I'm 17, and I think my friend has schizophrenia. She only trusts me, I really need some advice please just read this thread

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Hey guys,

So I’ve known this person for more than a year now and we are both from the UK. They live in England while I live in Scotland so we only text and call.

For aslong as I’ve known her she has had these highs and lows. Every couple of weeks she would be high and ecstatic and manic and then low depressed and unmotivated. Which I first thought was a sign of bipolar disorder.

But in recent months she’s acted different, she’s still had the highs and lows but at night she would wake up from her sleep in the middle of the night (she has a really hard time sleeping, waking up multiple times a night from nightmares, when she’s low of course) and tell me all these delusional things. One night she couldn’t sleep at all because she was convinced that there was a camera outside looking at her. She would be sending me videos of a bush with a light behind it and be telling me that it was someone standing there, recording her behind the bush.
On multiple occasions she’s been extremely paranoid like this. She’s also heard real banging on the wall which I can confirm is real because she send me a video with sound, but then went on to tell me that it was something in the closet making it. A Demon or entity.

Other things she’s done in the middle of the night is, tell me that there are people out to get her. She’s told me before in confidence that our food gets poisoned aswell as other things. But it always goes back to, these people or sometimes even Demons or entitys that are out to get her.

Today she told me that she’s been having these flashes of images, one of a crow standing. The other of a cat hanging off a ledge to more morbid things like someone getting suffocated by a pillow or someone’s face being mutilated. She also told me that she wasn’t allowed to tell anyone these things or bad things would happen. She was semi convinced that if she told people, something would happen to someone on a train and someone in her family would kill her. She said that when she went to bed these images kept happening and she panicked. She describes the feeling as things getting too loud.

She also said that her head was like In a way telling her to distance herself from people, in her words she said “when the thoughts have been happening the past few days, they want me to go. To get hurt. And it makes me scared”, she was ready to never talk to me again today but I convinced her to stay.

There are a million more examples I could give but it’s hard to remember everything, a switch sort of flicked in my head today when she told me about the images in her head. She has been smoking weed recently which can Increase the chances of schizophrenia in people already high risk.(according to my friend) so I told her to stop immediatly and not distance herself from her friends. I also told her to tell me everything she experiences from now on. She trusts me more than anyone with these things because I’ve been the person supporting her with her lows for the past year. What really concerns me is the fact that when she goes back to a high. Everything just disappears. Her trouble sleeping is fixed, her paranoia, delusions, hallucinations. Everything.

I really need some help and advice from you folk, if there is anywhere you guys would reccomend in the Essex area or just any advice in general I would really appreciate it. Also please ask questions if it helps you understand better, I’ll answer the best I can.

Thank you,

Ross

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@Ross_Todd you are a good friend for being concerned and trying to learn how best to help your friend. First, your instincts are correct, in the long run cannabis use is best to be avoided by people with any serious mental illness. There’s an overlap between bipolar disorder and schizophrenia symptoms, and there’s a separate in between diagnosis called schizoaffective disorder which is a mix between the two.

Generally when you have a mix of symptoms, how you are diagnosed often depends on which symptom is more prominent. In my case, I was diagnosed with SZA (a common abbreviation for schizoaffective disorder here) but my brother was diagnosed with bipolar disorder. I was more prone to psychotic symptoms like mild hallucinations, delusions and paranoia with minimal mood cycling, but had persistent trouble sleeping since early adolescence. Since your friend appears to cycle between high and low moods fairly quickly, she likely would be classified as having a rapid cycling bipolar disorder. Her psychotic symptoms would likely be considered more of an add-on. The criteria is four cycles within a year period. There’s a possibility she might get classified as schizoaffective, but I’m doubtful. Frankly I’m not a huge fan of hairsplitting and excessive emphasis on “proper” labeling— the important thing is she gets treatment.

The good news is that bipolar disorder tends to have less stigma, as the general public has an easier time relating to depression and feelings of elation than psychosis. My psychiatrist tells me when/if I “out” myself in social situations to say I have bipolar disorder, because stigma toward “schizo” anything is so strong. Both bipolar and schizoaffective disorders are associated with better outcomes than schizophrenia, so that’s more good news. Treatments for both disorders are similar. Usually either antipsychotic drugs or mood stabilizers or both. Even people with bipolar disorder without psychosis sometimes receive only antipsychotic medication.

The bad news is rapid cycling bipolar disorder is associated with a 20 times greater risk of suicide than standard bipolar disorder. In my experience self-medicating with drugs and alcohol is common with bipolar disorder and it rarely helps in the long run. Anosognosia (lack of insight into the disease) is also more common with bipolar disorder and schizophrenia than with schizoaffective disorder from some reason. For example, I’m self-supporting and have had a fairly successful career, achievements and social life, whereas my brother has self medicated with drugs and alcohol, has poor insight and drug compliance and hoarding tendencies, and lives a less successful life by most standards.

The best thing you can do for your friend is find a way to steer her to treatment and away from self medicating. The good news is there are far more testimonials of people with bipolar disorder by celebrities and seemingly extraordinary ordinary people than for schizophrenia. If you like, I can provide you with a long list and various TED talks, etc. Since your friends is in the UK she has the benefit of the NHS system and somewhat reduced stigma, we are less fortunate in the States. Cognitive Behavior (or Behaviour) Therapy is more common in the UK as well, and it may prove helpful in dealing with psychotic symptoms. I can’t speak much to any benefit to cannabis use, but some here focus more heavily on supplements, herbalism and other treatments. I hear CBT oil may be effective and less problematic due to diminished or absent THC.

The best of luck to you. I know from experience that remote caregiving of people with bipolar disorder can be challenging.

Cheers,
MB

Disclaimer: While I am a part-time caregiver of my brother and father with SMI, I was diagnosed with SZA over thirty years ago. I’m an advocate of appropriate drug treatments for SMI, but I feel they are incomplete treatments and additional CBT, supportive talk and psychosocial therapies are helpful where feasible. Any drug advice is from personal experience or research and not a substitute for qualified Psychiatric care.

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Thank you so much you have really helped allot for us.
Where would be the best place to get treatment?

Thanks,
Ross

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@Ross_Todd, I’d have to do some research. I have contacts in Scotland near Dunbar and in England near Essex but haven’t talked to either of them in a while.

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