Family and Caregiver Schizophrenia Discussion Forum

I think I'm starting to recognise the signs of relapse


#1

My 16 year old autistic son is diagnosed with child sz. He had a really hard few months, with some very intense and scary episodes during January/February. He’s been doing so well, he’s been stable with his meds and regular visits with the psychiatrist, she has recently stepped his appointments back to fortnightly.
This last week, he’s been sleeping in the daytime, irritable, and I’ve noticed bloodshot marks on his earlobes in the mornings (he pulls his ears when he’s struggling with auditory overstimulation, but we’ve not been anywhere loud). He’s denied hearing voices, but he’s been quite erratic in his behaviour and positively horrid to his little brother. He has been biting his fingers and nails till they bleed and is obsessively echolailic, which he usually has a degree of control over.
This morning started with refusal of meds. I explained he would feel poorly if he didn’t have them, he said “I want to be poorly”. I explained that the meds are really important, he said “they will kill me”. I asked him why he thought they will kill him. He said “the voice told me”.
So here we go again. He says the voices have been talking to him at nighttime, last night and the night before. I think maybe for longer, but he doesn’t tell me because he doesn’t want to worry me.
I’ve called the home treatment team, but they say I can’t access them unless child mental health services send a new referral. Child mental health services are on skeleton staff during Easter and don’t have anyone available to help. My only option is to wait till 5pm and call the crisis team to “chat” to someone, or go to a&e now and admit him to an adult psychiatric ward till Monday when child mental health services are available.
He says they are saying they hate him right now. They haven’t given him any instructions right now, but I know where this will lead to.


#2

The duty psychiatrist from Child mental health services has just called. He is writing a prescription for 0.5mg lorazepam twice a day to keep L calm until he sees his psychiatrist next week.
Just feels like he’s doping him up to save himself the trouble of seeing him.


#3

It’s 9pm, he’s had 0.5mg lorazepam, 350mg chloral betaine, 2mg risperidone about 2 hours ago and he’s still wandering around wide awake arguing with shadows and insisting there’s someone in the mirror.
Crisis team are going to call me when they are available, but they are busy and I’m on a list. I really don’t want to take him to hospital, as he will be put on the adult ward now he’s 16, and I have 2 younger kids at home that I can’t really leave overnight.
Poor kid, I just don’t know what to do for the best for him.


#4

Thanks for the updates. Wow - that sounds like a really tough situation. it sounds really stressful for your son too. I would have thought the lorazepam would have helped more. Discuss with the crisis team but perhaps a higher dose would be appropriate. It doesn’t seem to be helping him much right now.


#5

When things calm down for you and your son - perhaps some things to review:

7 Keys to relapse prevention

Recognizing early relapse signs:
http://www.schizophrenia.com/family/relapse.htm

Longer document on recognizing relapse early signs:

http://www.schizophrenia.com/pdfs/earlysigns.relapse.pdf


#6

@SzAdmin thank you for the advice and information, it was very useful. I will print that out and keep it safe for future reference! I’ve been asking L’s psychiatrist for info like this for months, but she says he is such a rare case on her caseload, she simply doesn’t have access to references I could use.

The crisis team eventually called back and told me to give him the other half of the lorazepam, and if he was still agitated after 30 minutes to call back and they would arrange for him to go in to the unit. He wasn’t great, but not so bad I could justify leaving him in a strange place with no LD staff available.

So I put up the camp bed at the foot of my bed and he finally fell asleep in my room in the early hours. He is awake now, And so far seems ok. The crisis team doctor said he will be calling camhs in the morning and insisting that he sees a psychiatrist before the weekend.

Then the usual process is home treatment team visits for a week and back to weekly visits with the psychiatrist until he’s stable again.

It all seems to be related to the change in routine with his visits being stepped back to fortnightly over Easter. Could that be the combination of sz and autism, not coping with the changes? He’s always said he feels safer when there are doctors around, when he used to be psychotic he would only settle on children’s ward.

Also, is it normal to relapse so quickly? It’s only been around 8 weeks since his last episode. The psychiatrist said something vague last time about possibly having to “revisit the diagnosis” if he doesn’t improve.