When you know your loved one is on the brink of a relapse

Family
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Hi all
I have posted before and have been in and out of these discussions. Most of my life is about dealing with my son, 25-years-old, who had a psychotic break last May, was hospitalized for eight days and now lives with me and my husband, his stepdad. I don’t come to this forum a lot but when I do I always find comfort - if even just knowing there are people out there who TOTALLY get what caring for a psychotic person is like.

Since my son’s hospitalization last May, he has gone off his meds. About two months ago he decided the Zyprexa wasn’t helping him and he stopped.

Since the holidays I have noticed huge changes in him. He takes moments longer to respond because he is dealing with his voices. He is returning to some of his delusional behaviors - for example, he has a ‘special aura’ because he went back to being vegan.

But the worst thing is that the more bizarre his behavior seems to me and his stepdad, the more normal HE thinks he is. He just says he’s doing great and all is well with the world.

Meanwhile I am seeing daily reminders of the same behaviors that got him hospitalized seven months ago. I’d love to hear from people who have been through relapses and how they handled those early signs. I feel a full return to psychosis coming any day now and I am terrified.

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Your right, a full relapse is underway! My husband has relapsed more times than I can count and it’s either the meds stop working or he stops taking them and it’s hard to determine which it is as he tries to hide it from me. The biggest mistake I make is waiting too long to get him help: the longer you wait the worse it is for them and you. I live in NJ and the county I live in has a psychiatric mobile unit that when called, they come to your house with the police and evaluate him and ask me questions regarding his behavior…I have had to call them quite often: just about every six months over the last four years and looking at a possibility of having to do it again. They never want to go to the hospital willingly! My advice for you is don’t wait too long…sorry you are going thru this as it seems never ending. Good Luck and I hope he gets the help he needs! Just remember that regardless of what he says or thinks, know in your heart you are doing what is best for him!

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I wish we had a psych mobile unit in our state! The care available from state to state is so immensely different. It is very sad. All we have is the Emergency Room. And even then they may not hold them unless there is an additional compelling reason.

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When I was a kid, my Father had a bad accident and ended up schizophrenic a few years after that. I remember my mother having to deal with the same thing with no options except the emergency room. My Mom was a on the first aid so she knew a lot of cops and they used to come to the house and talk him into going to the hospital, but what a fiasco it was… it amazes me that even now in 2018, there are states that offer the same type of help that was available since the 70’s or 80’s…so primitive! It’s unnerving to have to sit there and wait for him to either harm himself or someone else before he gets the care he needs! This country ought to be ashamed of itself for the lack of care for the mentally ill! They treat it as if it is still taboo! I feel for you and hope he gets the help he needs…Keep me posted! This forum is a good outlet as we all understand what you are going through and it really helps!

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We have a rule in our house, maybe because my child is a minor, but it’s a hard and fast rule. If safety is a concern, admission is a must. Whether it’s her safety, ours, or someone else’s, we do not hesitate to admit her. With an adult, it’s harder but still necessary. There has to be a line somewhere that’s held consistently. Medication compliance and safety are two of ours. Relapses are a sign of a safety issue for us.

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With an adult it can actually be impossible. Harder we do every day.

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I agree with both of the comments above - safety is a must, and with an adult it can be an almost impossible case sometimes.

Odd behavior is not grounds for hospitalization. Neither is destructive behavior. Dangerous behavior can be, but you must really state your case.

Last year things changed in my area where the police can no longer transport individuals to a psychiatric facility, they are required to take them to the ER. The last time he needed hospitalization, I ended up transporting him, with the police tagging along behind.

Guardianship allows me to make the decision of hospitalization, but he must meet inpatient criteria - which general requires that his ability to perform self-care skills be impacted, or that there be cause for concern for his or others’ safety.

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Great comments.

