Family and Caregiver Schizophrenia Discussion Forum

Any advice on preparation for their return?

I am relatively new to all this. My loved one, E, is currently in the hospital being evaluated after a disastrous bout of psychosis. Hopefully E will be medicated and put on a treatment plan. I am thinking it would be smart to prepare the house as much as we can before their eventual return. Looking for ideas from those of you who have been down this road.

We know we are going to have to replace our bedrooms doors and locks so that E can’t break them down again in the future, and I am thinking of getting a mini-fridge for my bedroom so I can protect some of my food supply. (E sometimes thinks things are poisoned and I am concerned they may attempt to throw some of my stuff out.)

What are some of the practical things you all have done to try to protect yourselves and your loved one? Or to head off future issues? Thanks in advance for your thoughts. This community is an invaluable resource.

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What I’ve found is that the hospital only keeps them about 9-10 days and they are discharged while still psychotic. They might be on more meds, but meds alone don’t totally stop a psychotic episode in my experience.

There was always trouble immediately after coming home. Maybe a little less trouble because of the increased meds from the hospital, but still trouble.

Months followed after release with once per week psychiatrist visits and maybe more telephone calls in the first week or two. His psychiatrist increased my son’s meds further until he was stabilized (less paranoid). That’s really the goal: stabilization. And that didn’t happen with the short 10-day stays for both psychotic episodes.

My only advice would be to make sure your relative and yourself have a good working relationship with your relative’s psychiatrist and to work closely with them to achieve stabilization.

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Welcome to this site @NeedAnswers . I am glad you found us so fast. My loved one was in trouble for quite some time before I found all the help that this forum can give.

Yes, get your doors/locks fixed. We built a back door to the outside into my daughter’s room while she was away so she could come and go without bothering us. We also built a hallway door that locked between the main house and her room, so it made a sort of studio apartment for her. There was a fridge in her room too. The remodel helped cut down on the nighttime screaming noise and fear of her nightwalking while we were sleeping.

It took several hospitalizations and two arrests to get her stably onto medicine that worked. Hopefully E will be med compliant on release to end the psychosis. If you can get E to sign the forms needed to let you speak to the doctors/get medical records, that will help in the future to help manage the illness.

NAMI is a great group for support also, if there is one near you.

I found it helpful to keep a sort of a journal. It helped me remember the good days, the bad days, the police visits, the hospitalizations, etc. It was useful for her psychiatrist when she finally started seeing one. The doctor had never seen her unmedicated, and didn’t know her history.

You will get other helpful hints from the wonderful people who share their knowledge on this site. Good luck sorting things out for the better.

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I’ll speak to a few things from E’s perspective. Ultimately you will have a better time of it if E does better, so as much as you feel you have to protect yourselves against E— investing effort to help E feel protected from the world where feasible can be a more proactive measure.

Consider known irritants and distractions and see if you can eliminate, soften or mask them. In my experience noise from inside and outside the home can be very distracting and can lead to added thought processing and reality-checking. When you have psychosis and delusions you are constantly in a state of alert, similar to feelings you have when you hear a noise in the night and you lay awake imagining it’s a burglar or wild animal. It’s a fight or flight mechanism, and can lead to escalating delusional explanations. It can be helpful to give E some control over the environment, some examples are drapes or white noise machines.

Unless E is a hoarding type who is comforted by collections of possessions, consider decluttering the home. Suicide is sometimes a risk after hospitalization, so removing any weapons and other high risk items that could be repurposed for self-harm is a good idea. I advise against playing radio or televisions for long periods of time and consider limiting Internet use if possible. If you keep a lot of food on-hand, especially sweets or junk food, consider giving surplus food to a food bank. Many antipsychotic drugs increase appetite and having loads of food in the house can be extremely tempting, and constant snacking and overeating may result if food access is uncontrolled.

Mental wards are often time-structured and regimented for good reason— it controls stimulation and adds discipline. Consider setting a schedule and help E stick to it. Try to have E wake, bathe, eat, sleep at fixed times. Mental wards also have ‘activities’ which encourage social interaction and stimulating physical and mental activities. Card and board games are good for this, as are social walking and calisthenics, interaction and care for animals, mealtime preparation and conversation, cooperative chores, running errands outside the home, etc. If E is musically inclined or interested in arts or crafts it can be therapeutic to encourage these by getting work materials before E returns.

