My sister is diagnosed with sz

Family
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Hello all,
My sister (28 yo) is having delusions about her former employer trying to spy on her, tap phones and emails or try to harm her in some way since last one and a half year (while she was already working there). She quit the job and came back home an year back and felt normal for about 4 months and the delusions started again.
I came to know about all this around 5 months back (just when the delusions started again). She suddenly stopped talking at home, eating at home and would be confined in her room. She even accused me of hacking her mobile and accused my mom of spying on her. This continued for a month, and then she got a job offer and she got a bit better for about 15 days. She started going for the new job, and within 15 days her delusions came back.
And since then, her delusions have started getting worse. She now thinks all her family members and friends are bought(bribed) by her former employer to try to harm her. She thinks her family members mix sleeping pills in her food & records her voice. She thinks that everyone is trying to prove she is mentally ill and whenever anyone suggests her to see a doc, she thinks they are conspiring against her with her former employer.
She doesn’t eat food at home, stays inside her room all the time, orders food from outside or goes out to eat.
We visited many psychiatrists and everyone said these are symptoms of schinzophrenia but were not ready to write the diagnosis on paper since we were not able to take my sister to the doctor’s.

Finally, we were able to arrange a home visit from a psychiatrist, and fortunately we were able to make our sister talk to the doc. But she refused to take any medications prescribed by the doc and told her that there is nothing wrong with her.

Now the doc is saying that she needs to be hospitalised since she is not ready to take medications and is not ready to accept that there is anything wrong with her. The doc also said that she has suicidal tendencies and it is dangerous.

Now the problem is, our family is not able to gather the courage to admit her to the hospital. We see her going to the office daily, take care of herself, talking to neighbours, delivery guys normally. Everything about her behaviour is normal other than the delusions.
We are afraid that if we admit her to the hospital, she will think that we are indeed trying to harm her and are trying to ruin her life and career. She also has freelance projects etc. that will be ruined if we admit her to the hospital. On the other hand, she desperately needs help and that could be provided to her only if she is admitted to the hospital as she is not ready to discuss at all regarding her delusions with anyone. She is adamant that all of this is happening in real to her.

The most disturbing thing about all this is that I found a print out of a blog post in her room, that she had written regarding that she supports the idea of suicide. In that article she has narrated that all of this is happening to her friend and she supports her idea of suicide as she doesn’t support all this harassment/torcher by her family members and former employer.

What should be done in this scenario? How to help her?

PS: My father has some symptoms of paranoid personality disorder that I realised a few days ago while browsing the web about mental illness. Also, in my fathers family history, there has been instances of paranoia, though at old age. This could be something genetic.

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Sorry to hear about your sister. What you are going through is something most of the families here have gone through at one time or another. You really want to get her treatment as quickly as possible - the sooner she gets treatment, the better the outcome (ie. chance that she will return to a healthy life). The best places to go are the Early Psychosis Evaluation and Treatment centers - see if you can find one close to you:

The whole issue of “forced treatment” is a really hard one - every family has to make their own choice. What would you want your sister to do if the situation was the reverse and you were the one becoming psychotic.

The best way is to get her to go to treatment voluntarily - and for that, what most people try to do is to get them to identify some issue that they do agree that they have (perhaps stress / anxiety, depression, etc.) - and then prewarn the psychiatrist about the true situation.

Write down a journal of all the unusual behaviors and thoughts that your sister is having - and document it so you can share it with the psychiatrist at some point. (obviously keep it far away from where your sister will ever see it).

Have your family watch these videos online:

and

and buy his book too if you can:

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And have your family read up on this. If you can get her treated quickly, be sure that they will keep her in the hospital for a reasonable length of time. Frequently they can only keep the person in for a few days (72 hour hold) or even a week or two - but then the person just can walk out and stop taking the medication - which is a huge issue. It gets hard to get them back in again if this happens.

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@SzAdmin I am really grateful for your reply.
I forgot to mention that I am from India. Awareness about mental illness is pretty rare here and in case if she does try to harm someone who she is suspecting is targetting her, she will be in real trouble.
The police here doesn’t know much about mentall illness and they will lock her up in jail for considerable amount of time if she does something really violent.
Also, both my parents are above 60 years of age and it is very traumatizing for us to see her in this condition. I am only 24 years old and at the end of the day, all the responsibilities are on my head.

The doctor has told us to admit her to the hospital forcibly via ambulance. Also, the doctor has hopes that once she is admitted in the hospital, she should get insight within around 2 weeks. Also, they will keep her for atleast 3-4 weeks.

Making her take medicine voluntarily is not something I can even imagine in the foreseeable future since she doesn’t even want to talk to us. I can see aggression in the way she walks, closes doors at home. She thinks we have taken bribe from her former employer to hurt her, spy on her and we are B-Grade people with no morals.(this is all written in her article)

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So,sorry you are going through this, one part I must make you aware, the doctor should not have said that within a few week on meds she will probably gain insight, that’s not true so please do not assume that at all.
Especially if she is forced to go to hospital. That could really traumatise her, and back up all her suspicions makeing them more valid to her.

