Monthly Archives: February 2014

Schizophrenia Triggered by Relationship Problems

Clinical Case Studies, Schizophrenia & Psychotic Disorder

Do you think it’s possible? For one to suffer from schizophrenia triggered by relationship issues? (quite commonly triggered by drugs, trauma, stress, alcohol, adverse experience… But relationship problems?!)

They have been in a relationship for few years, after knowing each other since 7 or 8 years old in tuition centre. They also have a common childhood friend Ernest who attended the same schools with the guy Kenji. Sue knew Ernest had a crush on her when he was 12 or 13. But she didn’t think it was a problem, and didn’t take any action. She continued to maintain their friendships, spending a lot of time together, sometimes they could chat over the phone for hours. Sue didn’t hide any of this from her boyfriend Kenji, for the first few years, Kenji never (appear to) mind his girlfriend’s close relationship with another guy.

Till one day more recently, Kenji started to shout at and scold Sue, for still staying with Ernest despite knowing the latter admiring her. He said Ernest isn’t a good guy to befriend with, and he is kind enough to warn her about this. For the sake of her boyfriend, Sue decided to slowly keep her distance from Ernest. That didn’t help, Kenji started to hear voices, asking him to leave her, saying she wasn’t “the one” for him, he’d be better off without her. The voices were haunting him, day and night, especially when he was alone, so bad that Kenji started to stay away from Sue (which somehow relieves the symptoms).

Of course he still loves her. But he couldn’t bear the voices and hallucination. He didn’t feel better staying away from Sue, as he’s still thinking about her all the time, and fighting for her against the voices. He feels like he’s going crazy. He’s slowly losing his ability to function in other parts of his life.

Sue then decided to seek professional help for him. There wasn’t any apparent or direct family history of mental illness in Kenji’s family. It was in fact difficult to find the trigger. But Sue thinks it was all her fault, she is the cause and trigger of the psychotic symptoms in her boyfriend.

Is it possible?

When Schizophrenics Don’t Recognize Their Illness

Clinical Case Studies, Issues & Debates, Schizophrenia & Psychotic Disorder, Treatment Approaches

Do you confront them? Do you “make” them realize their illness?

This couple came to consult the psychiatrist few months ago, but they paid only the consultation fees after seeing the doctor for almost an hour, without collecting any medicine.

The patient is their son, who is in his late teens. He’s currently attending a very famous top college in the town. He lives in hostel with two other roommates, only back to parents during term holidays. The son doesn’t think he has any problem.

But sometimes he sits on his own and laugh. He spends a lot of time thinking. His behaviour is purely “weird and strange”, as how his mother termed it. According to his roommates, he sometimes gets disappeared from college and hostel, for couple of nights, then came back and kept to himself, like nothing happened.

There isn’t much the parents can do about him, as he doesn’t live with them, they don’t even have the chance to put medicine for him (see case study 1 & case study 2 for why putting medicine without patient’s knowledge). They did try to confront him, they actually set up on him and made him to a general hospital where he was hospitalized for over 10 days, then put on medication for few months after discharge (he stopped medicine subsequently as it was causing drowsiness and disabling him from studying).

Since then he became more vigilant. The parents know it’s almost impossible to set him up again or force him to see a psychiatrist doctor again.

At some points counsellor from the college contacted the parents, they discussed about his strange behaviours. At one point the roommates even had to put tranquilliser or sleeping pill in his food or drink to make him stay in hostel and rest. Yet academically he was still not doing that bad (afterall he’s one of those top students… though the mother is sometime a bit doubtful whether being such a top student is a good thing for her son).

Few days ago he came back home for term and chinese new year break. The parents thought it was a good opportunity to help their son. However, after one night being home, the son couldn’t stand the confrontation and parents’ lecturing, he ran away from home, and hasn’t been home since. The mother has been trying to get in touch through phone, but when she spoke to him, she really isn’t sure what to say to bring him home.

Perhaps she hopes that the son get well without any medication and treatment? Perhaps she hopes that the college expel him so that he’d be home to get treatment? Perhaps.. she doesn’t know what to hope for.

So… back to my questions – how do we make them realize their illness? Or do we do this at all (let them be? confront them?)?

Asperger Syndrome

Clinical Case Studies, Developmental Disorder

Two of the tutors came to the mother today and said that they were unable to help the boy with his studies as his attention span is too short, he keeps get distracted.

This is a boy of 13 with Asperger Syndrome which was diagnosed when he was 6. With medication the boy still does not improve significantly after all the years. In school, he disturbs his classmates by walking around the classroom and talking to them while teachers are teaching. He also flips his books quickly (without reading them, but he likes creating that sound while flipping books), tears and folds books and papers. The teachers said he isn’t able to do any independent work, although he appears to have adequate intellectual abilities just like his classmates. Unfortunately he is never able to get seated down for a short test. The teachers don’t know what to do to help him, and he makes no friends in school due to his annoying behaviours.

Tutors were hired to assist him in school and to give tuition at home, but a few have left for the same reason as above – he’s too difficult to manage, to be helped. He can’t concentrate in studies or perhaps in “doing anything meaningful”, as how the mother termed it. He scratches himself badly, almost obsessed with this habit.

The parents are feeling helpless. If the medicine couldn’t touch him at all, what else would?

IPad Addiction

Anxiety Disorder, Clinical Case Studies, Developmental Disorder, Obsession & Compulsion

Came across this article and think it’s really worth sharing, also a very good case study reflecting the growing up environment of infants/toddlers nowadays:

‘The day I realised my toddler was addicted to the iPad’: Three-year-old William tugged at the duvet and woke his father demanding the tablet… at 4am

Some food for thought: How do we help the younger generations to develop healthy relationship with those advanced gadgets? How do we balance while using them as educational or entertaining tools (not iNanny!) but not overusing leading to obsession and/or addiction?

(To the educational psychologists and child experts: is this going to be a newly added and researched Developmental Disorder?!)