To ask about psychosis?

[BobbyBiscuits]

This is incredibly traumatising but basically my DH had a psychotic episode about 8 years ago while I was away and threw himself out the window, he nearly died and was permanently disabled. Other than that he has severe depression/ anxiety (as do I ) but no psychosis.

Now, he has out the blue had another one and done the same thing, threw himself out the window, this time in front of me, this was about 4 metres. He has broken ribs and pelvis and is in major trauma ward in hospital.

I am wondering what kind of care he can get in the community to stop this ever happening again?

He says there is only one route he is allowed to follow which is through an addiction service (they are useless, he has not been an addict for 10 years plus but that's the only way he can get opioid pain medication for his nerve damage from last accident), I am desperately worried as you can imagine. I just don't even know what type of medication he could take when the episode starts, before it becomes life threatening.

Any help greatly appreciated. Just to add, I do wish to be with him through this as he is wonderful in so many ways, I've no intention of leaving him.

he ABSOLUTELY needs to become abstinent OP@BobbyBiscuits ...and i'm afraid if you wish to be in a relationship with him you need to become abstinent too. Has he been honest with the professionals about his usage? "Some " people are able to use cannabis with no ill effects but sadly some peoples genetic make-up means they are far more likely to become mentally unwell with regular drug use - the fact that he has had this level of destructive self-harm is really serious and one day he may not survive such an episode. When you work in mental health you are so aware of the links between drug use and mental illness and I wish people realised the risks (although obviously people with mental health problems are often more likely to use drugs to cope with their illness)

@BobbyBiscuits he smokes weed, drinks, and is on long term opioids from the addiction service. He is an addict. this sounds like drug induced psychosis.

You should not be waiting for an psychotic episode to start to do something about it. He needs to be doing everything he can to prevent it from happening in the first. That includes avoiding any substances which can lead to psychosis. I.e weed and alcohol. This is not a one-off occurrence now. You need to take it seriously. He has only hurt himself so far, but that might not be the case next time. Psychosis is dangerous.

@BobbyBiscuits I have a somewhat relatable experience with my OH and found that the only way was the go private.
This in itself required determination as it wasn't easy but I eventually found a service online that pairs you with local psychiatrists. I was sceptical but the one my OH saw was very good and provided a diagnosis I didn't even know about but was spot on and prescription.
It does d set us back 450 pounds, yes the NHS was slightly annoyed we leap-frogged their process, but the treatment has been life-changing for us as a family.

Edit: I hadn't seen the cannabis mention - this waa not our situation, there were no substances involved but a medical issue.

Definitely stop all cannabis!

The problem with cannabis is that because its a “natural” product, you have no idea what you’re actually getting. THC levels have been increasing steadily for years. The psychosis could possibly be linked to him inadvertently (or deliberately) using cannabis that had ultra high THC levels.

You both need to quit the substances. Research has shown that people with psychotic disorders are more likely to become violent when using cannabis:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913867/

The weed is a huge issue here, you need him to stop smoking completely and it sounds like you should too in order to support him. Is there any way you can lock all the windows in the short term in order to prevent him from throwing himself out again?

www.brightquest.com/cannabis-induced-psychosis/psychotic-symptoms-in-marijuana-smokers/

He needs to stop smoking weed immediately.
Seriously, if I was a cannabis user & had a psychotic episode I would never touch it again.

WTF are you both thinking.

1/3 of schizophrenia diagnosis' can now be directly attributed to cannabis use...

This. I was really pro-alcohol use, until it became a problem and destroyed my mental health. I've never had a psychotic episode, but my life is much better without any substances. If he has cut down significantly by being in hospital with psychosis, that sounds like he was using quite a bit. Cross-addiction is a really serious consideration. If he has experienced opioid abuse in the past, it is so surprise that he's transferred that misuse onto something else. And he might have managed okay for a bit, but the bill has come in now and it's happened again. He needs MH support, but also needs addiction support. And you will, sorry to say, have to change your lifestyle too if you really want to put him first, it sounds.

Thanks guys. He hasn't smoked or drank for the last few days. The GP has upped his pain relief and apparently I'm a really good nurse. Lol, pay me then...haha.
I really appreciate everyones feedback at this time, and thanks to everyone for not being judgemental as these types of things seem so alien to a lot of folks (and rightly so)

@idontlikealdi By his own admission he was a hardcore addict back in the day. He is on the pain relief for his (previous) injuries only but is locked into the addiction service through beuaracracy. I'm under no illusions that he isn't an addict as that never goes away. The GP is speaking to them to release him and also the other orthopedic hospital he was under that didn't help his last injury. Then he can get a proper psychiatrist.
Thanks again.

Update- if anyone wants to know. The hospital missed the fact e had a collapsed lung with 4 litres of blood in it. He collapsed 4 days ago and was blue lighted back to the hospital. He has a haematoma on his lung with a drain sticking on and the blood is still coming out at about a litre a day after 4 days. But he hasn't smoke or drank lol. Don't get sick in East London Folks. The hospital sucks.

Sorry to hear that @BobbyBiscuits. How worrying for you.

My brother was in hospital in SE London and I agree with you, the NHS is absolutely on its knees.

Oh my word, how awful for you both! Can’t believe they released him with no real assessment or follow up to be honest! (I’m an RMN)

Does sound drug induced though and that might be the reason for the quick release, cannabis can affect people very differently and the same amount can affect the same person differently.

