Anyone had any experience of psychosis?

[chelle792]

Back story
FIL has been mentally unwell on and off for, basically, his whole life. Not long before I met DH he was sectioned due to a bout of psychosis. He has since "recovered" and although is still on meds, he leads a more normal life.

He was taken off his anti-psychotic meds about 12 months ago and about four weeks ago, cut back on his anti-depressant meds.

Cue a downwards spiral. He's becoming manic, paranoid and refuses to up his meds again. He's hard work - talks constantly, badgers us, doesn't listen, repeatedly asks questions, keeps locking things (i.e locking the van when DH is trying to load it with wood, etc).

DH is an only child and the pressure on MIL is huge although she's coping well at the moment

We are trying to see them twice a week and will up it if necessary.

I've never experienced this before. We are worried that the paranoia is increasing and in turn, he's beginning to not listen to anyone. e.g if we tell him he needs to sort his meds out he won't listen and will dismiss it.

Has anyone experienced this before? I'm trying to take cues from DH and MIL but don't want to ask too much as the pressure on them is increasing and they are understandably worried. What should I be doing? What should I be saying? I'm lost and scared and worried. I guess I'm just asking, what should I expect to happen?

We are about two weeks from ringing the head of the psych ward he was on to get some extra support time limit agreed by MIL and DH

Oh this is so hard.

I have a friend who was psychotic and refused to take meds.

I am not sure I can be of much assistance, but I will say that you should all be in touch with his psychiatrist/ward if you can.

He should have a "care plan" approved by his psychiatrist, with a plan of how to deal with certain situations.

You need proper psychiatric support for this situation.

Thankyou babyGanoush. I agree, we do need the support. MIL says we need to leave it a couple of weeks to see if he "settles down". FIL did have a good afternoon yesterday after being really hard yesterday morning - we managed to get him to sit down and read a book and the arm chair. At my place, the armchair is like his little special go to place.

It's all just so unknown for me.

Last time, the increased blood pressure from it all caused a stroke. Hopefully he will continue to take his blood pressure tablets

Get all the help there is.

My friend who was psychotic was and is ok but her husband got really stressed out.

He wrote in the care plan that if he had to go to work whilst she went manic/psychotic, he would lock her in the flat for her safety. That plan was not approved, obviously, so they sat him down and made a better plan.

Really, get all the help there is.

My partner has had two psychotic episodes in the last two years.
You can't have a wait and see approach it needs to be dealt with quickly.
The second one my partner had was far easier to deal with as I saw the warning signs and dragged him off to doctor. His care was then a hospital at home scheme rather than being held in a secure psychiatric unit.

Thank you, I'll go and see then on Monday and see how he is, persuade them to give the psych doc a call.

I don't know anything about a care plan but there must be one.

As far as I can tell, DH and MIL are saying that he's "bad" and "hasn't been this bad for a long time" but don't think he's bad enough yet.

I'll update once I know more. Would appreciate any more advice anyone can offer

I have experience of being with someone who was becoming psychotic, and overnight he changed into an emergency case! I would lean on MIL to get him to psychiatrist immediately, as you do not want to wait until he is "bad enough". By then it is much harder to treat and to get cooperation from the affected person.

Good luck! You sound caring and intelligent, but this is not something you can single-handedly control.

I work in psychiatric care (CMHT and inpatient ward). This kind of thing does not get better on its own. It can also be managed less coercively if he gets help sooner rather than later. Do not try and reason with him (he is not able to reason at this point, and he might find the reasoning ties into paranoid ideas). What is the logic of DH and MIL that they don't want to contact services sooner? If they were in his shoes, wouldn't they want someone to get them help ASAP? Try pointing out that it is not FIL they are helping, it is the paranoia and psychosis that they are colluding with... Contact the GP straight away, the GP can arrange further MH support (it will be likely to still take a few days). If the worst comes to the worst, all A&E depts have 24 hour emergency psychiatric services for this kind of thing, but you'd need to get him there. Police can manage that if need be, but might need to say that you are scared for your safety. Good luck, it is horrible and frightening. FIL will most likely thank you once he is recovered, although he'll fight against help now.

pannacott a really useful post, thankyou (and others). I think they are waiting to see if it will develop into psychosis? I must admit, I'm completely ignorant but will do some reading tomorrow. How can I tell if it goes from agitation/manic behaviour to psychosis? DH said today that it's a good sign that he calmed for a while in the afternoon

I'm bipolar with a history of psychosis. It can be managed - I've not had am episode in over two years now - but it's not something he should be trying to get through alone. It can be really dangerous.

Does he have a Community Psychiatric Nurse or Care Coordinator? If I start showing warning signs my partner had a phone number for my CPN so he can call her and get her involved sooner rather than later. I've found in my case early intervention makes a massive difference - the difference between home and psych ward. Definitely push them to seek help asap. It sounds like his meds need readjusted and he needs someone keeping an eye on him until he regains insight.

This is what's frustrating. The gp halved his meds.have since found out though that he started cutting his pills to halve the dose himself.

He's spiralling. I asked DH if FIL has a care plan. "what's a care plan?"

