Family and Caregiver Schizophrenia Discussion Forum

Life after 3rd episode? I am terribly worried, Please help!


#1

My sister is 33 years old and she had got 3 psychotic episodes till now. They all came at the same time in the year, something between October/November (November 2010, October 2013 and October 2014). She went to hospital where she stayed there for 3-4 weeks each time. Each psychotic episode starts by loss of concentration, weak memory and loss of interest in life, then it develops to positive symptoms like disorganized speech and behaviors, delusions, hallucinations, the sense of being controlled by outside forces and disorganized thoughts.

She is unmarried and lives with my old parents (my father is 73 and my mother is 64). I am living in another country. She feels lonely all the time and she is very afraid of living alone after the death of my parents. She feels that she has a great responsibility towards my parents as she has to take care of them after being old. She suffers from being over weight since her childhood and this made her stressed and feeling offense all the time. She hadn’t a normal life like other children. She tried many times to loss weight and went to many nutrition doctors but unfortunately she failed.

On the first 2 episodes, she had some stressful events that led her to these episodes. Before the third episode, there wasn’t any specific stressful event except that she reduced the dosage of medications (lithium) for 15 days because the company that produces it stopped its production and there wasn’t any alternative in the market (she took 1 tablet / 3 days instead of 1 tablet / 1 day).

At first she was diagnosed as bipolar disorder after the first episode, then as after the second episode. I am very worried about her and would like to know some medical questions regarding psychotic episodes in general:

1- Is it possible that the 3rd episode occurred because she reduced the medications dosage to 1/3? Or there are other reasons? She was totally fine just before the episode by 1 day!

2- Is it possible to get more episodes in the future even if she keep medications?

3- Is there any possibility that she get cured? Or these types of disorders can’t be cured forever?

4- what is the effect of multiple episodes on the brain? Is there any brain damage after each episode? Or it is all about the chemistry of brain?

I appreciate your replies as I am very worried and can’t do something except writing in forums!

Best Wishes,
M.Sedeh


#2

i have had 3 big episodes and a couple minors, i wouldnt say there is brain damage from it, just takes a while to recover from the experience.


#3

Is the damage reversible or irreversible? I mean id there is a physical damage, will this be regenerated?


#4

there is no physical damage. If anything I have become wiser. psychologically if you go through a bad experience it takes a bit to recover.


#5

Welcome to the forum @MSedeh

This link regarding Metformin and losing weight may be of interest for you sister.

1 - Yes it is possible that reducing her Lithium brought on the episode however there could be other reasons as well.

2 - Yes it is possible to get more episodes even if she keeps medications. I don’t know the statistics however the medications help to control symptoms (not a cure) but they will help a lot in keeping the symptoms under control and therefore lessening the chances of having another episode.

3 - There is no cure for schizophrenia at this time.

4 - I’m not sure about brain damage. I have been told that episodes cause damage and that full psychotic breaks can take up to a year to recover from. However they can be recovered from so the damage in my opinion is not permanent.


#6

@MSedeh , I have heard most MI get one psychotic episode in their life time. So I hope your sister does well after the 3rd psychotic episode. Hope no more. Good luck!


#7

I was 32 and overweight when i met my husband.

It is possible to live a great life with medication

yes you can get more episodes if you have not enough meds and too much stress but with the right meds and little stress, episodes can almost go away

cured? not likely at all

there is a little brain damage - but unlikely from 3 weeks every now and then. There is brain damage from severe long term psychosis i think, my mental state has got better for 8 years I’ve now been out of hospital

There is very very little you can do for a sibling.


#8

You can have a very productive life on medication. I’m on meds and work, have family and I’m a boy scout leader. I have my down periods too when I get on sick leave because I need to adjust my meds.

If she eats meds as prescribed chanses are she won’t have episodes as often. But there is nothing sure about it. I’ve had episodes while on medication. But I have learned to see the signs and call my pdoc or go to ER when things start to go bad.

The best thing she can do is to write a list of symptoms to keep an eye on. When she gets unfocused etc she needs to call pdoc asap.


#9

I am sorry about your sister’s troubles. Since your other questions were answered so well I will answer the last one, hopefully it will make sense.

Mostly, really it’s about the brain chemistry. The problem with schizophrenia is that it effects the brain multiple ways at the same time and no one knows exactly how-or we’d have better treatments. One theory has to do with dopamine, and how dopamine is both overproduced in parts of the brain-which create positive symptoms like hallucinations and paranoia, and underproducted in other parts of the brain, which create the negative symptoms like apathy, and a lack of emotional response. The main problem being that medications currently used work by lowering dopamine in the parts of the brain that overproduce dopamine, so it works well for controlling positive symptoms but not so well for negative symptoms-it could even make them worse.

There are difference in brain structures, but no one knows how or why. No one knows if it’s caused by the dysfunctional brain chemicals, or if it causes the dysfunctional brain chemicals, or even if it’s cause by medications. It’s not always easy to do before and after brain scans to check these kinds of things because there is no predictive tests for schizophrenia. The general belief is that differences in brain structures are not caused by medications. This is thought to be true because sz is usually begun in young adulthood, when the areas of the brain thought to be different in sz are undergoing rapid development. However, since brain scans done on sz are done on those who are on medications it is hard to rule out medication causes. It is nearly impossible to do brain scans on those not medicated because quite simply, paranoid, agitated schizophrenics cannot tolerate the procedures used to get the brain scans.

I would say, based on what they know-further episodes do not cause further damage-they occur because of the differences already there.

I hope that helps and that I explained it okay. If you have questions on what I said please let me know.


#10

Welcoem to the forums. Its good to post and we schizophrenics/fellow sufferers like to help. So, keep up posting.

