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boletusedulis
02-25-2011, 02:10 AM
Hi delightful experts!

The steamy love interest in my YA contemporary has schizophrenia. I could really use some advice/insights from anyone who is knowledgeable about this condition. Specifically, I'm trying to figure out:

-When you have schizophrenia, is it something that permeates every minute of every day, or is it like bipolar, where you can have an episode, then be symptom-free for months before having another episode?

-Would it be realistic for this character to start "slipping" (having paranoid thoughts, etc) after a few months of relative stability, but then successfully pull himself out of it by taking his meds?


The character in question is 20 years old. He's intelligent, talented, and normal in many ways, but he has a persistent belief that the MC is being followed by sinister agents.

I would be so grateful for any input on this question!

Best wishes,

Hilary

Switch-Phase
02-25-2011, 02:21 AM
If a schizophrenic person is properly medicated, they can manage their condition for the most part without panic attacks and severe hallucinations. There are positive/negative symptoms though; these are the differences in traist that are hidden behind meds versus the traits that still show up in daily life. Forgetting medication can lead to a freak out within a few hours, in which case sometimes an ambulance is called so they can give you an injection to relax you. Least that's what happens with one of my friends.

She's sane on the drugs, but there are little things. She's still on occasion overwhelmed by too many people in her house, sometimes needs to get up and take a breath in another room. If she hears a small sound at night she's compelled to get up and check every room to make sure no one's therem stuff like that.

Hope this helps

Buffysquirrel
02-25-2011, 02:42 AM
Schizophrenia is a term that covers lots of conditions that aren't really that well understood. This Mind leaflet gives a basic overview:

http://www.mind.org.uk/help/diagnoses_and_conditions/schizophrenia

If someone is symptomatic, then medication can suppress the symptoms. However, many schizophrenics resist medication because it causes flat affect, ie you don't feel paranoid any more but you don't feel anything else much, either. For that reason, it might not be entirely plausible for your character to resume medication without some persuasion.

waylander
02-25-2011, 02:51 AM
Depends on if he is taking his medication

wheelwriter
02-25-2011, 06:42 AM
Hello.

Hi delightful experts!

The steamy love interest in my YA contemporary has schizophrenia. I could really use some advice/insights from anyone who is knowledgeable about this condition. Specifically, I'm trying to figure out:

-When you have schizophrenia, is it something that permeates every minute of every day, or is it like bipolar, where you can have an episode, then be symptom-free for months before having another episode? I believe without medication, it could permeate pretty much every minute of every day. With medication someone can be pretty much symptom free. A really stressful situation or some sort of trigger could cause an exacerbation.

-Would it be realistic for this character to start "slipping" (having paranoid thoughts, etc) after a few months of relative stability, but then successfully pull himself out of it by taking his meds? Yes, if he stopped taking his meds.


The character in question is 20 years old. He's intelligent, talented, and normal in many ways, but he has a persistent belief that the MC is being followed by sinister agents. Small sidebar since you mention this is YA. How old is the MC? I ask b/c if she/he is under 18, then it could be an issue (at least in the U.S.). If he/she is over 18, then it makes it a tough YA sell, and you fall into that non-genre, somewhere between YA and adult.

Paranoia and delusional thinking are hallmarks of schizophrenia, so he could believe totally random people are plants, tailing the MC. He may "overhear" plots and threats on the radio or TV, or interpret a smile or a glance to have covert meaning. Someone close to the MC may not be who they say they are, they could be wearing a mask, waiting for the right opportunity to hurt the MC.

I would be so grateful for any input on this question!

Best wishes,

Hilary

M.Macabre
02-26-2011, 08:12 AM
Hi delightful experts!

The steamy love interest in my YA contemporary has schizophrenia. I could really use some advice/insights from anyone who is knowledgeable about this condition. Specifically, I'm trying to figure out:

-When you have schizophrenia, is it something that permeates every minute of every day, or is it like bipolar, where you can have an episode, then be symptom-free for months before having another episode?

-Would it be realistic for this character to start "slipping" (having paranoid thoughts, etc) after a few months of relative stability, but then successfully pull himself out of it by taking his meds?


The character in question is 20 years old. He's intelligent, talented, and normal in many ways, but he has a persistent belief that the MC is being followed by sinister agents.

I would be so grateful for any input on this question!

Best wishes,

Hilary


I think the answers to your questions is something that is sort of difficult to convey. Each individual manifestation of the disease is different, as well as their reaction to medication.

(1) People with schizophrenia tend to have good days and bad days(or at least what can be described as so from observation), and I'm pretty sure this can happen in general trends of severity that last for a few weeks. It will, however, affect how they interact with the world 24/7 mentally.