I know there is a doctor on the psyc ward who we can contact. Have now managed to shorten DH from saying "a few weeks" to "a week".

Do you know what his actual diagnosis is? I'd suggest that the agitated behaviour he is displaying now, suggests that he is currently psychotic / having psychotic ways of thinking. This is not how he is when he is well. And people don't become this unwell then get better spontaneously. The contact they have at the psych ward, would this be a psychiatrist? If your FIL has not been in contact with services for a while, things might have changed... Could you persuade them to call ASAP and just check the person is still working there, not on annual leave, that he would still be the best person to speak to? The points / phrases you might want to mention would be 'not taking his meds', 'relapsing', 'becoming unwell' and detailing his peculiar behaviour and that he is not taking advice from you, and that you are scared. It will probably take a few days for them to be able to see him, so if you set the ball rolling tomorrow they will likely not see him until next week - that gives you your week away. If they wait for another week it's a week of risk and anxiety for you to manage. Please do keep asking questions and I'll try and help if I can.

I've been psychotic. It is hideous.

One of the problems is that you lose insight and absolutely cannot believe that there's anything wrong. No matter how ridiculous the things he might say sound, they will feel completely real to him. Some of the paranoid delusions are absolutely terrifying.

Get help now. The longer it goes on, the worse it will get. This might be hard to hear, but I truly believed I was going to have to kill somebody. I shudder to think what could have happened if I had not got help when I did.

I'm not sure what his actual diagnosis is but listening to your descriptions I don't think my DH is right in his explanations.

Apparently every so often he would go through phases of a couple of weeks where he would be "not in the room", anxious, lack of sleep, paranoia, pacing, excessive talking but would apparently always settle down.

About a year before I met my husband this phase didn't settle. Eventually he just froze at the top of the stairs and wouldn't talk or move 111 said put him to bed this was a stroke. He was on a stroke ward but DH says the stroke induced the psychosis. As soon as he was physically recovered they sectioned him.

To me it sounds like he was suffering from psychosis before the stroke caused by the high blood pressure from being unwell, I guess

I think because the pattern has generally been him being unwell for a few weeks and then getting better, this is what DH and MIL are hoping for. They are just so accepting and kind and tolerant but I'm not sure if the gentle approach is best.

He was only medicated after his stroke. All mental illness up to that point was accepted and undiagnosed

That does sound quite an unusual presentation, and given the stroke and pattern of fluctuation in the past, I think it's really important to get a medical / organic cause ruled out. He could be having 'small strokes' which cause the temporary periods of strange behaviour. This is really serious and increases risk of major strokes - he should be being monitored and on medical treatment for this. It really is imperative that you get medical help straight away. Can you ask DH and MIL how they'd feel if he had another stroke because they wanted to hold off? A little emotional blackmail may be appropriate here. And whether it turns out to be physical or mental illness, or both, it sounds like they really need some support about learning about his conditions, how it is managed, when they should access help etc. Let us know how you get on.

Yes - I had a friend who went through something similar. The friend is now fine in the sense that his condition is all controlled, he is back at work and has a stable home/personal life.

This took years and for a long time (in and out of hospital) he was unfit to work.

I remember him saying to me that the SINGLE most important thing was finding the right consultant psychiatrist that is a good fit for the patient and that this can take several goes. Basically what he said was that the mind and its workings are still very badly understood. Some medication will work for person A and based on objective symptoms, you'd think it would work exactly the same for person B - but the mind doesn't function like that. It was a lot of trial and error - trying different medications, trying different consultants.

This is all with the benefit of hindsight. I think three things that helped him were his wife was a highly educated, intelligent professional with a sort of medical background so wasn't shy of challenging the health care professionals. [Too many people will just accept as gospel what the Great Consultant says]; he himself was also educated and intelligent so was able to articulate well when things weren't working and finally, they were well off so although he was being managed on the NHS, they had the capacity to have private treatment if they wanted and/or take second opinions.

It all had a happy ending but it took probably the better part of 10 years for him to come out the other side.

Thank you all for the info.

Pannacott I'm off to Devon to see my elderly Nan this weekend but will make sure I see them on Monday. I'll continue to badger DH gently over the weekend. DH tends to shut down if I go in too strong

It's so hard that it's FIL. If it were one of my parents I'd make the call and sort it straight away but it's not my place to overrule both MIL and DH. Frustrating

^^what Cheers said.
It is such an awful illness to cope with. My daughter (21 now)
Is five years into it.

Do you know if your fil tapered off the meds over a long period of time? Suddenly dropping them, or a too short tapering off period, could be problematic.

Does your fil have an awareness of what is going on? Or is he in denial/dismissive about it?

Also, talk therapy can help with awareness about it...but this would be with psychologists rather than psychiatrists. It took me a while to figure out these are not the same thing and don't really crossover-although they will communicate (with permission) with each other as part of my daughter's care team.

Also, your dh and mil might benefit from seeing a counsellor for themselves for support in dealing with this, or for you too.

(((Unmunsnety hugs))) It is a long slow smoldering dread dealing with what might/might not happen.