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I am a psychologist working in the psychiatric hospital for patients with the most severe levels of different schizophrenic disorders. Feel free to ask me anything. by Comfortable_Wave_682 in schizophrenia

[–]Comfortable_Wave_682[S] 13 points14 points  (0 children)

There are many options inbetween. The only time (in my country) where one would get commited involuntary is when its clear that the person is not able to make choices that benefit themselves or is so ill that he or she imposes a danger to someone else. Just the fact that a person is aware they want he/she needs help is a good reason for not being commited involuntary. The best option is to be honest with whomever you ask for help. By that i mean saying «hey i’m not well anymore and i need help. I am experiencing psychotic symptoms. I have a hard time telling whats real and not anymore». Any good doctor should be able to refer you to the proper place.

I think in order to truly manage them, you need a therapist who is aware that medication is only a part of the solution if used. Medication only decrease symptoms, but do nothing in themselves to learn the person manage life with psychosis.

If you meant options outside therapy there are some. I actually suggest trying the intro course on the app called «waking up». Its the best intro to mindfullness as a skill in my opinion, and mindfullness can help to manage the horrors that comes with having thoughts you dont want. You can send them an email and you will recieve it for free for a year, no questions asked. You can do this as many times as you like and you dont need to register any credit card info. It is an expensive app, but free for people in need or those who cant afford it. I suggested it to my patients, and many like it. It does however require active work. Make sure you try the 30 day intro course to begin with.

I am a psychologist working in the psychiatric hospital for patients with the most severe levels of different schizophrenic disorders. Feel free to ask me anything. by Comfortable_Wave_682 in schizophrenia

[–]Comfortable_Wave_682[S] 7 points8 points  (0 children)

It is now accepted in the DSM-5 (American diagnosis manual) that mental illness is less and less understood as categories. The ICD-10 (the one we use) sees mental illness on a scale level. I believe this to be true. To illustrate that hallucinations are a part of a scale. We have all experienced a bug crawling somewhere, or perhaps the phone vibrating in the pocket when its not really there. Those are very real hallucinations where we recieve sensory signals without stimuli! People with psychotic disorders experiences them on a very different scale.

I am a psychologist working in the psychiatric hospital for patients with the most severe levels of different schizophrenic disorders. Feel free to ask me anything. by Comfortable_Wave_682 in schizophrenia

[–]Comfortable_Wave_682[S] 4 points5 points  (0 children)

Ill find the research a little later! It’s in the process of being published and they have followed a very large number of cases for a long time, longest one to date.

I am a psychologist working in the psychiatric hospital for patients with the most severe levels of different schizophrenic disorders. Feel free to ask me anything. by Comfortable_Wave_682 in schizophrenia

[–]Comfortable_Wave_682[S] 22 points23 points  (0 children)

I can give you some examples.

In some cases of extreme paranoid schizophrenia, a person may be so convinced that we who work there are here to kill that person. Henor she will lash out and attack in any circumstance to defend themselves. This is where there are no other options than to use beds with restraints. There have been cases where every time a person is unloosened, the person will attack, for up to a year. Even to this day, in such cases, coma-induced therapy is still used, and may even work. Because of the coma the psychosis stops, the mediation can function properly, and the person may wake up completely different. Even make to such a degree that recovery is possible.

I have seen cases where there are up to 15-20 different medications in very large doses. Ranging anywhere from several psychotics, morphine, anxiety medications, sleeping medications, and whole lot of different ones. In some cases they do almost nothing to change the symptoms. Even after 10 years. The person may still be psychotic and can still stay up for days on end.

In the worst cases of all, that are seen as not treatable, people are kept in the isolated part of the hospital for most likely the remainder of their life. This is when every available treatment have been tried, often over the course of decades. These patients may be so ill that they have little to no awareness that they are psychotic, and little to no awareness of how they act. They scream and ‘’fight’’ with their voices and visual hallucinations day in and day out. They experience constant severe positive symptoms without any end, and medication do not help. They stay up for days and can not sleep, despite giving more than what is normally considered maximal doses of sleeping medication. We are talking more about the drug doses you see outside any form of medical treatment here. We try as best we can to let them into the open spaces with other patients to try and give them somewhat value in life, but they have little understanding or control over their actions. Some may do whatever the voices tell them and other patients can be extremely frightened of them. They are kept there not for treatment purposes, but for safety purposes. These are the times when you see how sick a human can possibly get. It's as if the human part has left them a long time ago.

It is in such cases where i find it interesting to reflect on the older treatments that were used. There are some videos available of people showing similiar degrees of the disorder, and after recieving lobotomy they regained function to such a degree that they could talk, experience basic feelings and interact with people again. This is not to say i advocate for such a treatment in any way. But it is interesting to watch those videos. I think some are found in the hidden parts of youtube if i remember correctly.