As for my son, his behavior doesn’t warrant a hospital visit - yet - but I can see the symptoms building rapidly: insomnia, delusions, constant hallucinations (mostly auditory). There is about a 5 second lag between a question or comment I ask/say to him and his response, all while lurking and staring. Most of all, I recognize the personality that comes over him when he’s slipping into psychosis. His voice takes on a higher, very calm tone. His attitude is overly agreeable, very passive and if asked how he is doing, he responds with things like, “very well” which is just absurd to those of us observing him.

I have never felt in danger, thankfully. I don’t think he has a violent bone in his body but I also realize how unpredictable psychosis is.

So it’s a waiting game and absolute hell for all of us.

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JooJoo, I am so sorry your son went off his meds.

Jeb’s episodes usually start with insomnia also. If your son is having constant, mainly auditory hallucinations, isn’t he in a psychotic episode now? My apologies if I sound confused - doesn’t this qualify for a hospital visit if he would go?

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http://www.treatmentadvocacycenter.org/texas

I don’t know what state you’re in but this is a guide that we use in Texas. If you seek admission at a mental health hospital and present information that matches the intake screening, they’re required to hospitalize for at least 72 hours, possibly longer. As an advocate, you have to speak up and insist on treatment for your mentally ill child. It requires being forceful and firm but polite. It requires clear communication of the safety risks to themselves and others to trigger.

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Its a big state Texas is, and, sadly, the reality is that its different from county to county. What goes on in Bell County for children or adults with mental illness is not the same throughout the state.

First of all - unless I can bundle my 6’3" 36 year old strong son into some sort of easy carrying contraption - he’s not going near a mental health hospital.

Second - Even bundled into some sort of carrying contraption and carried into a hospital - he’s not going to sign anything that makes me his advocate.

Many/Most of our adult children with brain diseases have periods in which no one can tell they have any sort of issue.

On one of these threads I have posted how my county in Texas handles people with brain diseases. I won’t bother posting it here.

I can speak up all I want, I can insist on all kinds of things, and I can do it politely - even charmingly.

It won’t matter. My son who is highly intelligent, graduated from university many years ago, whose brain disease didn’t disable him until he was 31, will simply tell them “no thank you” to whatever they would do for him.

He’s never hurt anyone, he’s never threatened to hurt anyone, he’s never threatened to hurt himself.

The things he has done were duly reported to the police and they simply offered to talk to him.

The 4th amendment of the US constitution prohibits unreasonable searches and seizures.

So for some of us, in some locations and in regards to the particulars of our loved ones with scz, it can actually be impossible.

So we do the best we can.

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He pretty much has had constant auditory hallucinations since his first break but now everything has just escalated with many symptoms piling on top of symptoms. But he’s still not quite fully psychotic, meaning he still has some connection with reality.

When he had his break before he was completely unable to distinguish reality and I guess that’s what my criteria is this time. He took a xyprexa (after some convincing and pointing out of all his problems lately) last night and hasn’t gotten up yet so I have no idea what he will be like today.

I know when we took him to the ER before they weren’t even going to keep him, in spite of him being out of his mind, but then the therapist noticed how thin he was and convinced the ER doc to hold him for transfer because he couldn’t care for himself. He isn’t thin now… don’t think they’d keep him over night even. That’s why I haven’t taken him.

I live in Oregon and it is one of the worst states for care of the mentally ill. Really awful. They just turn them loose out on the streets here.

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So glad you were able to convince him to take a zyprexa, hope your today goes better and he stays on his med.

Mine has the constant psychosis as well, but when he is totally overwhelmed n an episode - its a total disconnect. We can’t even approach him.

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He just came downstairs for the first time today ( at 530 PM!). I asked him if he was hungry. He said no. He got a drink of water then went back upstairs but he seemed clearer to me, his body language was more normal and his responses were not delayed by 10 or 20 seconds. So fingers crossed he’ll take the xyp again tonight.