I wouldn’t blame the fact she had a relapse on th efact that she reduced medication. Medication is a lot of the time rubbish. Its only good for relieving anxiety. Delusions are something that heal best with time. Sometimes in a year, sometimes two, sometimes five but you do make great progress in time. It just takes patience and a caring supportive family (like you are) to help things improve.

Trust me, if I was to say to my family before this illness took hold Id ask them to be caring, supportive understanding and tolerant and understand this illness could have afflicted you. Its just bad luck.


#11

I have a sister who is bipolar. She had one psychotic episode at 30 years old. She was also put on lithium. It took a good 6 months to a year to completely heal. However, she has never had one since. She monitors herself all the time, and knows if something is coming. She will call her doctor right away, and get away from anything that is causing stress.
That is pretty bad that she cannot get her meds filled when needed. Maybe call around or visit some websites that can be certain to deliver. I cannot say that her dose of lithium did this-but its very possible You can also assure her that you are always there to help with your parents when the time comes. I cant say about brain damage with bipolar. I would think not.
Hope your sister can heal quickly…


#12

Not sure how I missed that but I was unaware of the underproducted parts of the brain creating negative symptoms. I just thought maybe it was lack of serotonin. Makes sense though. Thank you for that bit of information :smile:


#13

If you google “dopamine hypothesis” you’ll find all kinds of good stuff on this theory. One should do their own research, because I am just a layperson trying to make sense of neuroscience. LOL. Serotinin is involved as well of course, and interestingly serotonin indirectly effects the production of other neurotransmitters such as dopamine.


#14

Thank you all for your kind replies, really this helped me a lot to understand the case and deal with it. I appreciate all your input and time to write all of this.

Now My sister is 1 week in the hospital. I am very worried because first they told us that we can visit her after a week, then when we called to ask for a visit, they told us that we have to wait one more week and her condition doesn’t allow people to visit her. Now I have more questions came on my mind:

1- What is the total period of time a patient should stay in the hospital till they can return home?
2- After how many days/weeks we are allowed to visit her?
3- Why visits are not allowed in general?
4- Doctors told us that she is still hyperactive, moving alot and talking alot to all people there, still saying some inconsistent words, is this normal even after 1 week in hospital?
5- Which strategy is better in treatment; to start by ECT and sever medications that let her sleep most of the time, or to start in reverse, I mean start by low concentration medications, see see the progress of the patient, then increase the dosage gradually? In this case the patient can interact with others and do some activities.

I am sorry for asking so many questions but I am really very worried!

Thanks again!


#15

Just got back here-sorry!
Normally, you should be able to visit right away.
if she is that bad, maybe they are worried that seeing you will cause her to “act up”. I can`t say for sure, everyone reacts differently to their medications. if they are starting with low dosages-it could take a few weeks.
I did not know they were considering ECT??
In any case, I would push to get in to see her, and do some research on ECT, also the meds they are giving her.
Good luck to you and your sister!


#16

1 - The total length of time will vary depending on how the person responds to medications and how long it takes to get the person stable. My son has been inpatient anywhere from 1 week to a couple of months. Some are in for longer periods.
2 - Once she is allowed visitors you should be able to visit as much as you want during visiting hours.
3 - Visits are allowed. I’m guessing that she is not stable enough yet to have visitors. This can take time.
4 - Unfortunately people respond differently to medications so it can take longer to find the right medication or even the right dose. The hospital may have to try different ones. Doing this in a hospital setting should help as they can give higher doses due to being monitored.
5 - I don’t have any experience with ECT. Generally it’s not one or the other but a combination of medications and other forms of treatment. I’m guessing that getting her stable on medications first would be the best approach however there are other members on the board that could probably give you better advise on this.


#17

I only wanted to elaborate a little on the medication question (I also don’t know a heck of a lot of ECT).

With medications what pdocs often do is prescribe the medications that they feel will most likely work for the patient, which have the lowest risks, and the lowest dosage and make decisions from there. This is why it can take a while, because it’s trial and error with those considerations. So if a low risk, low dose med doesn’t work well enough for the patient to have symptom relief they will up the dosage and/or change meds.

Every drug has a range of dosages that are considered at therapeutic levels (levels high enough for the drugs to work without really wreaking havoc on the body systems), and one can only go up so much. The hope is the drug will work at the lower end of the range of the therapeutic levels.

My daughter has treatment resistant psychosis, we’d tried EVERYTHING, with her at a very unsafe baseline the whole time on drugs at therapeutic levels before we found clozapine and lithium, at unfortunately high doses and with unfortunate health risks finally worked for her. It’s a crap shoot-sometimes people get lucky and find a combo that works right away, or sometimes it may take a very long time and lots of experimentation before a solution is found.


#18

(This is the world as seen by trevdna, so take it with a grain of salt.)

  1. Definitely. When my mom (who has sz) changes medications / decreases her dosage, I always sleep a little less sound for the next couple of weeks because that is when she is most likely to start an episode. Granted, many times she is changing medications because she is already starting to lose touch with reality and is trying to tweak things, but still.

  2. Unfortunately, yes. Again, there are some times that the medication will stop working for my mom, without any apparent explanation of why. I’ve noticed that it often happens when she has a significant stressor / life change for her to worry about.

  3. In the case of sz, I don’t know of any cure, just long-term treatment. However, I’m optimistic that with the relentless advance of medical technology, we might start to see legitimate cures within our lifetime.

  4. I just found this link today: http://schizophrenia.com/?p=

I’ve just noticed that all the answers I’ve given you probably sound pretty terrible. Like I said, it’s just based on what I’ve observed and learned based on my mom, your results may vary. However, I believe that the more you know, the better off you’ll be.

Best of luck!