I know because it was similar to our son. He was hospitalised twice involuntary. First time in hospital for three weeks and let out non med compliant, next time he was in five months and forced after two weeks to take meds. Insight is sometimes impossible to predict who will and who won’t.

Thinking of you , the thing is she is still holding down a job .

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Just a warning how well functioning a person with sz is is strongly correlated to how early she gets treatment. Over time, her brain will get slower and more confused till she is not functioning enough to work. That is what I read and also my personal exerience as someone with schizophrenia. You need to treat this like a time sensitive illness and not waste time taking her to the hospital. Also once she gains insight, stress the importance of staying on meds so long as the side effects are reasonably tolerable.

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Excellent advice , insight is not always something that comes quick even with meds, can take a lot longer , we thought the day my son was admitted to hospital was him on the road to recovery, yes looking back it was but took a further two years from then.

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@Jane57 This is what keeps me up at night. This and the fact that she is doing a job & also doing projects, makes me nervous to admit her. She had been very carrier oriented since childhood and now she will think that we ate trying to ruin her career.

I can imagine what you went through and I am scared to think you and your son had to go through it for a couple of years. But was it all worth it in the end? Does he realise now that he was admitted forcefully for his own good?
I know it can take time for her to gain insight and we should keep in mind that it could be a long journey.

@Tukey Thanks for your reply. Does that mean that her chances of recovery are faster than the people who are not functioning properly in sz?
And thanks for the advice, it is really motivating.

You guys don’t know how relieving it’s to talk to someone who understands my situation. Thanks to both of you.

Still, do you guys think in my situation, since she is not cooperating at all, we should admit her to the hospital forcefully? I am worried the symptoms will get worse, and she might hurt herself or someone else if the treatment is not started soon.

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Wonder if perhaps your sister would be up to trying to explore some therapy first, Maybe see if your sister would be open to perhaps talking to someone about her , let’s call them her “worries” “anxieties”
Unfortunately my son wasn’t up for that and that .

If your sister is still working and she is intelligent, she’s obviously aware somewhat with these blogs she writing and talking hypothetical like it was her friend. There is something there , but in time I find they build up the links to back up their delusions.

Although yes it was horrific but honest, I would do it all again , there was no choice , think about how hard it’s going to be but what if you did nothing? It’s not going away, sorry but what you are seeing today is only going to get worse without meds /therapy .

My son won’t openly admit anything now , we don’t push it either but , he’s here, he’s safe, he loves us again (previously I was a cocaine bitch (in his worst days). That’s the stuff he said to me. Now he hugs me, laughs at me, laughs with me, yes it’s been worth it.

As others say it’s a marathon not a sprint.
I understand you are trying to support and shield your parents , I know most likely a cultural thing, bless you but you need a lot of support and help too.
This forum has been a god send to me and many others.

Right now you can’t reach out to your sister, you have lost her, like my son but you can get her back. Three years ago i would never have thought I would said that .
She’s not in control right now , even though she is high functioning but who knows if her family weren’t involved what would become of your sister, eventually she could become more and more paranoid.

Thinking of you .

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Just to add my son tried to run off when at one point we had a psychiatrist, a dr a nurse and four police officers in here.
He jumped out his bedroom window and actually got away, none of them caught him. He returned to our house in the early hrs after a police helicopter etc was looking for him.
We got the police right back while he was packing a bag to run off and thankfully he got taken to hospital, I say thankfully but it wasn’t perfect, and to some extent has traumatised him to this day, but I’m s sure it was better than the alternative .

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@Jane57 She is definitely up for therapy but she is strictly against any form of medications. She thinks she needs therapy for anxiety and depression which is caused by all the bad things being done to her by her family, friends, co-workers.
She claims that she is already seeing a therapist/helpist/doctor (she has claimed these three different terms at different times). But I have my doubts regarding that. We can’t ask her which therapist she is seeing because that will kick her paranoia into believing that we are trying to buy the therapist too into proving that she is mentally ill and needs medication.

We can’t even force anything on her other than spontaneous forceful hospitalization because we are worried she will leave home and stay alone, and that way she will again live without treatment. She has claimed that the moment she is financially able to afford a place of her own, she will never look back at us.

I am feeling very relaxed after talking to you and others through this platform, feels so good to talk to some who is understanding the situation. Thanks a ton for sharing your thoughts and providing good advice, it is indeed helping a lot :slight_smile:

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I think the most worrisome symptom here is the suicidal ideation. All of the worries about her feeling traumatized or angry are legitimate concerns but the risk of her harming herself is much more important. Getting her treatment is imperative if she is to live a somewhat harmonious life within the family. I wish your family well and hope that you can gather the family around and get your sister into treatment.

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@TAG Thanks for your reply. I am also dead worried about the suicidal tendencies but I just don’t know how to go forward from here. The doctors say that we have to call an ambulance and admit her, and we have been reluctant to do that.

