Severed time with the criminally insaneâŚ
Ahh possibly? I was only a teenager at the time (she was mid-late 20s) so I was kept out of most of her treatment.
No, she doesnât smoke. Recently, sheâs been buying heaps of juice bottles and Gatorades. Like 2 litres of grape juice when she arrived, when that finished she got another 2 litres of apple juice next. She does drink some water I think so thatâs good at least. No tea or energy drink from what I can see.
The link you gave has a 404 not found. I tried just crazymeds.net and pretty much got routed back to the 404 not found.
Ohh that is great that she still has some insight about herself. Iâm really glad for you! Itâs really small things/glimpses like these that makes us not wanting to give up on them. Iâm still feeling the small win that my sister asked me out to go shopping earlier today (and tomorrow too). So yea, today is a good day 
Thereâs a little chicanery going on with that site with http v.s. https links.
Sorry about that.
@GSSP Hi This is heartbreaking to see and its very real and very farmiliar to me. My mother had alzheimers,my aunt had very agresseive parkinson disease and my husband had a massive paralyzing stroke in 2011 and now my son has schizophrenia.
What is her full diagnosis ?
Is she ever lucid or are her days all like this?
Peace
MJ
Ah, ThingsIDont, I am so sorry. There are a lot of parallels between my husbandâs situation and your sisterâs (to the point that he also found Abilify sedating rather than activating), except that my husband has not (yet) gotten to the point of inpatient hospitalization and his anosognosia has been an ongoing facet of his condition, with no real awareness even after returning to his usual high level of functioning. I have felt that this was the most challenging aspect of his disease for me (it is so strange that I know he has a thought disorder while he does not), but from your description of your situation, I can see how hard it is to love a person who does have awareness and then see it slip away.
I figured you were under a lot of pressure from the rest of the family to get your sister back on medications - very understandable, given that it sounds like when she goes down, she really goes down.
My first suggestion is to do your best to ignore that looming sense of time pressure, to stay as focused as possible in the present, and to not see it as âthe talkâ but rather as (most likely) a series of talks.
I totally get that this is VERY hard to do, with the stakes so high for you both. But the more you can go into the interaction(s) without an agenda - or rather, because of course you have an agenda (to encourage her to resume her medication), to try to push your agenda to the back of your mind and focus on communication, the better it is likely to go.
It is best, of course, to pick a time and a place where your sister feels as safe as possible. For my husband, the place is in the house.
Itâs also best to try to have in mind the best way to open the conversation. You know your sister best and so are the best judge of this.
One possibility might be to start with your own emotional reaction (usually we are really able to talk but during this visit it seems like the conversation isnât flowing as freely as possible - is it just me or does it seem that way to you, too?).
Another more direct approach might be to share your observation that she does not seem to be taking medication and ask about it - trying very hard not to be pressuring or judgmental but to convey that you are genuinely curious about her experience.
In terms of the talks my husband and I have had focused on his taking medication, one pivotal talk occurred when he first started taking the medication and decided after angrily taking the first dose that he was not going to take any more. As I recall, the conversation started when he got angry with me over unexpectedly finding cheese in his burrito (he likes cheese, just not surprises) and then indicated that âI canât heal with you in the houseâ. I just went with it, offered to move out and then when he indicated that he would move out, I asked him questions about the specifics, which got him to the point that he realized it would be challenging (he was very scared to leave the house, so how was he going to go to the bank for money, etc.) - not in a judgmental way, just exploring. When he realized his situation was pretty dire, I asked him what the downside was to giving the medication a try, since how was it likely to make things worse? He agreed, and although I had to remind him to take the medication for quite a while, he never really protested again.
I am struggling to remember the details of our more recent conversations on the subject (i.e. post his current relapse). But I think I opened both of them by sharing my distress at not feeling close to him and to be able to talk freely. I had to go with the flow again through some angry and paranoid accusations but we eventually were able to agree that we both really love each other and really want things to be better between us.
I think he spontaneously brought up the psychiatrist visits on both occasions, which was helpful. Because I knew from things he had said that he felt very controlled by me (âYou are more like a jailer than a wifeâ), I know that I needed to back WAYYYYY off, and let him know that he was totally in control of all of the decisions (whether to attend the appointment, what to share with the doctor, whether or not to take the medication). Once he felt in control, he agreed to go (although without me, which was OK) and he agreed to take medications if the psychiatrist recommended it.
