My brother has SZ and recently had an attack,its been 40 days after that but there is hardly any im

Thank you Mr Kennard for replyin,I wish to give you some information you had asked.

My brother is 26 and taking medicines regularly,He is taking (risperidone 4 mg + trihexyphenidyl 2mg) in the morning,At night its (risperidone 4 mg +olanzapine 10mg +zolpidem tartrate 10mg) pls advice on the medicines also.

He doesn't listen to us,Don't wish to stay at home.He gets mood swings,he says that he wants to get married, he stays quiet,keeps on thinking about his delusions,which are; he feels he has made dams,he is the one who gave the idea of hybrid car,he found gas in rajasthan,etc. He asks us to get him money for all his works.he says someone or we are throwing rays on him which troubles him and tying to kill him.He feels he is a scientist,who has to save this world,he wants to make humans immortal.He says that he just want to be with his friends who got him into smoking.He wants to smoke and drink alcohol

Thanks for the additional information. I think some of his wishes sound perfectly reasonable (wanting to get married) although it sounds like he isn't in a position to make this a viable proposition. Your explanation of his delusional state sounds like he may not be taking his medication, or his medication isn't really at a therapeutic level.

I see Christina has already answered the issue of smoking and I agree with her assessment of this. I do hope his friends aren't smoking cannabis as this is something he really should avoid.

It's a difficult situation. As a 26 year old he will clearly be looking for some independence and his friends are obviously more reinforcing to be with. This isn't surprising as I doubt they have the same level of concern over his welfare. Do you perhaps know any of the friends? Is there one that might sit and talk with you about your concerns, or maybe even accompany him to see the doctor?

If there is a way of arranging an assessment with the doctor/psychiatrist I think it might be a good time. His behavior may be due to his mental state or it may not. I think there is sometimes a tension between free-will and medication. He needs enough to help control the worst of the symptoms. If he is symptom-free his need for independence is something you may have to deal with as a different issue.

Thankyou Mr Kennard for the advice it would be very helpful.

Sir the problem we are facing is that we are not able to make him symptom free,I completely understand his desires as an adult,but i m with him since he had a relapse (episode) around 6 aug,09,when he was hospitalised for around 20 days,I think we were noticing some improvement on him,then we went to see his doctor and his medication was changed as he was eating a lot and drooling. After the change of medication,with in 2-3 days, his condotion got really worst.then few more medicines were added and now he is improving with a very slow pace.

I would like to know,what do you exactly mean when you say symptom free, If the medication is working do they completely stop talking about the hallucinations and delusions or they still do.because its been 2 months and he still talks about his  delusiong and hallucinations.

It sounds very much as if you are associating his current state with the change in medication. Why was his medication changed in the first place?

When I say symptom free I really mean that the person feels in control. Not all symptoms necessarily disappear completely but if medication is at a therapeutic level the symptoms should be minor. Many people with schizophrenia learn to live with delusions and hallucinations. They can be helped in this by cognitive therapy which teaches the person to recognize and manage the situation.

Thankyou so much for the advice Ms Christina, your advice would certainly help me in dealing with my brother.He is taking regular medicines,as we make sure that he does that,me and my parents always say with him,whenever he wants to go out i accompany him. He is not a chain smoker but he keeps on asking for it and since  i am with him from last 2 months he only smokes once a day,but we dont want him to do that also.

Problem is that he stays quiet,keeps on thinking something about him delusions.He feels that he has made dams and he is the one who gave the idea of hybrid car and he is not rewarded in the form of money for his work.Me and my brother share good trustworthy relationship.I strongly feel that medication is not working as much as it should.

You mentioned about therapies,pls suggest some therapies or other treatments which can help him.

Hello,

I recommend cognitive therapy which your brother may be able to find on a sliding fee scale based on how much he can afford to pay and where you live whether cognitive therapy is offered.

Please understand that Jerry is right in that sometimes minimal symptoms, called residual symptoms, could persist.  In this case cognitive therapy would hopefully help your brother in coping with them and managing them so he can live his life and be independent and maybe one day get married. 

Regards,

Christina

Thankyou christina for the answers,

I took my brother to his doctor yesterday,and asked his doctor about the cognitive therapy she said first we need to make him more stable and then we can think about the therapy.

I would like to request for your help on few more things;

1-My brother still do not know that he has SZ,but he knows somewhere that there is some problem,We were not able to tell him that he has SZ coz he has not recovred yet to a stage where we can discuss about SZ with him, so please tell about the right time to discuss that he has SZ and how to do it and encourage him to fight it, is there a chance that discussing this might worsen the situation coz he might get stressed by knowing about his illness.

2- What can be done to reduce the side effects of the medication?

Hello,

It is my idea that you need to be honest with your brother, however you can use the sandwich technique to talk with him if you wanted.  Sandwich the talk about the diagnosis between two positive statements, along these lines if you feel it would help:

Explain that you want to see him get better and will work with him to help him get better.  Then you could say he has a chemical imbalance in the brain that the medication is regulating.  Take the focus off of the scary diagnosis when you explain what is happening.  Next you might say, "The technical term for this is schizophrenia.  It is not your fault and doesn't mean you are crazy, it is a term used to describe a set of symptoms that occur when there is a chemical imbalance in the brain.  End with: again, I want to work with you so that you can get better and have a healtheir brain."

Something along those lines.  I don't think lying and denying about his diagnosis is ever the way to go.  Only when a person accepts that he has schizophrenia can he begin the road to recovery.  By the way, a diagnosis can change over time, so you might say something along the the lines, "This is your current diagnosis based on behaviors that have been observed now.  A diagnosis could change with time.  A diagnosis is simply a tool a doctor uses to determine the best course of treatment based on those symptoms."

Then you would tell him he's a great person, you have every confidence in him, and you would re-state that you will be there for him and help him.

As for the side effects of the medication, your brother has to work with his doctor to find a solution and your brother should discuss any and all side effects with the psychiatrist as soon the side effects are noticed.  Sometimes the side effects will require a medication change, or a dose change of the current medication, or a change in the dosing times, or adjunct medication to alleviate the side effects, or lifestyle changes.

Best,

Christina

Thankyou christina for the advice,YOU are at your usual beat,it would help a lot.I would like to know is it the right time to discuss about the diagnosis with my brother or should i wait for some more time to let him get more stable as he is recovering .

Regards,

abhishek

Hi,

It is up to you whether you feel he will be resistant to the diagnosis, that is why saying a "schizophrenia-like illness" could be the way to discuss it.

At some point, if not now, he will need to know.  I wouldn't wait longer than six months at any rate, however, that's just me.  Do what you think will be best.  You can't put it off too long.

Regards,

Christina