Family and Caregiver Schizophrenia Discussion Forum

How can you tell when your family member has an episode coming on?

For @glendalegirl

With my son the first thing to happen is his hours reverse. He will have go from a daytime awake schedule to being awake at night.

He will become restless and unable to sleep. His pattern becomes, eat, try to watch tv or try to play video game, try to fall asleep. He will actually triangle between the kitchen his computer or tv and his bed. He will become desperate for sleep and the voices are so loud he can’t sleep. This all happens when his scz is cycling towards more psychosis and frequently ends in a total break.

He can also be triggered into a psychotic break if something frightens him or a loud noise startles him.


This is a great topic. I am going to write more when I have time. Before I do, I just want to write that all the signs of an episode my family member might be entering also sometimes resolve without level 5 psychosis.

Definitely, can attest to changes in sleep cycle as indicator of upcoming psychosis. My loved one got to the point where he could feel an episode coming on. He’d say things like, “oh, boy. Things are getting loopy.”

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I know from the way he talks to me on the phone. when he starts cursing me heavily and saying bad words and talks that does not make sense, then I know he is deteriorating…

right now, my son is better since he has been taking Invega-shots for couple months and he will take the 3rd one in a week. when I call him, he has to think before replying to some questions when I ask him last night why did you have for dinner, I feel he was thinking … took like 20 seconds before I hear his response… does that mean that he is still hearing voices?

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If an episode is the full break from shared reality, I have noticed sleep disturbances, not eating, lots of running away, more erratic behavior, lots of out loud talk about delusions and also more responding to internal stimulii like voices. But all this can also happen and then go back to less psychosis, maybe 2 or 3, instead of an episode.

With treatment, my family member has not had an episode in more than a year. But it took months to pull out of the most recent one.

Honestly, I stopped paying attention much to anything besides harm to self or harm/ disruption to others because we couldn’t do anything about any of it and my relationship with my family member was and is my priority. But I think I would notice all these increased symptoms the way people learn to respond to weather cues.

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As with most of you not sleeping seems to be the beginning. My son will start calling me daily instead of by-weekly. He will then start keeping to his self a lot. Like taking walks along, going outside and playing his guitar alone. Most of the time now they stop here as they have on several occasions. If he is going into a full episode as I call them, then he starts talking in short sentences like “Yeah right, that’s right” or “Green yeah green green means go”. At this stage is when he will become incoherent in conversations. When he gets to this point I have to get him to the hospital until he recovers to prevent him from attacking anyone a second time. I will say though that he has only been to the hospital one time since we first learn of his sz 5 years ago.

My daughter’s pre-episode behavior is total isolation, non-acceptance of food, and a total switch of schedule to staying up all night.

However, I agree with you hereandhere, I have recently stopped paying attention to anything that isn’t shared reality EXCEPT for threats of violence. We have learned to be with each other again, in a new way. If she doesn’t answer my questions right away, I wait. If she talks to her voices while out with me, I act like I can’t hear her. If she won’t open the door when I knock, I go away and come back in 20 minutes and try again, like I didn’t just knock on her door 20 minutes ago. I no longer try to command her, order her, disagree with her, etc. over anything that is trivial. We are getting along well for the first time in 2 years now. And the household is mostly peaceful in the common areas (if not in her bedroom where she isolates to talk to her voices). The mental health check team member in our police department came to see me a few days ago to find out if all was OK, since my daughter suddenly stopped calling the police on me and her step-dad. My daughter even went back to her part time cleaning job. Unless something is life threatening, I just don’t pay it much mind anymore. It’s working.


Thank you @hope I guess I had not been on long enough until today to create a new topic. Just got on and noticed you posted it :slight_smile:

Things have not gone full blown and she actually seemed to sleep last night, but she also knows that her regular family practitioner appointment is Thursday so maybe her small bit of conscious self control that is left is kicking in so not to have anything to report after 8 weeks…


If it wasn’t for behavior that damages household items, and my son’s tendency to become accusatory toward me when I respond with a simple ‘no’ to some of his demands, being with him could be much more peaceful. I don’t really pay attention to his talk about spying and aliens and that his dad will soon be a billionaire.

His expectation to be taken to places when it is inconvenient for me is the most problematic behavior right now.

I guess I am reaching a point where I really want some simple respect of the fact that I have a lot of demands and also some wish to do some other things besides take care of him, and would like to be able to choose when we are going someplace.

