Helping you get through tough times

Psychosis and schizophrenia

Welcome to ReachOut.com’s Ask the Expert service

Each month we will concentrate on one particular mental health area and work, mainly, with one specific collaborator. In October Niall Turner from DETECT took your questions about psychosis and schizophrenia.

We won’t have all the answers to every question – but we do have access to the best available information, so let us know what’s on your mind by submitting a question here.

The advice provided through this service is not intended to replace face-to-face professional advice or any on-going support that a person may be receiving. If you or someone you know is in crisis now you should go to emergency support information.

Craig says:

What does it mean when a psychiatrist has put probable diagnosis of paranoid schizophrenia?

Dear Craig,

Thank you for your question. When a probable diagnosis of paranoid schizophrenia has been suggested by a psychiatrist it usually means the persons situation is evolving. The persons current symptoms are probably in line with those required for a diagnosis of schizophrenia to be made, but there remains the possibility that as things progress a different diagnosis would more accurately describe the persons situation. Also for a diagnosis of schizophrenia a person must be experiencing symptoms for more than 6 months, if this criteria has not been met the diagnosis is probable until the 6 months has passed.

I’d also like to make a quick comment on the debate regarding the value of diagnoses and give my perspective as a mental health clinician. I’m sure some will agree, others will not, the debate is healthy. Some people feel that diagnoses are stigmatizing, and that labeling someone with a diagnosis of a mental health condition is not beneficial; other people feel it is important, as with the correct diagnosis the best possible treatment can be provided. For me I see the different names for different mental health conditions as acronyms, like shortcuts, in one word they tell me the kind of experiences a person has been having. This enables me to start to think about how I might be able to assist the person, so the best possible help can commence quickly and effectively. I think this is not only good for the affected person but also efficient delivery of health care. If we consider other businesses, like IT, they all have their own language, it is used to enable efficient operating of that business. I see diagnoses as helping the efficient working of the business of mental health care and in the current times it is so important that our health service works efficiently and effectively. However I do agree that with the current amount of confusion about what the terms mean they may not always be helpful for the person, we need to change this and the good work being done by ReachOut.com and the See Change campaign needs our support. I hope that in the future when mental health literacy improves that there will be better understanding of what the diagnostic terms mean, and in time I think this will help increase people understanding of a affected person’s situation enabling us all to have better empathy for that person, which is what they often need.

All the best,

Niall

Bookle says:

I am a 41 year old man who suffers from schizophrenia. During the end of 2007 I suffered from psychosis and I was hospitalised for several months. Now I am on a maintenance does of both anti-psychotics and anti-depressants, which treat the positive symptoms of schizophrenia but which do not treat the underlying illness. My question is what can I do to help treat the underlying illness? Over the last 3-4 years as I have recovered from the illness, my symptoms have improved. However, no one has told me how to help the underlying illness other than to take these tablets which merely treat the symptoms. Is this something that medical personnel actually know or is the science at such a raw state that no much is still known?

Dear Bookle,

Thanks for sending in your query, its great to hear that things have being going well over the last 3-4 years. With regard to sorting out the underlying illness I’m afraid you hit the nail on the head in your last line and as far as I am aware the science is still at a raw state and we don’t know how to prevent or cure certain illnesses including schizophrenia. To be honest in order to cure a underlying illness you really need to know what causes it to happen, finding the cause of any illness is very difficult. The right combination of medication is very beneficial to prevent further acute episodes like the one you had in 2007, however it also sounds like you would like to talk more about your situation and gain a deeper understanding of it. I think it is important to say that traditional psychoanalysis has not been found to be beneficial for psychosis but supportive psychotherapy and CBT have so maybe discuss with whomever prescribes your medication what steps you could take to get this sort of treatment.

Hope this helps

Best wishes

Niall

Jay says:

hi, im in uni now, I live on campus, therefore we have a communal living room and kitchen, but what happens me is if im hungry or want to watch tv and im in my room I wont go to the communal, I build this thing up in my head like, oh I wonder what people will be saying about me when I walk in or they will be taking about me, and this happens all the time, it builds up so bad that I just go to classes then go back to my room and I buy food and eat it in my room, can you tell me what the problem might be, thanks

Hi Jay

Thanks for the enquiry. Could I suggest you go to the usually very good university health services, or your own doctor/GP, to talk through your problem further. What you are experiencing sounds like social anxiety but I couldn’t be certain so it would be good if you went to see a health professional to talk it through with them.