(2) Yes, I'm pretty sure someone can have relatively mild and 'manageable' symptoms and then have them become severe. Symptoms can become aggravated by different things, including stress.

I would invest some time in investigating the exact symptoms of schizophrenia, because I don't think anything anyone on AW can tell you will replace good ol'fashion research, or produce an accurate portrayal.

EFCollins
02-26-2011, 08:19 AM
Hi delightful experts!

The steamy love interest in my YA contemporary has schizophrenia. I could really use some advice/insights from anyone who is knowledgeable about this condition. Specifically, I'm trying to figure out:

-When you have schizophrenia, is it something that permeates every minute of every day, or is it like bipolar, where you can have an episode, then be symptom-free for months before having another episode?

-Would it be realistic for this character to start "slipping" (having paranoid thoughts, etc) after a few months of relative stability, but then successfully pull himself out of it by taking his meds?


The character in question is 20 years old. He's intelligent, talented, and normal in many ways, but he has a persistent belief that the MC is being followed by sinister agents.

I would be so grateful for any input on this question!

Best wishes,

Hilary

I suggest going to this website.

http://www.nimh.nih.gov/health/publications/schizophrenia/index.shtml

I'm writing a novel about a schizophrenic too and that site has been extremely helpful. I went ahead and directed you to the schizophrenia page. NIMH (National Institute of Mental Health) was recommended to me by my son's therapist when I asked him about pamphlets on schizophrenia. He said NIMH would be more helpful... and it was.

Sydneyd
02-26-2011, 08:25 AM
We need to know what type of schizonphrenia first. There are...7 different types if I remember right (without looking it up) each type comes with an entirely different set of symptoms. Relapses do happen, though mostly they happen when the person stops taking medication. The person could stop having the symptoms if they went back on their meds.

PinkAmy
02-26-2011, 03:14 PM
Hi delightful experts!

The steamy love interest in my YA contemporary has schizophrenia. I could really use some advice/insights from anyone who is knowledgeable about this condition. Specifically, I'm trying to figure out:

-When you have schizophrenia, is it something that permeates every minute of every day, or is it like bipolar, where you can have an episode, then be symptom-free for months before having another episode?

-Would it be realistic for this character to start "slipping" (having paranoid thoughts, etc) after a few months of relative stability, but then successfully pull himself out of it by taking his meds?


The character in question is 20 years old. He's intelligent, talented, and normal in many ways, but he has a persistent belief that the MC is being followed by sinister agents.

I would be so grateful for any input on this question!

Best wishes,

Hilary
Schizophrenics take years to accept their diagnoses, and most never do. They are constantly going off medication, because once they feel better, they think they don't need it. Also,medication is very strong and has lots of side effects. For guys, sometimes problems with erection are another reason they go off meds (aren't you glad you asked). If your MC is talented in a creative way like with art or music, medications will probably prevent him from doing his most creative work (which might be a reason he stops taking it)--my dissertation advisor wrote her dissertation on art and madness.


-When you have schizophrenia, is it something that permeates every minute of every day, or is it like bipolar, where you can have an episode, then be symptom-free for months before having another episode?

People with schizophrenia are off, either because of the disorder or the medication. Symptoms are pervasive, not like bipolar. The medications for schiz. are powerful and they have many side effects, they dull the senses and make the patient seem kind of removed and spaced out. They also have tremors often and they're slow to react to stimuli. Like if you throw a ball at someone, they are slow to realize the ball is thrown so I have to put my arms up to catch it. Speech can be impaired.




The character in question is 20 years old. He's intelligent, talented, and normal in many ways, but he has a persistent belief that the MC is being followed by sinister agents

He really won't be normal in many ways. Schizophrenia is such an insidious illness

-Would it be realistic for this character to start "slipping" (having paranoid thoughts, etc) after a few months of relative stability, but then successfully pull himself out of it by taking his meds?
It would be unrealistic for the character NOT to start slipping, even if we stayed compliant with his medications, because dosages often have to be tweaked. I think you may be "romancing" schizophrenia. The right dosages of medication and medication tweaks are very helpful, but your MC won't ever be like everyone else. He can go to school, even hold down a job. His relationships will be tumultuous, filled with drama and I'm quite certain anyone who he attracts will have his or her own issues because healthy people don't want to be permanent caretakers. Also, even medicated he will still have a nonclinical paranoia/ suspicious personality. The meds don't make that symptom vanish. Another thing, not all schizophrenics are paranoid.
When I interned at a state hospital we have 3 competing jesuses (jesi?sp LOL) and the dalai lama. There was a woman who constantly stripped because the voices in her head said god wanted her to be naked (making the male workers very uncomfortable). The voices they hear often have religious or other authoritarian connections.

