Adjusting antipsychotics in a short term mental hospital or at home?

Psych ward

If a seriously mentally ill relative is a danger to himself or others then the authorities must be called very hopefully a team trained to deal with mental health emergencies will answer the call.

Strange is not necessarily dangerous. Giving the seriously mentally ill individual some space can solve a whole lot of problems.

In short term mental hospitals given the diagnosis is schizophrenia and the individual is over 25 basically the only goal of the hospital is to get individuals stabilized on medications. The dosages will be high. There really are no other goals other than med stabilization.

The point is that in short term hospital meds are being adjusted and not much else. If the authorities had to be called the experience will be profoundly traumatic for the entire family including the ill relative. Despite the trauma if the seriously mentally ill relative is a danger to himself, herself or others the authorities have to be called.

That there are not more long term beds in hospitals is a good thing but even if this was a bad thing still there are no long term beds in mental hospitals available. The authorities are not coming to take the ill relative away for more than a few weeks. The ill relative is likely coming home after a very traumatic experience.

Meds can be adjusted at home. The key to an ill relative taking medications is the ill relative deciding to take medications. Giving the ill relative a lot of decision power over what meds he takes and at what dosages increases the chances he will take medications. Safe for himself or herself and others even though still strange even quite strange has to be viewed as a win when the diagnosis is schizophrenia. Low dosages are much better than no dosages. Keep the ill relative from posting on the Web.

Giving the ill relative as much decision power as feasible and giving the ill relative space in which he could be strange is the optimal strategy. Will this work every time? No.

The sensible old days when there was a continuum of care for the mentally ill

Parts of the continuum of care provided to the mentally ill prior to de-institutionalization. That dastardly President Kennedy undermined the continuum of care for the mentally ill when he signed the Community Mental Health Act.

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Apparently a sauna room

Theory of mind in schizophrenia

Various psychologists hold that individuals with schizophrenia have difficulties with grasping mental states of other individuals which goes under the rubric of theory of mind (ToM). This is not correct.

Individuals with schizophrenia are thinking about everything all the time. For the most part other individuals do not want to talk about everything all the time.

What individuals with schizophrenia have difficulties with is grasping what is in the attentions of other individuals. By and large conversation resides around what is in attentions and this is where individuals with schizophrenia have difficulties.

There are so many difficulties in schizophrenia that separating out the difficulties presents difficulties. Disorganization can be prominent in schizophrenia and one could hold with this disorganization that individuals with schizophrenia have very rudimentary ToM, however, the disorganization can be widespread. There is zip specific to ToM to this disorganization.

Individuals with schizophrenia can hit some sore spots with other individuals when talking about everything all the time. Individuals with schizophrenia then can become paranoid about what other individuals are thinking. The fails are not fails in ToM but rather in schizophrenia conversations are warped away from useful, pleasant or routine.

If someone were to say to President Biden, who by the way I think is doing a terrific job, that ‘politicians are the problem not the solution’ then future conversations with President Biden would be warped away from conversations that went anywhere. However, over the last few decades, there has been political gridlock in the US which President Biden is certainly aware of. The problem would then not be strictly fails in ToM but rather that conversations are warped away from useful, pleasant or routine conversations. The warping away from useful, pleasant or routine conversations in schizophrenia are not fails in ToM but rather is due to the setting up of paranoid feedback loops which basically arise due to individuals with schizophrenia wanting to talk about everything all the time rather than talk on what is in attentions.

Family turns to the system for help with their non-violent schizophrenic father

The family wants dad, who has schizophrenia, to take his medication. Dad is non-violent The family asks some one who knows zip about dad and his medications to drop by and encourage dad to take his medications. That dad has a knife is mentioned. Dad is shot and killed on his prayer rug in his apartment by police. The officer in charge had been concerned that Ejaz Choudry was at risk of self-harm. Problem solved.

When a knife was mentioned the police were going to be called. Turning to the police is a last resort only to be taken when life and limb are threatened. This death was totally unnecessary. The police made a Hollywood blockbuster entry into the apartment from the balcony. Minimally this elderly man could have been shot in the legs. The police had time to taser him and fire rubber bullets. The family do not get a pass. Calling the police, who will be armed, to get someone to take meds is the worst way imaginable to get an ill relative to take medications.

Employment rates of individuals with schizophrenia

Individuals with schizophrenia can not even make it into the unemployment line.

A Nation-Wide Study on the Percentage of Schizophrenia and Bipolar Disorder Patients Who Earn Minimum Wage or Above

“The percentages of patients with only 1 admission who were earning minimum wage or above in December 2010 were as follows: 10.6% of patients with a diagnosis of schizophrenia; 21.6% of patients with a diagnosis of nonaffective psychotic disorders; and 24.2% of patients with bipolar disorder. The percentages of patients with multiple admissions who were earning minimum wage or above were as follows: 5.8% of patients with schizophrenia; 11.2% of patients with nonaffective psychotic disorders; and 19.9% of patients with bipolar disorder.”

Individuals with schizophrenia have to give up every hope they had for the future. Medications do not deliver a ‘normal life as long as medications are taken’.

Relatives of the seriously mentally ill must protect ill relatives from the mental health system

Police shooting of mentally ill man who was holding a screwdriver (not a link to the video)

One of the key jobs of relatives of the seriously mentally ill is to protect mentally ill relatives from the mental health system. Relatives of the seriously mentally ill must ask themselves honestly ‘is my ill relative disabled?’ If the answer is ‘yes’ the mental health system is used for medication trials. Getting an ill relative on the best medication possible is key. After that the mental health system is very frequently more of a liability than an assistance.