What you’re feeling and thinking seems to be negatively affecting your life and preventing you from fully enjoying your time in university, but with the help and support of the university health services, or your GP, it is possible to work through those negative and upsetting thoughts.

I hope you use these feelings in a motivating way and pursue further advice and help.

Take care,

Niall

Afolabi says:

Is schizophrenia curable & what are the symptoms of it?

Hi Afolabi,

Thank you for your question. There are a number of symptoms that a person diagnosed with schizophrenia can have, it is not a requirement to have them all, but they would have at least two symptoms for at least six months. When a person is in an acute episode they would be regarded as having a psychotic episode.

Kurt Schneider was a German psychiatrist who suggested thinking of ABCD to remember some of the symptoms of schizophrenia: Auditory hallucinations, Broadcasting of thought, Controlled thought (delusions of control), Delusional perception. These symptoms are referred to as being “positive” symptoms, not that they are good but rather they are additional experiences the person has over a non-affected person. They are often very distressing. Other symptoms of schizophrenia are severe lack of motivation, lack of emotion, lack of expression, poor concentration and social withdrawal. These are collectively known as negative symptoms as the affected person has lost something. One further symptom of schizophrenia that an affected person may experience is disjointed thinking which can be recognized by those around them by their disjointed speech.

We do not know enough about the cause of schizophrenia to be able to cure it. However it can be successfully managed and many people with schizophrenia recover and get on with their lives, others do not. There is now hope and evidence that early intervention will lead to better outcomes for affected people however it is not yet widely adopted.

I hope this answers your question

Niall

Teresa says:

My cousin has been told she has bi polar. She is currently in hospital and doctors have given her Lithium. She was home for the weekend and was hyper active not eating not sleeping and was very cross with everyone. I brought her back to the hospital yesterday and her medication has increased from 600mg to 800mg Is this correct do you think .She has a 5 month old baby and a 5 year old son and the family have been told that she may not be able to rear her children !!! I find this so sad and wonder if there is anything I can do to help her

Hi Teresa,

I’m sorry to hear what your cousin is going through. Bipolar disorder was previously known as manic depression and the symptoms can be extremely disruptive and distressing to a person’s life.

A person with bipolar has extremes of mood – highs and lows – hyperactivity, not needing sleep are all typical when someone is manic, also known as elated or high. It takes time for these episodes of altered mood to pass, so it’s important for everyone to be patient. Once it has passed, the hard work of preventing it happening again, known as a relapse, starts. This is something you can help with, but can’t do for the person. Usually there will be early warning signs of an impending change of mood, its key that the person themselves and those close to them know what these are, and if they emerge that the necessary action is taken. This might be reducing stress, seeing a doctor, taking regular exercise and as you mention happened your cousin, the dosage of medication can be changed for a short period of time. There are many ways to prevent a relapse from happening, knowing the early warning signs is essential.

Shine and Aware offer support groups for people experiencing mental health problems, and Shine also offer Relative’s Groups, which might be helpful for you to look into, to help you understand a bit more about what your cousin is going through, and how you can help.

It is sad to hear news like this, but don’t give up hope – many people are able to manage their bipolar and live full, successful lives through working with their doctors and other supportive people and services.

Take care,

Niall

Conor says:

I’m 29 and have suffered on and off with bout of anxiety and depression for the last 12 years. I have always feared that there might be something else ‘wrong’ with me. I’m terrified that I might have a hidden personality disorder. When I read about the symptoms of ones such schizoid, dependent, I fear they describe me. How do I know if this is the case or if it’s just distorted thinking and me being hard on myself?

Hi Conor

It sounds as if you have good insight into how someone’s thinking can get distorted by fear and negative thoughts. One can often see similarities to themselves in broad descriptions of conditions; one tip is not to look at how you are like the description but how you are different to it.

Also trust in any professional advise you have been given and try to use self help strategies like going to a support group (Recovery, Aware, Grow). I also recommend you try the new Australian online Cognitive Behavioural Therapy website – MoodGym. MoodGym is an online training program to help prevent and reduce depression and anxiety in young people.

