Category Archives: Schizophrenia & Psychotic Disorder

Introducing “The Quiet Room”

By Lori Schiller

By Lori Schiller

It is brilliant book, very informative, from the views of different persons (the patient herself, parents, brother, close friend/housemate during the onset, attending psychiatrist etc). It gave me a feeling that I could go into her head and understand, for example, why certain patients who clearly do hear voices denied it so strongly; how one might interpret those voices, so differently from practitioners’ way. In addition, it suggests the insight of how immediate family members handle the fact that their closed one is a “schizophrenic”, and not just pretending, manipulating or attention seeking.

Also here’s a great quote from her psychiatrist,

A long time ago I realized that, as psychiatrists, we had to have a healthy respect for our own humanness, and our own smallness in the face of what we were dealing with. If a person got better, we could appreciate that we had done a great job, but we also needed to realize that God – or luck – was on our side. If the person got worse, we had to keep ourselves from feeling that we hadn’t done enough. For the truth is, we were powerless in so many of these situations. We did what we could, but sometimes the illness was just bigger than we were.

And from the mother,

How many times over the past few years had I wondered why we had fought so hard to keep Lori alive. She was so miserable. She was so unhappy. She was only staying alive to please us. …

Religious Experiences and Psychotic Symptoms

I was recently having a conversation in the clinic and a patient back in the time when I was working in North London Forensic Service popped up in my mind. This is a big black man with a diagnosis of schizophrenia, he also assaulted his ex girlfriend and hence was in the inpatient security ward that I worked at.

From day one I met this man, he was in good order and discipline, never exhibited any of the psychotic symptoms, abusive language or aggressive behaviour of any sort, unlike many other patients there. He was also doing an MBA course through the Open University. So most of the staffs in the team believed that he would make his way out soon, to the community, starting a new life. However, his stay was extended. To our surprise, it was due to a note recorded by a nursing staff (what each patient does every day is recorded on every shift). The nurse got along quite well with the patient, on one occasion, the patient shared with the nurse his experience of seeing white light in his room coming from the sky, and an angelic human coming to him and passing him some positive messages.

The patient surely didn’t know this was recorded in the note. However, this was used against to the patient in the court as evidence of him still experiencing psychotic symptoms (both visual hallucination and delusion) and  was not well enough to leave the ward to the community. The patient came to know the details only after the hearing, from his solicitor. He didn’t get to defend himself on his experience, which he later expressed that this was completely a religious experience, which he found amazing and intriguing, and in no way is related to mental illness. He came from a very religious family.

This was at least 4 to 5 years ago. I still remember it because until today I still cannot be sure whether that decision made by the team was correct. I am not a religious person (few years ago I was turned down as a volunteer in an NGO because I told the interviewer that I have no religion!), I can’t truly understand how a very religious person’s experience with god is like. I did complete the Alpha course in the church when I was doing postgraduate in Brighton. I met a lot of very nice persons, some I still keep in touch today. Sometimes I could be quite shocked by their presentations and behaviour during the services, but I respect that it’s their belief, and I learnt from them although I have not experienced it at all.

If it was a so-called normal person experiencing and sharing their religious or cultural experience, we might or might not believe them, but we wouldn’t think they are having hallucinations. How if a religious person with a history of mental illness experienced and shared such encounter? This is like when I worked there, sometimes we had to do night shifts, and many of those African nurses wouldn’t stay on the ward alone no matter what (we shouldn’t anyway, but there are times of emergency etc). They have had so many encounters of “ghosts” and “spirits” and scary stuff, it’s a hospital afterall, it’s easily linked to deaths (and then “ghosts”). But when this was expressed by a patient, even the African nurses would suspect that he was just having hallucination!

I can’t really have any say about these, I have experienced none, spiritual, religious, or thrilling (to be honest I’m happy and keen to experience them). We were told that we should pay attention to cultural influences and backgrounds before we “judge” someone diagnose a patient. It’s true, I now think it was wrong to hold the big man back solely based on that.

Substance-Induced Psychosis & Addiction-Linked Divorce

When I was doing my master back in the uni, I remember one of the presentations I did was about substance induced schizophrenia. That was just about 4-5 years ago, but I can’t quite remember the details, though I’ve always remembered that one of the triggers of schizophrenia was illicit drugs, I had a diagram in my powerpoint showing how much it contributed to the population with schizophrenia and related illness.

