Category Archives: Schizophrenia & Psychotic Disorder

Paranoid Schizophrenia

Clinical Case Studies, Schizophrenia & Psychotic Disorder

It was a very busy day and one staff was on emergency leave.

As all was in the waiting area for their turn, suddenly a woman in blue top rushed through the staff door that wasn’t closed properly, and ran all the way, through the treatment room, to doctor’s consultation room. The doctor was seeing other patients there.

We don’t know what she was going to do to the doctor, as we, including the doctor who was in shock, had already grabbed her hands before she did anything. We pulled her back to the treatment room. She was undeniably strong, despite all four of us were grabbing her, and one was preparing the injection. She scratched our hands, kicked our legs, screaming, resisting.

She has defaulted with medicine since 2010. Recent few weeks she has become unwell again, but the husband was too busy with work so he didn’t bring her here immediately and let her deteriorate. She started to see a psychiatrist from the year of 2005, being diagnosed as paranoid schizophrenia. With very regular injections and medication she’d got much better. Then a second breakdown in 2010, when she moved to a low-cost flat with Malay and foreign neighbours, whom she was so paranoid with. Later in the year she stopped taking medications, telling our staff that she feels much better without medication.

When we pressed her on the bed, she was shouting, saying her Malay neighbours were spreading her personal details and photos on youtube and other social medias. We could hear her saying 8TV, radios, youtube… the Malay neighbours were spying on her, peeping her, going through her rubbish, taking her pictures and videos then spreading them online.

The husband said she cannot get along with her Malay neighbours, she actually went to argue with her neighbours due to her delusions.

She came from a big family, being the youngest of her 10 siblings. She has two girls and one boy with her husband.

With medication and injection she has got much better now. Though relapses are likely to happen if she is not going to come back for follow ups and maintain with her medications.

Consent to Treatment & Mental Health

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

I wrote a clinical case study previously (see here) and demonstrated under certain conditions it’s not always possible to gain the consent of treatment from the patients yet the family has some other options to help the patient if they want to.

Few days ago I spoke to a husband who all the while has been putting medicine in drinks for his schizophrenic wife. He has been cooking soup, buying Chatime, fresh milk etc at night, just to let his wife who thinks she’s well to take the medicine. (I wonder if married women who are reading this will become suspicious of whether their husbands are putting medicine in their supper drinks?!)

Recently the patient started to refuse to take supper at night. She got angry and asked husband not to let her eat anything at night. She goes out with friends till late night. Once she gets home she just wants to go straight to bed. She said those drinks are making her fat (she’s mostly right).

So husband started to fail giving her med and she started to demonstrate poor sleep, agitation, paranoia…

The husband said he’s really been suffering doing this (putting med in his wife’s drink/food). He said one day when he was dining out with the wife, while the wife was away to the washroom, he poured the liquid medicine into her drink, and guess what? Somebody saw it!! He was very embarrassed as if he was doing something illegal, wrong and sinful (imagine what the public would think about having seen that?).

It’s good to have consent to treatment from the adult patients, much easier for the clinicians and family members for sure, but when the patients think they are fine and completely healthy psychologically, guess it’s the family then, that have to suffer.

Anorexia & Psychosis

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

At first glance, you probably don’t quite find any obvious relationship between Anorexia (irrational fear of gaining weight, food restriction, distorted body perception) and Psychosis (“loss of contact with reality”) in my title, but with some explanation in the brackets I hope it does make it a bit obvious…

This young boy came with his parents that day. He seems a bit underweight when we were told that he’s already 13 years old. The mother said he was above 60 kgs, much bigger size than most of his peers, but now he has lost almost half of his size, and is still losing.

He was the target of bully, his schoolmates made jokes about his size and weight. He made no friends and had very low self-esteem and confidence. Then he started to avoid taking meals. The parents have to persuade, convince, force him with all kind of methods. Still, he continues to lose weight.

He’s also obsessed with cleanliness (yet another OCD case), very fear of contamination and infection. Though one very different thing from the other obsessors, is that he can’t take off his shoes, as he thinks if his feet have any contact with the floor, the dirt and dust will be “transmitted” into his body, causing him fat! causing him fat! causing him fat! (Something’s wrong with my writing style, I think I’m also obsessed with repeating when I talk about OCD cases).