I hope this is helpful to you

Take care,

Niall

Kathleen says:

My son who is 21 has been prescribed zyprexa 5mg and lexppro 5mg when he was diagnoised in 2010 with depression and psychosis since 27th August 2011 refuses to take his medication. He is again talking to himself constantly lacks concentration and refuses to attend collage and will not see his doctor

Dear Kathleen,

I’m sure this is a very difficult situation for you and your family. Let me reassure you that you are not alone. Many people who develop mental health conditions, particularly those that feature psychosis, find it difficult to accept treatment. Many good books have been written on the topic, I’d recommend “Henrys Demons” by Patrick and Henry Cockburn, “I am not sick I don’t need help” by Xavier Amador and the online carer education course available at www.mentalhealth-support.ie . Also Shine offer support to relatives of people with mental health conditions and there may be a relatives support group in your area.

Also I’d recommend you have a chat with your son and try to agree that there is open communication between the two of you regarding his mental wellbeing. It sounds as if his symptoms are reoccurring and what is very important is that these symptoms get treated as soon as possible, you seem to be aware of this. Maybe if your son realized that the fact that coming off medication didn’t work does not mean he has failed, its just not the right time and he could try to come it again later would help him to come to terms with the need for medication at this time. Also that getting assistance is a sign of strength, not weakness and going back on medication for a while to prevent himself for getting any worse is the best course of action. The website I mentioned above also has a relapse prevention course your son can do for free.

In the event these approaches do not work, and even while you are attempting them, I’d enlist the support of your GP and mental health service, your son may not be willing to attend but they can support you through this difficult time.

Hope things improve soon

Sincerely

Niall

Clara says:

I always have negative thinking all the time.

Dear Clara,

Sorry to hear you have being thinking negatively, many people are affected with this problem. It is much more distressing than people realize, you can’t just switch it off you must develop new habits which will help. There are many ways to develop these habits. If its possible, it would be worthwhile seeing a psychologist to do some Cognitive Behavioural Therapy (CBT). This will help you to challenge your thinking and recognize that you may be looking at things through dark tinted glasses rather than seeing the situation clearly for what it is. To read more about CBT on ReachOut.com, follow this link

If its not possible for you to see a psychologist, I’d suggest you use MoodGym an online CBT course. Also borrow some books from the Library if you can – The Mindfulness Way Through Depression is one good book to read, Mind Over Mood is another very useful book.

Hope you break your negative thinking habit soon, you’ll feel liberated once you do.

Thanks for writing in

Sincerely

Niall

Ps if something works for you and you break the habit, share your knowledge and pass it on, you’d be surprised how many people you know are suffering in silence

Prince Rules says:

Hi I have a problem of seeing things as if they happen before i could explain each particular thing to happen next,Sometimes i argue with my friends telling them this is a second experience of such an act.what problem do i have and how can it be solved

Hi Prince Rules

 

I couldn’t be certain what your problem is or how it can be solved but I have some advice. You may be experiencing déjà vu, or you may be having something we call “magical thinking” . For some people this is like elaborate day dreaming and does not grow or develop, for others it does develop and can become distressing, even affecting behaviour.

It might be best to get some advice from someone that knows you well. Discuss with them these experiences and any other similar experiences you have had. Could you talk to your GP, school/college counselor, parents, sibling? If they have noticed you are not “yourself”, particularly if they mention that you are behaving differently, I’d look into it further. You could do this with your GP.

Hope this advice helps, look after yourself

Sincerely

Niall

Laura says:

Hi Niall,

I am impressed by your very frank answers above. In the past I have had a terrible time getting straight answers from mental health professionals, and often I find that they use very big words that I do not understand and then prescribe cocktails of drugs that make me feel sick and impotent.

What I really find difficult to understand aside from the big words is “how do psychiatrists diagnose all of these illnesses?” For example if I go and have a blood test done, there is evidence in the blood test if for example I am anemic the iron level will be reduced below an accepted norm, but mental health professionals perform no such objective tests, they just meet with you, ask a few questions and then blurt out a diagnosis and prescribe medications that they really have not explained the effects and side effects of and tell you “If you don’t take them they will inject them into you” I find it really difficult to accept that in this day and age that such irrational practices are acceptable, but I know for a fact that these things happen. How is it possible that such subjective diagnosis with very fuzzy descriptions of what exactly is meant by the diagnosis can be handed out to people and essentially forced upon them, to me it often seems like the kettle calling the pot black, for example, psychosis = delusional thinking, however non evidence based diagnosis are acceptable to the medical profession and are in fact justification for doling out medications with very serious side effects?