After starting to work in the clinic in KL, I’ve encountered quite some patients who have had a history of taking ecstasy pills or other drugs and have led to psychotic episodes. For the majority of them, their family members took charge and managed to stop them from continuing taking illicit drugs (by stopping them from mixing with so-called “bad friends”, moving to different or new environment, cutting off their finances, threatening to cut off their relationship with the subject etc).

Recently I’ve had this big man, who has had a long history of taking aramine and ecstasy pills, and is seeing the psychiatrist for his anxiety (no, he didn’t show signs of psychosis). He once told me that everyone has their way to release stress, some people go exercise (like me), some go shopping, some watch movies, some do gardening, some just need a good sleep, and for him, he hangs out with his friends, singing karaoke, and… taking pills, spending their nights high. During Chinese New Year, he could be drugged for over a week continuously. Though on normal days, he works, he goes gym (hence he’s called big man, as he’s not just fit, but muscular – like a staff always says, he doesn’t look like a typical drug abuser), he looks after his wife and children. Oh yes, I didn’t mention that he has a family. The wife is lovely, supportive, and all good qualities you can expect from a traditional Chinese woman.

Each time he tries to quit the pills, he would experience a moody state which lasts for two to three weeks, with fears, insomnia. Normally the psychiatric medicine that he’s taking will bring him back to normal and functional. The last time I heard from him after Chinese New Year, he said this round he would definitely quit it, he would stop seeing those friends (I later learnt that it’s much harder because one is actually his business partner), he wouldn’t want to have relapse again and again, and he doesn’t know when those drugs are going to destroy him (his brain/mind), and his family… because the wife said if he takes it again, she’s leaving him (I still remember he said “妻离子散”, such powerful words). I believed what he said, for I know how much he loves his wife.

On last Monday I encountered a motor vehicle accident and had to take the day off. On this very day, big man’s sister called up to the clinic saying that he was really unstable, as the wife brought the kids back to her parents’ house, big man was threatening to cut his wrist (which he did later on). The family members were advised to admit him to psychiatric wards in general hospital. On Thursday when I was at work, big man came with his father (who is also our patient but is in good remission and maintaining with a minimal dosage). The wife called to tell me what had happened this week. She said big man has become really paranoid and delusional recently, always suspecting that she is unloyal to him. On the Sunday before, he went outstation with his business partner (aka one of the bad friends), and spent the night being high, and had called her on 5am, questioning her about the man she kept, threatening that he would do her harm when he came back later. On the next day, he beat her up after being really angry for “what she has done behind him”. That’s the day she had to run away from him with the children, even after he sliced his wrist twice, she didn’t go back, she knows the children’s safety is the utmost important and her husband is not her husband anymore.

What the man presents, is what we call Morbid Jealousy, or Othello Syndrome (an old case study here). He was never delusional or paranoid during the years he was seeing us. He was just having anxiety and fear over some life issues, and is a perfectionist. I believe morbid jealousy is related to paranoid schizophrenia or other psychotic illnesses, and so I can’t help thinking the links between his history of substance use, and the development of his morbid jealousy. From a lot of cases that I have observed, suffering from schizophrenia or other mental illness don’t usually make your partner leave you, quite often the partner can even tolerate morbid jealousy despite how frustrating it can cause and how destructive it is to the relationship; but being mentally ill, having addiction yet refused to go into rehabilitation, and beating wife, that’s the bottom line for any woman, I believe.

N.B. this post was written in March 2016. According to the sister, big man passed away jumping off from a building at the end of March, after calling the wife and speaking to her. 

The need to maintain with psychiatric medicine

He’s a long-standing patient with paranoid delusions, all the while maintaining with medicine and depot injection. Though, past 2-3 years, he started to reduce his medicine, and at one point, he stopped them all completely, didn’t come back for follow-up and injection.

Within half a year, he had relapsed, with agitation, insomnia, sensitivity and sometimes he could be violent. He isolated himself from the family, spending all the time in his room. When the parents talked to him, he either ignored them or responded angrily.