If an ill relative enjoys visits to the mental health system clearly that is a good thing. Very frequently they won’t. Mental health administrators tell legislators that they can get individuals back into the labor force. Mental health administrators then tell their medication prescribers ‘with that prescription pad and other billable services which we provide we have the tools to get individuals back into the labor force. Use that prescription pad!’ They are paid to believe the drugs are very effective and they do so believe. They have zip for negative symptoms.

When an individual is not safe for himself and others then the proper authorities must be contacted. The mental health system is also very helpful in finding the right medication regime, which will be not too much medication and not too little medication. Rarely someone with a serious mental illness who is disabled will find a mental health professional that he or she clicks with whom he or she can talk comfortably with about his or her difficulties. That would be rare but that would be a good thing. Other than that avoiding the mental health system is the optimal strategy for someone who is seriously mentally ill which relatives should be very supportive of.

Primary responsibility for care of seriously mentally ill family members resides with families not with the mental health system.There are many, many newspaper reports of parents of the seriously mentally ill complaining about the inadequacies of the mental health system. These reports are almost always reports of major disasters. These parents rely heavily on the mental health system and there are major disasters. The two are connected.

There are 3,870,000 results on Bing for ‘police shoot mentally ill relative on front lawn.’ Now the police could not have shot more three million mentally ill individuals on front lawns but by page 11 the mentally ill are still being shot by police. Here is a not atypical headline Man shot by Portland police was legally blind, suffered from schizophrenia …

Hidden Valley Road

Hidden Valley Road tells the story of a family with twelve children where six of the boys had schizophrenia. Not only did six of the children have schizophrenia they had treatment resistant schizophrenia. And a Catholic priest who was a close ‘family friend’ sexually molested the boys. This family was devasted by all the misfortune. Half of the story is about how growing up in this terrbily afflicted family affected the two well sisters. Very understanadbly the sisters have emotional scars. They were abused by the brothers and terrified to be around them. They were neglected by their parents as the parents were always dealing with the ill brothers.

I skimmed a lot of this book as I found the book too painful to read. There seemed to be some blaming of the father for being a bad father and bad husband but he never got to tell his side of the story. Focusing on the dad’s faults was somewhat of a non-sequitur as the behavioral imperfections of the dad did not bring the blows of fate down on the family.

To some extent this book seemed like an after battle analysis but there is no way that a lot of the battles the family lost could have been won. The parents could and should have kept a closer eye on the children but there were 12 children whereby keeping a close eye on the children presented terrific difficulties.

The book points out that extensive use of mental health services does not guarantee good outcomes or even acceptable outcomes. The six schizophrenic brothers all had terrible side-effects, causing deaths in couple of instances, from their medications which were frequently prescribed in outrageous combinations. One of the brothers is given weekly ECT and could be a character in One Who Flew Over the Cuckoos Nest. He emphasizes now every chance he gets that he is totally compliant. Multiple antpsychotics were prescibed at the same time which makes no sense as there are only so many dopamine receptors to fill. Expecting too much from the mental health system can be disastorous as then lots and lots of treatment will be given but too much treatment can severely impact the quality of life of patients. Safe for themselves and others should be the goal aimed at. The brothers were all too frequently not safe for themselves and others.

The goal of the book in addressing the genetic aspects of schizophrenia was most likely to suggest that there was a very distant light at the end of the tunnel. However, in terms of treatment genetic studies do not seem at all helpful though genetics is an area that had to be explored in terms of the etiology of schizoprenia.

What I think must be underlined is that the portrait of this family is not a typical portrait of family amidst which there is schizophrenia. There were six children in this family with schizophrenia all with treatment resistant schizophrenia. 30% of individuals with schizophrenia are treatment resistant which leaves 70% who respond to treatment. They can give TED talks graduate from college etc. and may not be high functioning ‘economic units’ but can be very decent, interesting individuals.

Safe for themselves and others

Treatment that looks to individuals with psychoses being safe for themselves and others is the optimal treatment approach. There are steps that individuals with psychoses can take to ward of impending personal apocalypses where such steps would not survive rational criticisms. Demanding than individuals with psychoses stop various ways that are employed by such individuals to address the World crowding in, or the encroachment of the liminal, a term used by Esmé Weijun Wang in her terrific book The Collected Schizophrenia, that are not rational but do stave off personal apocalypses brings personal apocalypses closer which is bad for individuals with a psychoses and bad for everyone. The demand that individuals with psychoses have insight into their illnesses rather than that such individuals be safe for themselves and others has been a treatment catastrophe.

If individuals with psychoses realize they are ill but do not want to talk about how they are ‘cracked’ or their psychological symptoms though can be talked to about being safe for themselves or others that is more than enough for treatment. Very, very frequently family stories about how there must be more services of every kind to get our very ‘cracked ‘ relatives uncracked are disaster stories.

Pushing Individuals with psychoses to examine how they are ‘cracked’ is worse than pointless from a treatment perspective, infinitely boring for both patients and therapists, unless the therapists are sadists, and increases greatly the likelihood of catastrophes. The surface attractiveness of the ‘sensible demand’ that individuals with psychoses have insight into their illnesses is a trap all too many individuals have fallen into.

In a word individuals with psychoses are anti-psychologists and that must be respected to deliver optimal treatment.