He was becoming unapproachable for sure, as you stated about your son. He just kept saying “I’m doing well, thank you” and things like that, like we were acquaintances exchanging pleasantries. But when we drove 45 minutes to another town last night because he got on the wrong bus, and found him standing stiff legged with hands behind back outside a restaurant, in the rain, just standing there waiting for us all the time it took us to drive there… well then I had something to use as evidence that things aren’t going as well for him as he thinks. That really helped. I am actually learning, little by little, how to talk to him to get the best response. It doesn’t always work but most of the time, I can at least get my point across.

Of course, that was last night.

Tonight will be a new experience, as each and every day/night is with this brain disorder.

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Just hurts to think of him standing in the rain waiting like that, just really hurts my heart. He could be any of our kids. Mine lost his brother’s car the other day. He convinced someone to let him use their phone. The kind person had to give me the address as he didn’t know where he was. I hadn’t even answered my phone the first time because I didn’t recognize the number.

Really, really hoping yours stays on the med, you’ve had him on meds and working - good job JooJoo!

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Good he had the where-with-all to borrow someone’s phone! Bless your son. If my son drove, I could totally see that happening.

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After he went outside to wait for the Uber to pick him up, I called the person back and thanked her, mentioned Jeb was special - she was so nice, she went to look to make sure he got picked up. I have used the “special” reference before, people do respond well to it.

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Yes my 21 yr old son relapsed again and is in the hospital again. I brought it to his doctor’s attention after I had failed to get a Baker Act last weekend and the doctor Baker Acted him. He was changed back to zyprexa 3 weeks ago and it has not been good. I am his legal guardian so I always meet with the doctor. I am looking for an assisted living for him. It seems that his meds fail every 9 months. It is a merry-go-round and I want off. So hard to look after me. It is a comfort to know I am not alone dealing with this

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Common warning signs of a schizophrenia relapse include insomnia, social withdrawal, difficulty concentrating, irritability, loss of interest, increasing paranoia, and hallucinations. Knowing these symptoms is important, but knowing the symptoms that are specific to each person with schizophrenia — called “relapse signatures” — is more important. Up to 70 percent of people with schizophrenia will experience these early symptoms before a full relapse sets in.

“These warning symptoms can be very specific," says Michael T. Compton, MD, MPH, chairman of psychiatry at Lenox Hill Hospital in New York City. “For one person, it may be insomnia or worries about the neighbors. For another person, it may be irritability or hearing whispers.” In fact, warning signs may be as specific as avoiding a certain food or color, Dr. Frangou says.

That’s why it’s important to know the symptoms of previous episodes and to watch for them. "The first sign of a relapse is repeating symptoms of a previous episode,” Frangou says.

The first symptoms of schizophrenia onset may develop over months or years. Relapse tends to happen more quickly. According to the BMC Psychiatry review, the average time from return of symptoms to a full relapse is less than one month. Recognizing these symptoms early on can help immediate steps be taken to get proper treatment.

Common Causes of a Schizophrenia Relapse

Knowing the common causes of a schizophrenia relapse can tell you when to be on the lookout for a relapse of symptoms.

Not taking medication regularly or as prescribed is by far the most common cause of schizophrenia relapse. Persistent use of drugs or alcohol and criticism from caregivers are next on the list. “Many people with schizophrenia abuse some type of drug, most commonly marijuana,” Frangou says.

Stress is particularly problematic. “Stress may contribute to schizophrenia relapse, but symptoms of relapse can also increase stress,” she says.

First Steps to Take If a Schizophrenia Relapse Occurs

“You may not be able to prevent a schizophrenia relapse, but early recognition and treatment may prevent a hospital admission," Dr. Compton says. “The first thing to do is call the person’s doctor to find out if his or her medication needs to be adjusted or restarted.” Other strategies include:

Staying on medication
Avoiding stress
Avoiding drugs and alcohol
Sleeping and eating well
Not withdrawing from friends and loved ones
Having a social support system
Getting psychosocial treatments

Psychosocial treatments help people with schizophrenia and their families learn how to live with the condition. They include individual, group, or family education as well as counseling. “Increasing psychosocial treatments can be an important part of relapse prevention,” Compton says.

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Thank you for the info.