If E smokes or drinks alcohol or stimulants like coffee or tea, consider rules and logistics for these like ashtrays, designated smoking areas etc. People with SZ and other SMI tend to self-medicate for various reasons. Many people with SZ tend to smoke or drink coffee compulsively, in my case I drank coffee to counteract sedating effects of medication. Drugs and alcohol are sometimes used to escape or distract from symptoms, but these are rarely helpful and often exacerbate conditions.

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I’ve heard of the poison delusion before in an individual who was having food allergies. It was later found out they couldn’t have milk. Have you tried adjusting their diets?

Thank you for the suggestion. In less psychotic times E has said they do not have any known allergies or sensitivities. Of course it’s possible they may have a sensitivity that they don’t realize they have, but in any case, E is an adult relative who is not my child. I can’t control their diet, outside of trying to keep certain food items in my bedroom where they can’t get to them.

Thank you so much for all your ideas and suggestions. I will see what I can do but E is an adult relative who is not my child. I can’t control their schedule, hygiene or diet, though I can keep sweets and snacks in my room.

We live in a relatively quiet suburban area but various normal sounds do sometimes drift in from the neighbors. Perhaps once they are back from the hospital/the psychosis recedes I might be able to suggest a white noise machine.

In more stable times E is also an arts and crafts type of person so I will think on how I can assist with that as well.

All of E’s many delusions have centered around safety fears and they have stated several times that they want to live, so at this point I don’t think suicidality is a concern. I hope that remains the case going forward. I am also praying the delusions never get to the point where E decides my sister or I are a threat to be eliminated.

Unfortunately we do not own this home, we are renting and our remodeling powers are limited. Our bedroom door/lock replacements are about the extent of what we can do.

A journal is a good idea, for E’s sake and for mine. I also intend to sign up for a NAMI FtF class. Hoping we are able to attend without making E suspicious or triggering any persecutory delusions.

I am quite sure that due to their anosognosia E will not be med compliant unless we can find a way to force it. Surprisingly, E did sign a waiver the night they were taken to the hospital to allow me and my sister to speak with E’s care team and to be informed about how things are going. I would like to be able to continue that after E’s return but I am not sure how to go about it. We have been considering making ongoing treatment, meds and access to their care team and records a condition of E’s continuing to live with us. Is that a good idea or a bad one or even a doable one? I am not sure how to even go about it, considering E is an adult relative who is not my child.

The NAMI FtF course was a game changer for me. It was a pretty big class with a lot of suggestions and discussions and help made available. I do hope you can do it.

Any situation that arises has several choices of how to handle it, only in the future looking back will you know which were good and which weren’t so good. But any time you trust yourself to make the right decision, it is probably the right decision for your situation. I can’t tell you what is a good or bad idea, I can only state what might have worked or not worked for me. In my own situation, my daughter would never have voluntarily stayed on medicine, but then again, no pills she was prescribed ever worked very well. In order to maybe tell E that meds and access are a condition of E staying with you, you also have to be willing to have E leave if they won’t comply. I just couldn’t ever have made my daughter be homeless so I couldn’t make that threat. You must do what you feel is correct.

Glad to hear E went to the hospital and received care. Try to thank E for going and taking care of themselves.

I had a similar situation and I had wish I handled it differently. If I had to do it again I would ask the hospital care team to give E the injection medicine. That way you won’t have to see if they took the medicine every single day, I would also ask the hospital to prescribe E a sleeping pill so everyone in the house can sleep including you and your sister without the disturbance.

I think it is important to make clear boundaries and say you want E to live there and you want everyone to feel safe and be comfortable so E will have to stay med compliant. If E is not willing to take the medicine will you be able to continue living like that with your sister? Is your sister a minor? If not, definitely set your boundaries and stick to them.

I hope E will be med compliant.

Also if you sign up for F2F class you can always just listen if E is in ear shot so as to not upset them.

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I have never heard of this poison delusion. Interesting. Can you tell me more about it? Thanks.

Sometimes ppl suffering with SZ or SZA will think their food is poisoned and don’t eat. Seems to be a common delusion.

It’s also common for people with SZ to think drugs are poison or are poisoning them.