Ironically, the psychiatrist has been wanting to hold off for some reason - he seems to need my husband to actually make the request. And because his symptoms appear to be relatively stable at this point and because things are better between my husband and myself, I am OK giving it a little more time to see what happens and to revisit the issue when his next appointment approaches. Plus I have the âbig gunsâ of his family (who live out of the area and so are much less looped into his paranoia than I am) to draw on for extra encouragement if needed.
Ah thanks for the explanation. All good now!
Again, thank you so much for your suggestions and sharing your experience with your husband. I read this earlier before I went out shopping again with my sister, and you have given me some good ideas on how to start the conversation. Youâre right, it should be a series of talks rather than âthe talkâ. I monitored her mood while mulling over what to say to her, then when we got back home I just blurted out âCould we please talk about what has been bothering you?â
Not the best opening, I know. But our parents always tiptoed around her issues, only hound her about medications without asking if sheâs alright or if she wanted to talk, and she knows Iâm usually quite blunt with things so I thought Iâd just go straight to it. She did get defensive, especially when I said she doesnât seem like herself. I mentioned that I saw her last in September and she was a very different person then. That something is obviously bothering her, that if she doesnât feel comfortable talking to me about it since we donât usually talk about these things, then let me know so I could find someone who could probably help her out while sheâs here. Or if she has someone she trusts to talk about things back home, perhaps that would help as well. I guess she was trying to find out what my angle was by saying all that, she kept asking âso what now?â I didnât know how to respond to that, so I just repeated what I said earlier. After some silence, I mentioned that it took me a while to finally get along with her again after her (I struggled to find the words) episodes back in 2000 and 2007 when she was not well. And then when I thought we were okay, she started behaving like before again. I also told her that I was scared, that I donât know whatâs going on with her now. She went on to say something about not needing my help for some work stuff anymore and went into her room to lay down. Conversation over.
I was shaking throughout that conversation. Mostly because I was terrified and didnât know how sheâd react. Looks like Iâll give her some time and try to be as ânormalâ as I could with her. I hope she doesnât see me as an enemy with an agenda after that conversation.
Iâm not sure this will help practitioners, but at least for me I didnât mind an air of âI know betterâŚâ when it came to the agreeing and planning parts of the things. What would infuriate me is people trying to say they knew how I thought or felt without listening, or that what I thought and felt were wrong, and if I just took the medication or otherwise did the needful, that this would all go away and then youâd think and feel âbetterââ like me (often in an an emotional and insecure tone that belied that sentiment)
Well, maybe or maybe not. I mean how could you know anything about any of this, or how medication might workâ especially if youâve never experienced the illness or took medication. My interactions with my brother are quite different than my other siblings, because I know what my symptoms were like and what itâs like to take certain drugs and what psychiatrists are like and how they and family members treat you. But I donât try to lord it over him, he knows it and knows I can play the no bullshit card at any moment, but I donât.
The method is more about restraint, like a Jujitsu of the mind. Listening and empathizing and waiting until the right moments to agree and plan, when your superior clarity of thinking and power over the person under your care and their environment are greatest. In the end, people under your care are looking for some way out of their situation, they are often miserable but donât know what to do or donât have to power and resources to do it. Your job is to help them find their exit out of the dark, not your exit, or the doctors exit. And they wonât mind the help and may actually appreciate it if itâs something out of their power, but it needs to originate from their decisions based on their needs, not yours.
I donât know what you know about John Nashâs, Nash equilibrium theorem, but it strikes me funny and poignant that LEAP appears to be a cooperative game where Nashâs game theory applies. The outcome is better for everyone if they think about whatâs best for themselves AND the group.
Wouldnât that air of âknowing betterâ sort of translate to also knowing had you taken the medication youâd be better off? I guess Iâm trying to find a good balance between âknowing betterâ and to still listen to what they have to say and understand/emphatise with it. At the moment, what I offer to my sister is that I clearly have no idea what is going on with her, only that she seems troubled. That I can see her being very different from when I saw her last (less than 3 months ago). And that if sheâs not comfortable sharing her troubles with me, I could help by finding out people who sheâd be comfortable with.
Iâm not sure how sheâd take that. Just hoping she wonât see me as the enemy now.