Kind regards,

Laura

Ps, in relation to Jay’s question above, if you are in your first year of Uni and it may be your first time living away from home, you may be just experiencing difficulty adjusting to all of the new things and new people in your environment, take your time settling in and get to know people 1 by 1, in a comfortable surrounding. Make small talk, many people find it difficult eating in front of strangers as we are all at our most primeval (not sure if that is the right word) when we are hungry.

Dear Laura,

Thanks for your comment and questions, it reminds me of a very good article I once read by John McCarthy in the Evening Herald where he compared his experience of getting a diagnosis of a mental illness to when he was diagnosed with a physical illness, cancer. Both were obviously very difficult, one involved many scientific tests over a number of weeks that confirmed one diagnosis, the other involved being questioned by a mental health professional and then, from Johns account, been quickly given a diagnosis. In his article John posed many similar questions to the ones you pose below. I didn’t have all the answers then and I don’t now but I do have some thoughts.

Before the days of modern medicine diseases existed, yet it was not possible to diagnose them with blood tests, x-rays, or MRI scans as these had not been invented. Instead doctors were reliant on the signs and symptoms a person presented with. Some of these where physical signs, like rashes, coughing, diarrhea, etc whereas others where changes in the persons usual abilities and behavior. As the ultimate end of most physical illnesses was death, medicine has spend much of the last few hundred years trying to better understand these illnesses in order to find effective ways to treat them and even prevent them. Due to this research we can now prevent some conditions like TB, measles, etc and while we can’t cure others we can treat them effectively so people can lead meaningful normal lives. As part of this research there were also discoveries of scientific ways, like blood tests, x-rays etc to diagnose these conditions, but what about mental health? Well the short answer is we are not there yet. We are still at the stage where we diagnose people through observation of their biological functioning, their behavior, and discussion of their thoughts. Making a diagnosis of a physical illness is easy compared to diagnosing a mental illness as we are hindered by our lack of understanding of what causes mental illness; we need to catch up and we are trying.

Although there are no physical signs, no blood test, no litmus test for most mental health conditions, these conditions exist and have a profound effect on a person’s life, driving some people to take their own life. There is usually some biological changes and functional problems. We do know that when mental ill health develops that biological changes often occur to sleep, appetite, and libido; functional changes such as poor concentration, poor ability to manage day to day activities also ensue, and behavioural changes like socially withdrawing, not looking after oneself, and stopping usual hobbies and interests gradually happen. There are also usually changes to the way a person views themselves and thinks about the world. I think it is important to consider the two perspectives on these changes – the perspective of the person experiencing them and the mental health professional who is listening to them and interpreting them. For the person experiencing them they are distressing emotional problems that affects how they feel about themselves and the world around them; for the mental health professional they are possible signs and symptoms of ill-health.

Laura, I’m sure no-one likes to think of their life problems as signs and symptoms but the mental health professional has the task of objectively interpreting them in this way in order to determine if the person is indeed ill, and if ill prescribe the best possible treatment to help them get well. Unfortunately there is not widespread knowledge among the public of what the signs and symptoms of mental health conditions are, and even when they are recognized sometimes the terms are misunderstood – for example schizophrenia is regarded by many as meaning the person has a split personality which it is not. Many organizations like ReachOut.com, DETECT, Shine, Aware, Bodywhys are trying to improve the mental health literacy in Ireland so everyone are understands what the signs and symptoms of conditions are and where to go for help. If this comes about, it might demystify mental health conditions, empower people with mental health issues to ask for the type of help they want, and improve the communication between mental health professional and the person experiencing the mental health problem.

In addition to the work being undertaken to improve mental health literacy there is also scientific advances being made. A recent article in Nature, which I wrote a blog on in ReachOut.com, said that the next 10 years will see many breakthroughs in our understanding of the mind, I certainly hope this comes through. In the future as research concentrates on mental illness we will hopefully catch up with the level of understanding achieved by our colleagues who work in the treatment of physical illness and be able to better diagnose, treat, and even prevent mental health conditions.

Laura, I’m afraid it’s a very long answer, I hope it does justice to your very important question.

Best wishes,

Niall

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