranoid or not. As though a few weeks of doing nothing will do me any harm. I have been going around for years without job and didn’t really have a nervous breakdown. This one, the one I am going through was clearly brought on by pressure at the office. It makes sense to be out of a job for a while, or to choose a less stressful job. At the last time, the doctor escalated my medicines, just because I told him I am suspicious of everything. If it goes this way, then they will say I need shock treatment. They already did that years ago by giving me a shock and obliterated a part of my personality. I am really thinking about alternative forms of treatment. I have been reading about Dr. Laing and I think he feels that mental illness is just not treated by pumping medicines. Your forum has been helpful though for airing my views.
Thanks
Ganesh B
Dear Dr.W,
I think my therapist out here in India thinks paranoia is like a common cold. You take Tylenol, and a few Kleenex and you can go to the office and work. I wish one could have paranoia and still go to work.
Looking forward to hearing from you,
Thank you,
Sincerely,
Ganesh B
Dear Dr. W,
I was hoping to hear from you. Anyway, I’ve just got a nagging doubt. You know, I am paranoid and go around suspicious of everybody. But there are times when I feel good, listen to music, or read a magazine. Does that mean I am bipolar or maybe, manic depressive? I hope you don’t mind, but through your forum I get a lot of things off my chest.
Looking forward to hearing from you,
Thanks
Sincerely,
Ganesh
Dr W,
I am 26 yr old, recent graduate living in the US. My older brother, who is now 34 suffers from paranoid schizophrenia for almost 10 years now, and lives with my mom in india. My father who was a heart patient passed away 3 years ago, since my brother’s condition was too much to handle for him.
The reason I am on this forum is because I am really frustrated as to how i should go about dealing with the situation, now that he has turned homicidal. He tried to kill my aunt, because he thinks she and her family are plotting against him. His doctor in india suggested hospitalization for 15 days after which he said that my brother will return to a more stable state than right now.
Socially, the biggest issue is having him stay with my old mom, and with my aunt their family who he thinks are his “enemies”. Being here in the US, there’s only so much i can do, since my career would end before it starts if i go back to india. His doctor mentioned that he needs to be hospitalized for 15 days, and depending on his condition, a decision of him being treated at a bigger facility (and about 4-6months)can be made, which me and my family interpret as “he will be treated at the bigger facility if he attempts to kill someone again”. I would appreciate it if you could suggest something in this situation.
hi
i have a boyfriend who has paranoid schitzophrenia
we have a child together when i first started dating him i did not know this today 6 yrs later he has had a really bad episode so bad he had to be put in a hospital but they only kept him for a couple of days he is now taking zyprexa and has been for 6 days. I am tottally stress though im loosing my patience i dont no have long i can try to tell him no ones after him or there is no microphones in my ears he also believes he is responible in some way for the sniper murder. How long does it take for this medication to work? At times he can seem so normal but lately his pariona is getting worse. Do you have any advice please help. Is it selfish to say I just want to leave and live a normal life with my son or i should just hold on a little longer to wait because he will get better?
Jamie
I have been married to my husband for 15 years now, just in the past year he has been hospitalized 3 times for Paranoid Schizophrenia. He is 32 years old, with no family history of this disease. He has hacullinations and is very delusional. He is taking Risperdal 3 times a day, Seroquel, Prozac and the Risperdal Consta shot every 2 weeks. He use to drive an 18 wheeler, he now thinks he is “fine” and wants to return to driving. How can I convince him that he cant go back to driving at this time? I dont want him to discontinue taking the medication and end up in the hospital again.
Iam suffering from Paranoid schizophrenia, My age is 30 years. I am on Divalprex 500,rispfortplus and belif 25 mg.Can my disease is curable
I have a former friend whom I suspect strongly is suffering from paranoid schizophrenia. Her speech patters are often extremely disorganized, where she jumps from one thought to another. It would often become very hard to follow what she was saying. She has a hard time holding onto one job, because she always seems to have problems with the people she’s working with (i.e. she thought that the people in one company put ’something’ on her head to track her movements and had her under some kind surveillance, as well as her dog’. She also thought that since a man looked at her in a certain way, that he was able to make her trip on the carpet. Her family is very unsupportive of her– I think they have their own issues. She insists that a spell was put on her when she had her tonsils out as a child. When my husband wished her luck at her start of a new job, and she saw me a couple of days later, she said “your husband wished me luck, and then ‘they’ attacked me”. I terminated the friendship, which caused some problems, since she lives in the same neighborhood as me. I could not deal with the delusions anymore. She mentioned to me in the past, her belief that mental health doctors are in the business along with the drug companies to just make money off of the drugs. At the start of the friendship about 1.5 years old, I knew something was wrong and I thought I could deal with it/maybe help her. A couple of weeks ago, she saw me outside and she started to yell about the ‘that rude woman’, which I’m assuming was me.
How do you tell someone that they to go talk to someone/or that they might need medication?
HI,
I was wondering if one of the doctors can give me some advice. I have developed tardive dyskinesia while on geodon. I was exposed to the older drug haldol before because I was non-compliant at one time.What should I do? should I get on clozaril right away?
Comments are closed.
June 22, 2006 at 2:18 am
I wonder if Paranoid Schizophrenia is common among psychological disturbances. I mean, how often do you come by such case? You’ve already mentioned you had taken care of 3 cases at the same time. This makes me think it’s really common.
And do you think antipsychotic therapy is enough for such advanced psychotic disturbance? or does emotional encouragement plays a bigger role?