Although we can’t really be sure chicken or egg which came first, here it seems likely that he first became anorexic, then only led to obsessions with cleanliness. But being highly fear about things on the floor causing him gaining weight, he is so close to delusional and psychotic. Guess what’s happening right now? He thinks the medicine will make him fat and so is refusing the medicine…

It seems that anorexia is also a kind of obsessions and compulsions, but it can also be so serious and appear like psychosis. Just like how they see themselves in the mirror, completely distorted, different from how we see them, isn’t that “losing contact with reality”?

How anorexic people see themselves
How anorexic people see themselves.

Teenage Schizophrenia

Clinical Case Studies, Schizophrenia & Psychotic Disorder

She comes from a single parent family, with three younger siblings. Her father runs a stall in market, has to look after all four children and a grandmother of old age. She stopped schooling at the age of 14, being unable to continue due to her mental illness.

This is a girl suffering from schizophrenia. She is paranoid, hallucinating and very easily agitated. She spent her day pacing the floor in the house, talking to herself, and doesn’t sleep at night. When she sees her younger sister, she will be abusive and swearing at her, saying she wants to destroy her sister’s face, saying she couldn’t accept that the sister is prettier than her (the sister is only 4-5 years old!). When she looks into mirror, she gets angry and will be cursing again. She uses the meanest words despite her young age.

Her father tries very hard to do his best for her. He does all the washing, cooking, tidying up etc for her. But sometimes he has to protect the younger children. One day they had an argument and the father even slapped her twice. The father was later regretful, understanding it was her illness not her, but also feeling quite lost not knowing what to do with her. He wanted to move out with her so that the younger children are not negatively influenced, but who’s going to look after the younger ones?

When her father first came to the clinic she had already been suffering from Schizophrenia for at least 2 years. Over months the father consulted psychiatrist on behalf and giving her medicine, she takes them willingly not knowing what they were for. She gets better and is able to start some tuition classes although not the mainstream education. She recently gets so much better that she could come to consult doctor with the father, still agitated, paranoid and abusive, but much better compared to 3-4 months ago. I think this is also a good example of family consulting doctor on behalf that brings a satisfying outcome (see post: Schizophrenia & Consent to Treatment).

What happened to the patient later? See here: Leading a Normal Life after Recovery? 

Schizophrenia & Consent to Treatment

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

One day a mother of a 17-year-old patient called, said her relatives have been calling her, asking about her daughter. She posted several status on her Facebook (see? social media is what an important tool?!), saying she was going to kill her parents, and she has a plan about it (e.g. will chop father into how many pieces, then…). As patient has already blocked her parents on it, so they couldn’t see the status, but other relatives noticed it so they called mother.

This is a girl with Schizophrenia, having various kind of hallucinations about god, devils, aliens, thinking she is special, different from everyone else; isolating herself, easily agitated, bad tempered… She doesn’t sleep at night (well, most schizophrenic patients that I’ve come across don’t sleep at night). She has two younger brothers, she gets along ok with them. She thinks the youngest one is special like her, but he isn’t aware that he is special yet, at one point he will reach her stage.

Do you think someone like her will come for treatment, take medicine, go through treatment willingly?

If the answer were No, do you think we should then give up on her, and many people who aren’t well out there like her?

I guess many people understand the importance of consent to treatment (e.g. the surgeon is going to operate your brain, you or your family will have to sign a consent or else what if the surgeon is merely operating because s/he thinks this is the way s/he can earn the most?! Opps), but in the field of mental disorder this may not always be the case. It is not always possible to get the patient’s consent, the abovementioned is an example.

So maybe the parents can consult on behalf, then dispense medicine to the girl somehow… Till one point when the patient herself has the insight about her problem, she can then come for treatment personally!

There are some overly anxious parents or family members, who cannot accept “consult on behalf”- I’m not sick, why should I see the doctor?! Right, but your ill family isn’t coming either, how can we help her?