I’m sorry your DH is back in hospital, sounds like both these incidents have literally been life threatening! Hope he is better soon and remains abstinent from all substances. It’s really not worth the risk or trauma for both of you.

@89redballoons Thanks so much, that's kind. Sorry to hear about your brother's experience. it seems a world of difference to when I was in hospital in 2022. (It was admittedly a statistically much better hospital, but still NHS)
I'm so worried for the future of it. No-one wants to kill it but evil politicians.

@Doyouthinktheyknow Thanks so much for your input, as an RMN it's really valuable. The answer to the cannabis thing is he was not smoking on the day of the psychosis and I've known him for 20 years and it's only ever calmed him down. I know it sounds like I'm too pro-cannabis to listen to people in this vein but in his case I just know in my heart and soul it's not the cause. He needs a decent psychiatrist who will offer confidentiality.
I'm devastated they kicked him out at midnight with a hole in his lung.
His immediate neighbour in the ward was a fucking prisoner who was violent and terrifying, he was re-arrested in front of normal desperately sick people.

So sorry to hear the latest developments, and really hope his recovery runs smoothly from here on.

It was explained to me that weed can definitely bring on psychosis IN PEOPLE WHO ARE ALREADY PREDISPOSED to psychosis.

So not everyone who smokes weed will get psychosis - and I get that there is a big debate about whether it can be helpful for some people - but if there is any indication that someone is at risk from psychosis then definitely need to steer clear. Even if you think this latest episode isn't directly linked, your DH needs to give up altogether.

He absolutely does need a proper mental health assessment! His risks are so high!

If you have the money, it might be worth seeing someone privately.

Whatever has caused the psychotic episode needs to be thoroughly explored before there is an even worse outcome!

I hope he gets the treatment he needs this time.

Sorry to hear your DH is back in hospital.

As for cannabis - my DH's first episode in his 20s was attributed to cannabis - he admits himself he smoked a hell of a lot back then, and he completely stopped after. The second episode was years later and he hadn't touched cannabis since but he honestly believes that "switch" had already been thrown. Your DH is right - it's a very fine line and anything psychoactive has the potential to push him over that line. He really needs a psychiatric assessment, a diagnosis and likely long term medication.

I think it's genetic, or some people just have the tendency there - FIL has never taken drugs in his life but is suffering from some psychosis now, it's just taken longer to come out as he hasn't had a "trigger" there (plus isn't being entirely compliant with his medication which is another fast track to being pushed over that fine line - this is not helping and we thinm a section may be imminent!)

Sorry to hear your update @BobbyBiscuits , it's horrible having anxiety/ doubts about the quality of medical care on top of everything else that you're already dealing with. Fwiw while I'm also pretty relaxed about cannabis use I'd agree with others about it being risky for some individuals, and any history/predisposition to psychosis is definitely one of them. It doesnt mean there's a direct cause and effect. It can be a factor in people developing psychosis, albeit not everyone will. It can certainly make episodes more likely for someone who has had psychosis before, and that's especially the case now as the levels of THC (the psychoactive element) are so, so much higher than they were twenty years ago.

@Toopolitetoask Thanks very much, really appreciate your feedback. That's very interesting. I see your point. He has no desire to smoke now and said he was too depressed to see me today : ( I was hoping we could go out for fresh air but he feels to self concious in porter chair with the drain and he needs to exercise but can't as he's too weak.
I have to say though on your last point that I must be missing out because my weed has been the same strength for the last 20 years. lol.. I shouldn't joke but sometimes if I don't laugh I'll cry.?!

@BobbyBiscuits depends where you get it from I guess! But if you remember when they reclassified cannabis and made the punishment for producing it much more severe at the same time... It became more worthwhile for the organised criminals to focus on skunk, the home growers died off. The tech behind producing the different strains has also developed, and stronger and stronger types have been produced because now the majority of weed is grown indoors in controlled environments rather than outdoors. In particular there has been the increase in the THC content, with a reduction in the CBD content (which is the element that can be calming and thought to mitigate against some of the negative effects of THC). Another issue can be the use of synthetic chemicals added to poor quality skunk - eg adding 'spice' or similar to it, which can have really terrifying implications for mental health.
The knowledge I've got is a bit piecemeal but I used to work in harm reduction services for homeless people, and more recently with young people with mental health issues who are involved in or at risk of crime. Those are some of the general themes that get shared, along with info by the police around what is happening locally. It's a very different drug to the one that I was around as a teenager!

Hopefully his interest in smoking it has reduced, but it might be worth seeing if there are any harm reduction services locally to if he's likely to go back to it - if abstinence isn't realistic then he could get some advice about ways to use it in a less risky way. I hope he feels up to a visit soon, j must be hard not seeing him.

Here's a link though about general trends
https://www.newscientist.com/article/2396976-is-cannabis-today-really-much-more-potent-than-50-years-ago/#:~:text=A%20study%20from%202020%20examined,year%20from%201970%20to%202017.

@Toopolitetoask Thank you again for your reply. I love THC as it's my pain/anxiety/depression/anorexia/insomnia relief so I could easily get a script if I was rich, but the weed would be worse and more expensive, lol. Bloody Government.
I'm not the one with psychosis though am I? So I fully understand your point. And thanks again for the info. : )

I understand what you mean, and even though I have seen some horrible effects, I personally would support legalisation - because at least then people could make informed choices and know what strength they are taking, instead of it being a lottery that is controlled by organised crime gangs! It would also allow more research into the effects, benefits and risks to take place (which is already happening in the US, though with the complications of the influence/finance of big pharma)