Recent example - I arrived at his house to prepare him an evening meal, and he declares that he wants to go out to such and such a place for dessert (which would be on my dime). I am stopping at his house after working, and before going home to my husband. And I just didn’t have the time, so I said, not today. NOT what he wanted to hear. His latest favorite accusation is that I am saying this because of ‘poor impulse control’ (yeah, right), and he gets nasty. I feel taken advantage of. Maybe I am. But I am left having to decide between taking him, or a new hole in the wall, or another broken door.

I try to not respond to such nonsense, but it can be so hard. ‘Poor Impulse Control’ is such a ludicrous thing to say! Sometimes I tell myself I should be tougher. But it is really hard. Any reasonable response as to why I don’t want to go at the time he asks just escalates his anger.


Sounds like something my 10 year old would pout about (minus the damage an adult can make). I usually say something like, “We can go at a later time, but if you throw a fit then we won’t go at all.”

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I’m reading a lot about not stepping in unless threats are made. You Mamas are more experienced than me. What do you all consider threatening behavior?

My brother habitually writes on the pads of paper we give him. Mostly it’s benign stuff, but occasionally there are unpleasant words. On this page, for example, he wrote, “He wants someone to die,” among other things (like “clam chowder” which he ate earlier). No idea who ‘he’ is referring to - maybe himself, or a voice, someone else, or maybe it’s just something he heard in an action movie. Is this something you would ignore or something that should be brought up to his pdoc?

I used to comment on such things, but don’t much anymore. He has never acted on all the stuff he has said. Sometimes I say, ’ I don’t want to hear that, please don’t talk that way while I am here.’

Unless your brother has acted on such things in the past, it can likely just be let alone…

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Yes, a 10 year old seems able to process logical consequences better than my son does.

I’m sorry, I didn’t mean for that to come out wrong! I just meant to relate to how all kids can be a bit selfish at any age. They are huge parts of our lives of course, but we can’t drop everything for them all the time. Maybe you can “bribe” your son, or “dangle carrots” as they say, for good behavior when he’s in a more agreeable mood.

No worries! Its just a fact of this stupid illness that what would be a logical response often doesn’t work.


It’s so true that the behavior can be toddler tantrum-like, and basic behavior modification strategies really just don’t work the same way they would with a person with a typical brain, or the way they worked when our kids were little.

I do still “dangle carrots”, but the aggressive behavior is sure as hell better now that he’s on meds. Things don’t get broken anymore. I suppose the anger is settled down by the mood stabilizing of the meds?

Before meds, if I said “No” to something, his automatic response would be to accuse me of something completely disgusting. His response would have absolutely nothing to do with what we were talking about. So bizarre.

This still happens when things are getting rocky for him. It’s hard to ignore, but it’s worse to respond. It’s just really bad when it happens in public. We can’t go places together when he’s entering a downward phase. It’s too risky.

So, in response to the title of this thread, I guess that’s how we know a relapse or an episode is coming. The accusations start up again, in a big way.

But, then again, his illness is progressing, so who knows how it’ll look a month, a year, or 5 years from now. Things seem to be changing day to day at this point.


I do think the worry points vary from person to person as Vallpen wrote.

We would be concerned if Jeb had ever written a threat directed at his dad. He never has. When he keyed letters into his dad’s car, he wrote “bigot”. Had he written Dad will die, or something like that, we would have taken it as a threat and had him arrested.


Thank you all for your insight!

During his conservation (approximately the past 4 years? Maybe a little less) there hasn’t been any record of violence against anyone. The time leading up to his hospitalization/conservation I know he had some vocal arguments with a roommate, but he had lived there for a few years beforehand. That being said, I also know statistics say that caregivers are the most likely to be a target if there is violence. So I will be cautiously optimistic and continue to observe for any other changes in behavior like the ones mentioned in this thread.

I have a few follow-up questions for you all. I know there’s no set “schedule” and every year can vary, but ballpark estimate how often do your loved ones usually have an episode? Do some seasons seem worse than others? Are there any triggers that tend to set your loved ones off? (Types of movies, activities, topics of conversation, etc)

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I’m not sure there will be answers that can be generalized to your questions. In these aspects of the illness, everyone is so different!

The stress of the change will likely be difficult for your brother, just as changes, positive OR negative are stressful for anyone - just likely more so for your brother.

For my son, the holiday season - which also includes his birthday, and also the time of year when daylight is limited - tends to be difficult.

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Strangely enough, I can count on full moons to upset my son. A couple of times a year the moon is even closer than other months. The full moons those months are the worst for my son.

I suspect its gravity that is causing the problem, I know it sounds odd, but I kept records to verify it. The moon has powerful effects on tides and our brains are mainly water.