Family and Caregiver Schizophrenia Discussion Forum

Advise on how to handle my isolated son

My schizoaffective son who has no insight but is med complaint has completely turned his days into night and nights into days and barely answers my calls . Does anyone have any ideas or suggestions to help him out of his apartment ? The last time i went to see him was about a month ago and his room was a total mess and dirty , by some miracle he allowed me to clean which he never does but rushed me and finally said i had to leave before i finished . I can’t imagine the state of his room now . I tried so many ways to get him out and offer to clean for him but he refuses .Right now its worse as he sleeps all day and is up all night probably playing on his xbox . Any ideas or suggestions ?

Offer to hire a maid to clean every two weeks or so. I’m SZA and I did that for myself and it changed my organization and social status for the better. My parents also hired her for themselves and my brother with bipolar disorder.

It gets boots on the ground in his space and gives him some social contact and a clean apartment without Mom-ing him.

A likely reason he’s turned night into day is to reduce and control how much stimulation he gets and social contact which is also stressful. I did this when I was in college. To get him out you will need some incentive or reward for going out, and some assurance the environment is safe and controlled.

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Thank you , i did offer him a hire maid and he refused , i need to somehow bribe him with money or a new game or something … so hard . I tried so many ways to get him out the house and last night he left for 20 min to buy food and came back home . Its as if he is allergic to the outside world !

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My husband (still not wanting a return to medication) has been making efforts to get out of the house more at the encouragement of his family (who live far away but whom he trusts). He hasn’t been very motivated to leave the house on his own accord, but he has been doing so with me, as I have told him I really miss being able to do things with him and it is clear that he feels much better about himself when he is able to do “husbandly” things.

On the positive side, we have gotten out for a couple of hikes in the past week and we bought a Christmas tree yesterday.

On the negative side, these outings are quite stressful for us both.

Given that he remains paranoid about me and my motivations (although I know he is doing his best to push these thoughts aside), it is hard for me to provide him with an assurance of safety - especially as his ideas of reference are pretty strong, so he tends to perceive anything a bit out of the ordinary as threatening. And sometimes the world just does NOT cooperate, such has having a young woman with a high quality camera hanging out at the trailhead to our favorite hike!!! I could hardly have designed something worse for someone who thinks he is constantly under surveillance . . . .

My basic strategy has been to try to pick activities that are likely to be as low stress as possible (I was really quite pleased that he was up for the Christmas tree purchase, as that certainly was innately a lot more challenging than getting out for a walk etc.) and then to just let him have his reaction as I know if I try to suggest that things that worry him are likely just a coincidence etc., it is not helpful. And although I have been giving him feedback that I feel a lot better when he is kind to me (which surprised him but he has really been working on it), I have been ignoring the cutting comments when we are out and about, as I do get that anyone is going to be more irritable when they are actively under increased stress so this seems like a time when I need to cut him some slack.

Any thoughts?

he is afraid of the outside world…

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That’s great that he was able to leave to buy food. Trips to the store are probably less stressful for him at night, when most people are sleeping rather than shopping.

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Yes, it is. When first became psychotic, I had to pretty much pull out of all social contact myself, as the more I interacted with other people the more of an “enemy” I appeared to him.

This increased my own stress quite a bit, of course, so when my husband was taking medications and doing a lot better, I started pairing an outing with friends with bringing him home food he especially enjoyed.

I continued to do this during his relapse, and it has made him much more OK with my spending a little regular time with other people. Bribes can work!

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I will try and never give up on my boy !

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Proud of you for having insight , i think thats amazing and wish one day my son may have insight also . On another note do you think that therapy will benefit someone having no insight ?

I’ll consolidate a few responses here. I forget who it was who mentioned that her son responded well to going on impromptu car rides and opened up and talked much more than usual, but I’d recommend trying that and perhaps leveraging from that to going through drive in services like banks and food service, drive-in movies (there are still some of these in places) or scenic drives etc.

Riding in a car is a unique environment where you have the feeling of control of your environment, but are outside. By yourself and seemingly safe, but part of the community. It’s also more difficult to believe you are under surveillance unless you are being followed.

I’d view it as if you are building up endurance or exposure to a difficult environment. A short walk or drive might lead to a longer walk or drive if you keep checking in on him and promise to end the activity if it’s too much for him.

Incentives like gamification with rewards or medals etc. may appeal to him. As far as therapy goes, I’d again try to leverage his Xbox gaming and go for directed and goal-based therapy like CBT. Most games employ operant conditioning and goal seeking behavior so it may seem familiar to him. Another component of online gaming is text or audio chat with fellow players. There are similar interactions he might have with online therapists.

I wouldn’t recommend undirected or traditional face-to-face therapy for someone without insight.

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So about 2 hours after i put up this post i get a txt from my son saying , what do you have to eat mum ? i went through 10 different kinds of foods i made until he decided which foods he was allowed to eat or not (he has belief that most foods are not good for him ). I told him to come over and surprisingly he did . I didn’t mention work to him or therapy or anything that would stress him out and he stayed for an hour , i was soooooo happy .Yesterday i was crying how isolated he was and today was a good day . I also bribed him with some money that we both clean up his room this week and he agreed . Thank you for your suggestions ! i also thought about online therapy but his ability to concentrate and take in what people are saying is very hard for him and he would be distracted with his surroundings but my thoughts are if he would see a therapist face to face it would be in an office and he would have no choice to try and take in what would be said but on the other hand how can therapy help if one has no insight ?do you know what i mean ?

