Family member with mental illness

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That's a hard situation Greg. This is a common problem with schizophrenic patients, they get better while hospitalized for psychotic episodes because of anti-psychotics. Once they are stable they have to be released. There is nothing legally we can do as medical professionals to hold a stable schizophrenic. The problems often arise when these patients get back out into the community and decide they don't need their meds anymore or they don't like them because of the very real side effects they often have. Off their meds they go and back into psychosis and another hospitalization. Each "psychotic break" a schizophrenic patient has damages their brains more and more--its additive. Often causing a progression of symptoms, usually negative ones, you see in long histories of uncontrolled schizophrenia.

The good news is the newer generation, ie; 2nd generation, neuroleptics (anti-psychotics) are much better at controlling both positive and negative symptoms. They have some available in depot form (IM injection) which takes the compliance issue of oral neuroleptics out of the patients hand. Unfortunately I feel like a lot of psychiatrists (particularly the older ones) use these depot forms less because they simply aren't used to them. Its something that certainly needs to be utilized more. That might be something to consider talking to his doctors about the next time he is hospitalized (depot forms that is).

You're right to worry about the substance abuse too. Schizophrenia with any comorbid disorders (be that anything from depression to substance abuse/dependance) has a worse prognosis. Unstable home environments, stress and substances can all be harbingers of psychotic episodes.

If he can get the schizophrenia under control (preferably with something like a depot neuroleptic) then it would be a good time to discuss an inpatient substance abuse and treatment program, which it sounds like he needs too.

Down the line there is specialized social training therapy for schizophrenic patients to help with issues like personal hygiene and social interactions. Which sounds like it would be useful for him, but he's going to have to get the schizophrenia controlled and the substance issues taken care of before that type of thing would likely be useful for him.

Its unfortunate that the cost of psychiatric and substance abuse hospitalizations can be so costly to patients and families.

I wish you and your family the best of luck.

I'd be curious to know, as a practitioner do you think that it's possible for the concept of mandatory institutionalization to evolve in a way that could find the right moral intersection? Or is that just never going to be a good answer? When you see what happens to the seriously mentally ill when given normal human freedom, it seems so hard to argue that it has as much to do with what's best for them as our own discomfort at having no humane choice but to deny another human being freedom, and or no willingness, nor ability, nor trust in our ability to exercise painful and confusing responsibility - so complicated. Right now it seems mandatory institutionalization is occurring anyway, it's just prison as often as not, also hard to argue that's the lesser of two evils.
 
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