I have to try to talk to her again tomorrow and I am too anxious to talk to her. She talks like a butcher’s knife ( I know she is not doing that intentionally) whenever we try to talk to her about going to a doctor.

I feel guilty about delaying the admission, we are hurting her only by delaying the treatment she needs/deserves but I am also worried about the negative outcomes of getting her admitted to the hospital against her will.

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Pizza, I don’t know what it’s like in India, but here in the UK, we couldn’t just call an ambulance.

We had a doctors, a psychiatrist and a mental health Nurse here.
My son wouldn’t go in the ambulance so sadly the police had to be called too.

This is the criteria here ie two doctors and a mental health professional.

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@Jane57 Here in India, human rights/ laws governing mental illness aren’t that great and is a blessing in disguise in such a scenario. A doctor, a nurse and some staff comes with the ambulance and will try to convince the patient to go to the hospital. In case the patient is not ready to cooperate at all, they will sedate the patient forcefully and then take her to the hospital.

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The earlier you get treatment for her, the better outcome she will have in the future, I have read. If she has SZ, it will likely get worse. The statistics I have read are that the illness tends to progress and then plateaus after 5-10 years. Figuring out when the illness started, however, can sometimes be challenging. If you call the ambulance, does she have to know that YOU are the one who called? If she is a danger to herself, I can’t imagine you would not call. People who talk or write about suicide should be taken seriously. Once she is at the hospital, the hospital medical staff will decide what is her best care. It is NOT YOUR fault. If she is not able to admit that she is sick, you really MUST read the book “I’m Not Sick; I Don’t Need Help”. It will help you understand how to talk with her. There is also a book “You Need Help! A Step-by-Step Plan to Convince a Loved One to Get Counseling”. Counseling could also be very helpful to helping the person agree to take medication or get other help.

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Thanks for your helpful reply.
I searched online and I don’t think these books are available in India. Will try to look for e-books. I saw the videos od Dr.Xavier Amador suggested by @SzAdmin and they are very helpful. But I think talking to her will take time which we certainly do not have and she is not ready to talk to us at all regarding her delusions because we are a part of it.

(Through texting)Today I asked her if she is free to go the doctor sometime this week and she said that she is not going there and I am free to call an ambulance to drag her there. I also asked if she doesn’t like this doc we can go to some other doc she recommends, but to that there was no reply.

Still in a dilemma about what to do.

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Pizza, i’m so sorry. But we do all understand fullytrying to get our loved ones help and not hospitalization. Sometimes hospitalization is the only way at least for my son. And it is almost as though he or the illness chooses it for him.
My son was much better when I saw him yesterday and we had a really good visit. He is so clear and I did not see any indication that he was hearing voices. He did get quiet at one period but seemed content. Then he said he wanted to go lay back down. The paranoia was not present but the grandiose ideas are still there.

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Hello all,
Sorry for not posting for a while.

After a lot of waiting anxiously, we admitted her to the hospital last Sunday. I could see her symptoms progressing from the last couple of months and now I could see she was always very anxious and irritated. The day we had planned to admit her (she didn’t know we were admitting her), she was getting very irritated by sounds of cars going in the neighbourhood, somebody running on the stairs of the building, faint music sounds coming from a religious function a few hundred meters away. These were the things she didn’t seem to mind earlier.

After calling the ambulance she didn’t get violent but argued a bit. After a while, she walked to the ambulance by herself. She was told that doctor has asked for some tests to be done and since she is not going to the doctor, the ambulance people have been called to take her there.

She is on aripiprazole since Monday. They have increased the dosage to 30mg day before yesterday. My dad has been with her all the time and she thinks that he believes that she is not ill, so she was okay about having him there.

Surprisingly, she called for our mother yesterday. Since the illness started she has always been thinking about our mother as someone who has been bought by her former employer into spying on her/mixing poison in her food. It was surprising to see her spending the whole day with her yesterday. However, she still thinks that me and my mom have admitted her there forcefully and she doesn’t think she is ill. (I think it is possible that she was acting to be good with mom so that we think she is normal now and we will get her discharged)

Doctors say that her thought process has still not changed and her delusions are still there. They have chosen aripiprazole because it has the least side effects (Amongst the drugs available in India) but however, it effects slowly. They say they hope to see some improvements in her in around 4 weeks.

I feel terrible as I had made the call to admit and she thinks the same. She told our dad that she doesn’t want to see my face as I called for the ambulance to admit her. I just want that she gets her career back even if she does not want to look at my face for her whole life.

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You have did the right thing, hard as it is , you have did for your sister what she couldn’t do herself.
It could well be she sees your Mum as the “softest” person, the one likely to get her out.
Here in uk it usually goes to the elder (husband) of the relative.

My son is on 20mg of aripiprazole and so far it’s been the best med he’s taken.
My son was the same he didn’t want to see it speak to us , that will change as your sister improves I’m sure.
Hang in there .

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