So the mother started to put the medicine in his dinner, over time he got more stable, at least willing to listen to family, going out with them, and having better temper.

Few days ago his sister called up, saying patient’s condition has got so bad, he was threatening, paranoid and picking on the mother, throwing away her stuff, very agitated and always scolding the family members, also he has spent all his time awake.

The sister said the mother stopped giving him medicine since three weeks ago, as patient was listening to some calming religious musics, and was so much better — better-tempered and didn’t appear sensitive or paranoid at all. The mother thought he’d recovered, decided that he didn’t need the medicine anymore.

Now with his very much deteriorated condition, the family members have no ways to bring him to see a psychiatric doctor and for injection, also no way to make him take the medicine. The mother has also been threatened so much that she was afraid her life could be in danger, and is in the dilemma of whether to move out from the house (which then means nobody can help him).

This is not to say that calming religious music, chanting or prayer, relaxation exercises, meditation etc couldn’t help with one with psychotic disorders, quite often they can be very soothing and calming, at times they can even prevent mild relapses, but they cannot be a complete replacement of medicine. It’s always practical to at least let the patient (with schizophrenia or psychotic disorders) to maintain with a mild dose of psychiatric drugs, so that the condition will be more manageable even when a relapse takes place. (though for patients with good insight of their conditions, especially those with anxiety disorders or depression [but not psychotic disorders], it’s possible to stop all the medicine and only take back when needed).


Post related to client’s consent to treatment: Schizophrenia & Consent to Treatment 

Brief Psychotic Disorder

It’s approaching Chinese New Year and it’s this time of the year where Chinese Restaurants are at their busiest period, whether it’s for reunion dinners, company year-end party, annual dinner or casual friends and relatives gathering dinners.

She’s in her 30s, a manager in one of a big Chinese Restaurants. Past few nights she hasn’t been sleeping well, under great stress and worrying about the bookings, menus, dishes, prices, ingredients, staff, part time staff etc. After few nights of poor sleep and poor performance at work in the day, one afternoon her family found her not gone to work but crying and laughing at the same time in her room, at times screaming, and at times talking about things that they can’t understand.

Her husband and mother admitted her into the general hospital, where she was put under anti-psychotic medication and injection. Though a lot more stable and spending more time in bed, she’s still screaming and at times talking nonsense. She then started to experience some side effects from the medication and injection, drooling, tremor, stiffness.

Upon discharge from the GH, the husband decided to bring her to see us. She has to come in in a wheelchair, still drooling and having stiffness, still screaming and non-responding.

She’s believed to have Brief Psychotic Disorder, triggered by great stress from work. There’s no history of mental illness running in her family. More about the illness on wikipedia here. It’s kind of difficult to believe that people actually get psychotic disorder just merely due to stress (oh well, what can stress not do!), it’s more usual depression or anxiety disorder.

So, well, guys and girls, do make sure you are aware of how much your body and mentality can take, not to put yourself under too great stress (hard!), and more importantly, always find healthy ways to de-stress yourself (e.g. exercise, hobbies, movies, outings with friends etc)!

In the news: Mum killed for asking son to take psychiatric medication

I heard this news on the radio this morning. It just somehow worried me wondering whether it was one of our patients, and I had this mother in my mind.

She used to consult doctor on behalf of her adult son and collect medicine for him. All the while she brings medicine to her son but according to her, the son doesn’t think he has any problems. The son isn’t very keen to take those many tablets and liquids, but she can always make him take them.

Recently she insisted to bring the son to come to see psychiatric doctor, despite the son saying he has no problems. She said he’s willing to come. But hey, if you think he has no problems, why would you come to see a psychiatrist? Are you being forced to come?

In our job we came to know a lot of family members who have to supervise the patient’s medicine. Though we never encourage forcing patients to take medicine. So this morning when I heard this news I was worried about some old parents who are very caring but also too anxious and sometimes stubborn being involved in this kind of tragedy.

We are not asking you to stop caring about your mentally ill family, but sometimes they’re no longer themselves when their mind is taken over by the psychiatric illness, you don’t know what they’re going to do, you can’t make usual expectations as if they are not sick. So please seek professional help! And no, you don’t have to take them with you, or force them to come with you!

TheSunDaily: Mum killed for asking son to take medication