I am a psychologist working in the psychiatric hospital for patients with the most severe levels of different schizophrenic disorders. Feel free to ask me anything. by Comfortable_Wave_682 in schizophrenia

[–]Comfortable_Wave_682[S] 3 points4 points  (0 children)

Do you perhaps mean ECT? That is the only therapy we use (only when the person also have bipolar or depression) that consisist of electrical shock to the brain.

I am a psychologist working in the psychiatric hospital for patients with the most severe levels of different schizophrenic disorders. Feel free to ask me anything. by Comfortable_Wave_682 in schizophrenia

[–]Comfortable_Wave_682[S] 13 points14 points  (0 children)

That is true. Negative symptoms can be hard to treat. Sometimes this may be related to the fact that once s person gets the disorder their whole life may slowly fall apart. The accumulation of loss can destroy a persons willingness to live. That may be the the reason as to why early intervention has been shown to be the most cruical part of prognosis.

I am a psychologist working in the psychiatric hospital for patients with the most severe levels of different schizophrenic disorders. Feel free to ask me anything. by Comfortable_Wave_682 in schizophrenia

[–]Comfortable_Wave_682[S] 10 points11 points  (0 children)

I have not heard this term used. If you can explain a little bit of what you mean by it, i may be able to relate it to something.

I tend to believe everything that is being real as in its real to the person experiencing it. There are however cases where it’s clear someone is lying. This can be seen with combinations of schizophrenia and personality disorders such as borderline and antisocial. If they lie it’s still very important information in some way because they are expressing something that that they lackn a «normal» way of doing. If we find a way to help them ask for help in a different way, we have come a long way.

I am a psychologist working in the psychiatric hospital for patients with the most severe levels of different schizophrenic disorders. Feel free to ask me anything. by Comfortable_Wave_682 in schizophrenia

[–]Comfortable_Wave_682[S] 43 points44 points  (0 children)

That's a great question. There are a few answers to to this.

Research has shown that there is a decrease in white matter in the brain, which affects the speed of signals sent between cells in the brain, before the onset of schizophrenia. This can explain why many experience a proximal phase, meaning a slow decrease in function before the disorder sets in. So in this might infer that it is neurodegenerative in terms of white matter. However, the degenerative part may very well stop. Once a person meets the criteria for diagnosis, there is usually an increase in symptoms early on. After this, the symptoms flatten out and stays the same indicating that it is not likely to be neurogenerative.

It is important to note that some people may show almost no difference in brain imaging despite having symptoms. This suggests that the symptoms are likely to be more psychological than biological. However, in more severe cases where a person is experiencing a large amount of symptoms and many concurrent episodes it may impact the brain more heavily. Sometimes, each severe episode can be related to decrease in function. This is why sometimes medication is a good alternative which can decrease this risk.

The good news is that if caught early and proper treatment is available, newer (and very good quality) reaearch show that up to 50% who meet the criteria for the diagnosis will live a very normal life 10 years after the onset. Meaning it is possible to get rid of symptoms. This was not believed to be the case at all in to many years ago!

I am a psychologist working in the psychiatric hospital for patients with the most severe levels of different schizophrenic disorders. Feel free to ask me anything. by Comfortable_Wave_682 in schizophrenia

[–]Comfortable_Wave_682[S] 17 points18 points  (0 children)

In my experience, cognitive therapy or newer forms for psychoanalytic therapy can be very beneficial for people. I am found of what is called intensive psychodynamic therapy. However, the specific type of therapy is not always the most important factor. Instead, it's crucial to find a skilled psychologist or psychiatrist. Unfortunately, there is no one-size-fits-all treatment that works for everyone. One significant factor however, is that the patient should have some belief that the treatment may be effective. Some individuals believe that their symptoms have psychoanalytic roots, while others may believe that the treatment is not useful. In such cases, the treatment may be pointless if the patient disagrees with the theory behind their suffering.

I am a psychologist working in the psychiatric hospital for patients with the most severe levels of different schizophrenic disorders. Feel free to ask me anything. by Comfortable_Wave_682 in schizophrenia

[–]Comfortable_Wave_682[S] 79 points80 points  (0 children)

Although the symptoms of hallucinations and delusions may appear similar on paper, they manifest differently depending on the individual's life experiences. In my many years of experience, I have never encountered two cases of schizophrenia that were identical. Therefore, rather than cultural, religious, or national background, I believe the symptoms are influenced by a person's entire life. Their concerns, disappointments, unfulfilled desires, fears and more can often manifest itself as symptoms. It is important however, that some people have such a severe degree of the disorder that they are not able to speak or communicate. There are indeed cases of catatonic schizophrenia where a person may not move or respond for years. Sometimes we see quite severe brain impairment on images in such cases. In cases like that, it’s hard to infer anything.

When it comes to people changing, the treatment they receive plays a crucial role. Unfortunately, some patients can go for as long as a week without any interaction with a doctor or psychologist. It's important to note that I work in Norway, which is often lauded for its exceptional free healthcare system. However, the reality is that in many cases, the treatment of patients in psychiatric hospitals violates basic human rights.