I donât think so, because itâs based on your observations of her external behavior, not assumptions of her internal state. As long as you limit yourself to that, and say you are different, whatâs changed for you (internally), I think you are fine. Outward appearance and behavior are hard to self observe. I know from acting thatâs why you have/need a director (aka therapist 
).
I wouldnât telegraph a supposition of cause and effect of you stopped your medications this is what you get, even if thatâs your conclusion, unless pressed should you think this a cause for conflict. I think it falls under the delaying difficult or contentious subjects if pressed by saying Iâll have to think about that, and give an answer at a later date and agree to disagree. Sometimes you have to be a bit coy. Thereâs a bit of a Poker element to this game too.
Excellent points on your 2nd paragraph! I guess this applies not only to people with sz but to people in general.
This forum has given me so much to think about and has provided me with some game plans to navigate around my sister. Iâm really grateful to all of you!
Some good updates: her mood seems to be improving slightly and she actually laughed at my jokes! My sister is still in there somewhere, she resurfaced a little from time to time. Today is another good day
No problem, Iâd like to think weâre all glad to help. I think we all wish/wished for the guidance of someone whoâs been there before, and unfortunately much of this information is very hard to capture in a book or put in a bottle. Itâs more of a coaching paradigm thatâs hard to package.
Glad reddit brought you here, Iâve avoided it as many subreddits are free for allâs. I prefer walled gardens.
My discussions with my husband tend to be blurted out, too (i.e. driven more by my emotion than logic). Honestly, I think for us it tends to work better this way, because I am totally in wife/fellow human being mode in these situations.
Ultimately, we are all just human beings trying to connect and we all have our very human failings and limitations.
I have a strong tendency towards overthinking and over-responsibility/guilt, so part of what I am trying to let go of is my own version of highly irrational thinking (i.e. that if I do everything just right, then things will go as I want/need them to go).
Ultimately, we can all only do our best and our best may or may not lead to the desired outcome.
Funny thing about Anosognosia, a lot of people donât seem to realize is it is not always 100%, there seems to be degrees of it a lot of times. In my spouses case it was anyway.
You can call it ârelapseâ but it maybe one âside effectsâ of Abilify. Abilify inhibits serotonin receptors causes âSerotonin Syndromesâ. You need to talk to your MD.
@jack168 Serotonin Syndrome is usually only associated with Abilify when it is used as adjunct therapy as an ad-on to an antidepressant like Zoloft. The syndrome is largely associated with antidepressants, and reported links to atypical neuroleptics are in doubt. Neuroleptic Malignant Syndrome (NMS) would be more likely, but itâs more associated with typical antipsychotics than atypicals like Ablifiy.
The OP didnât mention antidepressants, and thus far dosages mentioned are on the low side. Her sister is under the care of a psychiatrist. But yes of course, a doctorâs, psychiatrist and pharmacist opinions are best to have. Unfortunately, with anosognosia in the picture-- her sister might not see the need to seek their opinion.
âSerotonin Syndromeâ and "Neuroleptic Malignant Syndrome (NMS) " symptoms are the same. The only difference is the name. Majority SSRI, typical and atypical antipsychotics drugs are all inhibit (attach) 5-HT2A serotonin receptors. The side effects will certainly come out inevitable. You can call it âRelapseâ but it never go away.
I donât understand what youâre talking about serotonin receptors and whatnot. But I searched for the term Serotonin Syndrome and webmd gave this list of symptoms:
- Confusion
- Agitation or restlessness
- Dilated pupils
- Headache
- Changes in blood pressure and/or temperature
- Nausea and/or vomiting
- Diarrhea
- Rapid heart rate
- Tremor
- Loss of muscle coordination or twitching muscles
- Shivering and goose bumps
- Heavy sweating
The only symptoms I observed that could be applied to her so far was confusion, headache (from possibly laying down on the bed so much the first few days she was here), and possibly shivering/goosebumps because she came from a tropical country with over 35°C to where I live now at low 20s°C.
Webmd also states âThe condition is more likely to occur when you first start a medicine or increase the dose.â She has been on Abilify from 2008, and recently her dosage was reduced to only 5mg once a week. I honestly donât think the Serotonin Syndrome that you mentioned fit in here at all. But thanks for bringing this as a possibility.