Category Archives: Schizophrenia & Psychotic Disorder

How much courage does one need to jump off a building?

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

There are various ways people can use to end their lives, but when it comes to jumping from height, it always makes me wonder how much courage it requires to take that step, and do they regret as they are falling down before hitting the ground? Are they terrified? Do they think about going back?

This is the third patient in the past 3 weeks.

The first two both were longstanding depressed patients, both had attempted suicide in their history, so though it was heartbreaking, at least it didn’t shock us as much as the one who chose to jump off from an apartment far away from his house this week.

He had been diagnosed with paranoid schizophrenia for years. Never a negative person, he could function well in work and with family, maintaining with medicine.

Nobody would have anticipated that. Not even his caring sister. And with the method he chose to terminate his life, he does show how determined he was.

So never think that people with depression are the only ones who would attempt suicide.

So never think that those who think about suicide would always mention it before the attempts.

So never think that long-term mentally ill patient without previous suicide attempt are very unlikely to commit suicide.

Also, never think the reason everyone suffering from mental illness end their lives due to their mental illness, there are still various other possible explanations, and suffering from mental illness, is just one of them.

Please give yourself a second chance. Malaysia suicide hotlines:

The Befrienders
03-7956 8144/ 03-7956 8145
www.befrienders.org.my

Life Line Association Malaysia
03-4265 7995
http://lifeline.org.my/cn/

Agape Counselling Center Malaysia
03-7785 5955 / 03-7781 0800
http://www.agape.org.my

If you come across someone who’s suicidal: https://huibee.com/2020/05/somebody-you-know-is-suicidal/

Paranoia? Anorexia? Body Dysmorphic Disorder?

Clinical Case Studies, Obsession & Compulsion, Schizophrenia & Psychotic Disorder, Unclassified Disorders

It was first suspected that she has Othello Syndrome (morbid jealousy, case study here). When she came, she just split from her boyfriend and was having suicidal thoughts. The mother said she was constantly checking on the boyfriend, his phones, his whereabouts, his friends etc (similar to the case here). She was also hearing voices, very bad-tempered, having very unstable mood and insomnia.

Few days after she started taking anti-depressant and anti-psychotic medicine, she called up and asked if she could take weight loss pill “L*** B***”, she said it helps to lose body fat only, will not lead to diarrhea. So she was told ok to take this weight loss pill along with her medicine.

Few weeks later, the mother called and questioned us, why we allowed patient to take weight loss pills. Mother said patient has been taking the pills, along with laxative pills (for constipation) excessively, she could take over 20 tablets a day, and purging herself (to vomit). She’s in fact only 43 kgs when she first came to see us, she doesn’t need to lose any weight. But our position is to tell patient that the weight loss pill is safe to be taken with our medicine, but that’s obviously based on the fact that patient is taking it accordingly. It’s not our position to advice patient regarding her weight (we can do so, but we can’t stop her). It also important to note here that if the pill will cause diarrhea or vomit then it won’t be suitable to take with medicine.

So mentally she’s got much worse, as she wasn’t regular with the medication, plus all those means that she’s using to lose weight, her body probably couldn’t take in any of those medicine. She got more sensitive and paranoid, always thinks that people are talking about her, especially when she is out. At one point they had to admit her into hospital for drips as she was taking too much of those pills. After the discharge she finally realized what harms those pills are doing to her body and brain.

So she stopped purging and trying to lose weight. She’s given up on the idea of losing weight. But few days ago she came back for review, now she’s considering rhinoplasty (plastic surgery on the nose)! Almost obsessed about going for it…

Paranoia, anorexia nervosa and body dysmorphic disorder are undeniably inter-related and co-morbid, but does one move from one to another?

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?)?

A Revenge?

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

She first saw psychiatrist in 2005, being sensitive and very bad-tempered, with paranoid ideations and hallucinations. In 3-4 months with medication she got better, but soon got a relapse as she got a new job, because she couldn’t handle the stress from work. Since then she has never worked. During the end of 2005, despite the medication her condition got much worse, more paranoid, fearful,  having persecutory delusions. Her husband and sister accompanied her to visit various temples, praying, seeking for help through different mediums.  Two sets of 6 ECTs were done from Dec 2005 to Jan 2006, because she didn’t get better significantly after first set of ECT, still hallucinating (see here for a case study of a severely depressed woman recovered through ECT).

Through 2006 to 2011, her condition wasn’t that good. She wasn’t keen to take certain medicine as she thinks those medicine cause weight gain (which was quite right). So it was difficult to have her condition under control. She continued to be sensitive, paranoid, avoiding crowds, hallucinating, and also getting more and more obsessed with body weight. Later she got a lot more stable from mid 2011, till recently…

The husband said he wanted to go to start a business with a work partner in East Malaysia, he will have to be there for at least 6 months. This is when the patient got unwell again… Irritable, insomnia, restless, hearing voices, agitated despite maintaining all her medication. The husband gave up the idea and the business plan, continues running his coffee shop.

However, the patient doesn’t recover just when the husband made the decision to stay with her. He brought the patient with the sister to consult doctor almost every day, for injection and medication. The husband is now suffering financially paying for the bills and not being able to work. But she doesn’t turn better, at all. Despite all kind of medication she’s taking, she’s still restless at night, wanting husband to bring her out, saying someone is waiting for her outside. During the day she stays at home, saying someone is coming to visit her soon. Of course none of these “someone”s turns up. She continues to hear voices, paranoid, and not sleeping. Sometimes she doesn’t use the toilet at home but does the business outside of her house. Sometimes she stays in the rain not wanting to go indoor.

Sometimes when we talk to her, she seems to be completely fine and ok. But when we hear the description of what she does outside of the clinic, it seems completely abnormal and unwell. Then one staff has come out with this theory (which doctor also kind of agrees with it), that this is a revenge plan:

The patient is trying to revenge to the husband, for “attempting” to abandon her, at the same time, (I think) she is also wanting to stay unwell [subconsciously maybe], so that all her family especially her husband will stay with her, be there for her and care about her.

What do you think? How do people fake their mental illness to serve some purposes? What can we do about these people? How do we know if she’s really unwell or just faking? Are people really willing to ruin their own life and those of their family members’ just for the sake of care and love?

Leading a Normal Life after Recovery?

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

Part I:  Teenage Schizophrenia (the same topic person as below)

Few days ago the father rang us. The patient is now in ICU in a general hospital. She attempted suicide taking over 200 tablets of medicine. As she usually wakes up late in the day, so the father wasn’t concerned that she’d been in her room all day. Till that evening when the father was thinking to bring her some food, and found out that she was covered in urine on her bed, and was unconscious.

Over the past few months, she had got so much better with medication, no longer spending all her time pacing in her house, talking to herself or swearing at her younger siblings. Her father was even able to get a tuition teacher for her, and later the patient even requested to go back to schooling. They were looking forward to seeing patient going back to lead some “normal life” just like any other teenagers. The only thing is probably that she’s spending a lot of time looking at her phone (don’t you think this is also a common feature of a “normal” teenager nowadays?!)

Then this happened. She tried to kill herself and is still unconscious. The father could only guess that as the new academic year is starting soon, patient couldn’t manage the stress and intended to avoid it by ending her life. She went to school to collect the text books the day before. The younger sister said the patient asked for a cut blade from her, but she didn’t give it to her.

Quite often we may think that the patient is ready for a normal life once the active symptoms of mental illness is not presented, yet it is very difficult to judge whether or not the patient is ready psychologically, to go back to the society, to face other so-called normal people and function normally just like others.

What can we do about this? What can we do for them? What can family do to get them prepared to go back to the society, if they can ever achieve it?