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your son seams pretty far gone, as with both of mine, therapist are a total waist of time and money, both our doctors have never required them to see a therapist, in one ear and out the other… make sure he is not shooting H with the cash…

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@Maggotbrane , my son loves to drive. I’m so glad he found the ONE thing that he looks forward to. He used to walk for hours and hours when he started getting really sick, but now he walks maybe an hour a day (a normal walk). He says he does it because he doesn’t want to get fat. He did put on some weight with Zyprexa, he was always athletic, (6’2”, 180 lbs), now he is close to 210 lbs which is still not fat for his height, but he’s still uncomfortable.

That was me that posted about our impromptu drives. We still go together sometimes, but he seems to really enjoy driving alone. I was filled with anxiety about him driving because of his condition, but the driving has had the opposite effect on him. The driving seems to bring him back more to reality and in sync with the rest of the world. Now if he could only find a job…

@Linda, not sure if your son drives, would he enjoy short car rides with you? I found my son talks more in the car. Maybe that could get him out of isolation for an hour or two, while also having him open up a bit. Having him talk more is a great start, that leads to other things, maybe like taking more of your suggestions? My son & I talk about everything from bad to good, just about life. Very bonding in such a short time. Like mini therapy for both of us. My son is like a different person in the car than when he is@ my house or in his apartment. And if your son doesn’t drive, maybe you drive, and ask him to go with you?

great for a cluttered room…

I don’t know whether or not therapy would help your son in particular, but it does have the potential to be helpful in general, even for individuals with no insight.

My husband, who is incredibly smart but who has no insight into his symptoms, was seeing a psychologist for several years at my encouragement, and although he never saw it as helpful, it seemed to me that it did help increase his awareness of his inner emotional experience and improve his ability to communicate it to me -. all of which went out the window once his relapse really got underway, of course, and the psychologist was the first person he “fired”.

But I agree with Maggotbrane that it probably needs to be a solutions-focused therapy (such as CBT), which focuses on managing current issues rather than exploring the childhood factors that set things into play. And the therapist would need to be experienced in working with people with lack of insight/psychotic symptoms.

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Thank you , that’s very helpful , i wish you and your husband the best .

My son does drive and he uses his car for very quick rides , to buy food or sometimes to visit me . Some days he doesn’t leave his house at all and that worries me and other days like today he left for about 20min to buy food which makes me happy as i know he has eaten even if its a small portion and i know he left his home and has seen a little of the outside world . I wish i could have a proper conversation with him but he doesnt like to talk and if i ask him something he delays answering me and sometimes says Stop mum i need to relax . I can see he has racing thoughts as he is distracted and a lot of the times he smiles and giggles to himself as if someone had said something funny . It makes me sad as there is so much i want and need to say to him .He seems like he gets very stressed when i talk with him , even when my family call him he doesnt usually answer the phone to them and if he does its for about 10 seconds and he says he has to go i love you and cuts them off .

Thank you.

Here’s the abstract of a very interesting British study that uses basic CBT approaches to address what Dr. Freeman considers the “maintenance” factors for paranoia/delusions (e.g. poor self-esteem, disrupted sleep, avoidance behaviors). He is in the process of developing a comprehensive behavioral intervention for psychosis, and so far his results seem promising.

He does not address anosognosia directly in the article and clearly people have to be able to show up to be able to benefit. However, his clinicians are careful to focus on things to help people feel safer now (the basic idea is not to combat the underlying delusions but merely to suggest that in any given moment, they can feel better than they do) and to give everyone the choice of where to start (e.g. improved sleep vs. improved self-esteem etc.), which helps people gain confidence in the approach when they begin to see improvements in their chosen area.

Hopefully, some day this will become integrated into standard of care. The UK is really ahead of the US in studying/promoting psychosocial approaches. Here, medication is not only the first line of intervention but the only line available for many - really too bad.

Behavioural and Cognitive Psychotherapy, 2016, 44, 539–552
First published online 5 April 2016 doi:10.1017/S1352465816000060
Targeting Recovery in Persistent Persecutory Delusions: A
Proof of Principle Study of a New Translational Psychological
Treatment (the Feeling Safe Programme)
Daniel Freeman, Jonathan Bradley, Felicity Waite, Bryony Sheaves, Natalie DeWeever,
Emilie Bourke, Josephine McInerney, Nicole Evans, Emma Cˇ ernis and Rachel Lister
University of Oxford, UK
Philippa Garety
King’s College London, Institute of Psychiatry, Psychology, and Neurosciences, UK
Graham Dunn
University of Manchester, UK
Background: Many patients do not respond adequately to current pharmacological or
psychological treatments for psychosis. Persistent persecutory delusions are common in
clinical services, and cause considerable patient distress and impairment. Our aim has been
to build a new translational personalized treatment, with the potential for wide use, that
leads to high rates of recovery in persistent persecutory delusions. We have been developing,
and evaluating individually, brief modular interventions, each targeting a key causal factor
identified from our cognitive model. These modules are now combined in “The Feeling
Safe Programme”. Aims: To test the feasibility of a new translational modular treatment
for persistent persecutory delusions and provide initial efficacy data. Method: 12 patients
with persistent persecutory delusions in the context of non-affective psychosis were offered
the 6-month Feeling Safe Programme. After assessment, patients chose from a personalized
menu of treatment options. Four weekly baseline assessments were carried out, followed by
monthly assessments. Recovery in the delusion was defined as conviction falling below 50%
(greater doubt than certainty). Results: 11 patients completed the intervention. One patient
withdrew before the first monthly assessment due to physical health problems. An average of
20 sessions (SD = 4.4) were received. Posttreatment, 7 out of 11 (64%) patients had recovery
in their persistent delusions. Satisfaction ratings were high. Conclusions: The Feeling Safe
Programme is feasible to use and was associated with large clinical benefits. To our knowledge
this is the first treatment report focused on delusion recovery. The treatment will be tested in
a randomized controlled trial.
Keywords: Delusions, paranoia, cognitive, treatment.

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