Friend with paranoid schizophrenia-- what to expect/how to handle?

[CatWithNoTeeth]

Hi, I have made a new friend who has paranoid schizophrenia. Our friendship is very much 'big sister/little brother' and I want to support him. He takes medication and it helped him get back to himself after a long and difficult onset.

Most of the time he is lovely and I don't notice anything of his illness. But now and then something just switches and he becomes paranoid and accusatory. He can say some very odd things, is convinced that people are talking about him, that I am against him etc. I have noticed that from time to time he also hears voices because he will respond as if something was said when it wasn't. These episodes can last a few days or just a few hours before he gets back to normal.

My question is, how is best to deal with these episodes from my side? I find it very difficult to know how to respond/act when this is happening. Is there a best way to react when he is like this, that would de-escalate? Or should I just remove myself from the situation (I've tried this and he bombarded me with messages).

Looking for some experienced advice, I've never had a friend with this issue before, I don't know a lot about what he is actually experiencing and am not sure how best to navigate it.

Any pearls of wisdom or insights are welcome.

How has this friendship come about? I'd be very concerned that he either wasn't taking his meds or wasn't taking them properly or he needed them to be reviewed. His behaviour is already erratic.

Be very careful, it's an awful disease and if he isn't taking his medication I would not advise being alone with him.

Our friendship is very much 'big sister/little brother' and I want to support him

This sounds unhealthy. How did you meet him? Why do you want to support him?

If he is having hallucinations and is becoming properly paranoid then I hope he can access proper medical help.

Sounds as if he could be having breakthrough symptoms (if compliant with meds) or off them

Thanks for that, I hadn't heard of breakthrough symptoms and just read some things about it-- sounds like that could be what is happening.

Would be wary of involvement to be honest, particularly if you've met him online or something like that and you're not party to his full background. Also think the big sister thing sounds a bit unusual since you have only recently got to know him.

Breakthrough symptoms are considered quite usual with this diagnosis, this isn’t usually to do with med compliance. Often people who have this diagnosis have a very low stress tolerance and increased stress levels, or even physical illness can cause an increase in breakthrough symptoms. Unfortunately on Mumsnet, there are some individuals that consider those with mental illness such as this as criminals, potential murderers or such and such. There are also a lot of people with this diagnosis that would not hurt a fly, and just require a gentle reminder of what is reality and what is not, this can be helpful if your friend as a good insight into his illness (again, a lot can differentiate between “illness” and the assurance that these things aren’t “real” can help). If you notice at particular times there is an increase in these behaviours, it could be one of the things I said above (an ongoing stressor, a trigger, a time of the year, a family member, a particular thing on the news!) Hope this helps x

It can be tempting, when someone has false beliefs that are distressing for them, to try andreason the beliefs away, but it can often be much more helpful not to challenge the beliefs. Instead, focus on letting the person know they are safe with you and that you hear them.
Another thing I wanted to say is that it is brilliant for this person that they have your friendship. Just the 'normality' of friendship is a bit of ordinary life for them, and potentially protective for them. But don't slide into feeling responsible for 'managing' any blips and so forth. Make sure they know that you are there as a friend, but let the healthcare professionals take the stress of dealing with the illness.
EDIT: Sorry, just wanted to add that I didn't mean to contradict the suggestion above about giving gentle reminders about reality. Yes, definitely this can help and be very reassuring. It's just that, if it isn't helping, it can be important not to push at that strategy, but instead to try a different tack that helps the convo to stay relaxed.

@Ems1992 @ValueAddedTaxonomy Thanks so much for your responses. I will try different ways of responding to it when it happens-- I've definitely seen that challenging it doesn't work. He himself has suggested that being reassuring and warm can help him feel better when it happens. Also I do agree that it seems triggered by stress.

My Mum had schizophrenia. When she was well you genuinely wouldn’t know she’d ever had it. She would never tell anyone and worked in various jobs, had friends etc. She was in and out of mental hospitals in the 80s and 90s and then took meds for a long time and then slowly weaned herself off them and didn’t relapse or have any symptoms for about 20 years. She then completely collapsed into it again and became as ill as she was in the 80s. People she’d made friends with were shocked, she was (in her worst states) incredibly horrible to them and to me. I understand that it was part of the illness but it is incredibly difficult. It’s a very unpredictable illness. One of the main problems is that the drugs they give people make them feel so unwell and they themselves don’t believe themselves to be unwell so they don’t take them. Be careful. It’s lovely you want to be his friend but schizophrenia is no one’s friend, it very much depends how stable he is.