kathleea
02-27-2011, 01:06 AM
As a Psychiatric NP (my day job) we admit people with schizophrenia all the time. Usually off medications but not always, sometimes the wrong meds will also cause a psychotic break. The saddest patients are the young adults having their first psychotic break which can be brought out with substance abuse. I've seen higher functioning people with schizophrenia too who manage well as long as they have the right medications but it can be long slow process to find the right ones. Some have to have weekly/biweekly/monthly injections otherwise they wouldn't take their medications. Why schizophrenia for your love interest? It's a difficult diagnosis to treat and first time schizophrenics fall into the college age range (although it can happen earlier and later in life and does). If you have other questions you can PM me.

backslashbaby
02-27-2011, 04:08 AM
I know a couple of scizophrenics whose condition is not as severe as what is usually seen in hospitals, etc. They do totally fine and have no more complaints about their meds than I do about my antidepressant. If they have strange thoughts, you'd never know it.

Schizophrenia can be horrible to treat, and the cases can be quite severe. I assume your character has Paranoid Schizophrenia from what you describe. That is what my friend and aquaintence both have.

More typical, I gather, is like other medicated schizophrenics I've had contact with. They still have some problems with delusions, particularly. The full hallucinations are gone (they say) with meds. I hope that helps rather than confuses things :D You can tell those folks still have something off, but generally they are aware of the fact that the delsuions are a symptom. It doesn't necessarily help them stop believing them (an imaginary friend and alien issues for one; a belief that he wrote famous songs on the radio for the other).

eta: of the ones you'd never know it, one of them used to think he got messages through the television, spying on him probably-governmental stuff. The other had voices that just said mean things to her. She could hide hers before treatment, mostly. He could most of the time, but the TV thing got him too upset sometimes, and he hit his wife once thinking she was in on it. Both got treatment and do take their meds, clearly.

Rufus Coppertop
02-27-2011, 08:31 AM
He really won't be normal in many ways. Schizophrenia is such an insidious illness

It could be that psychologists working in psychiatric clinics and psychiatric nurses, only really see schizophrenics when they're at their worst.

Whilst it is an insidious illness, as you say and frequently debilitating, I don't think it's always as severe as we see on inpatient facilities and not every sufferer is treatment resistant. There are people in the community functioning perfectly well with low/lowish doses of medication.

PinkAmy
02-27-2011, 06:17 PM
It could be that psychologists working in psychiatric clinics and psychiatric nurses, only really see schizophrenics when they're at their worst.
.

Agreed, people are their worst in hospitals, otherwise they wouldn't be in the hospital.
My experience with schizophrenics is not just in patient, other's I've seen are not former hospital patients--people who care somewhat functional in society. You might not know they are schizophrenic, but to the trained eye something is "off". There are people who function at a higher level than others, some people who respond better to meds than others, some that are more compliant than others. Some can hold down full times job and do relatively well in the workplace. But even at their best, they aren't like people who don't suffer from a major psychiatric illness. Do you know the movie A BEAUTIFUL MIND about Mathmetician John Nash? He functioned pretty well in his job but in real life, his marriage was a disaster and he was reportedly a substance abuser and beat his wife (of course, people who aren't schizophrenic do that too)--he couldn't function well in multiple areas of his life at the same time. People who knew him as a patient or coworker thought the movie romantacized his condition.


You can tell those folks still have something off, but generally they are aware of the fact that the delsuions are a symptom.
That has not been my professional experience. They can be helped to realize their delusions aren't real as they gain insight, but in most cases their inclination is to believe the paranoia or to question the validity (is this real or symptomatic?) For a teenager, insight into schizophrenia is going to take a while and lots of treatment, trials and errors of going off meds. Even getting the right initial dosages can take a long time. With auditory hallucinations you might see the person quickly turn his head as if to see where the voice is coming from- at that point they may realize they are having a delusion if they are high functioning, but they will initially respond. With visual hallucinations the same thing.

Wiskel
02-28-2011, 04:20 AM
When you have schizophrenia, is it something that permeates every minute of every day, or is it like bipolar, where you can have an episode, then be symptom-free for months before having another episode?



Schizophrenia is a collection of symptoms. Some are what are termed "positive symptoms" and some "negative symptoms". Positive symptoms are generally experiences that you have when psychotic that you don't have when well - Hallucinations, delusions, paranoia, ideas of reference (e.g. thinking that the tv is talking directly about you). Negative symptoms are things that are harder to do when psychotic - concentrate, think clearly, take in what's happening around you.

People tend to think of the positive symptoms when thinking about the illness. Voices and visions tend to come and go. When ill, they may well be there every day, but probably not every minute of every day (although they could). Delusions tend to always be there but if you're doing something to take your mind off them then, by definition, you're taking your mind off them. This is sometimes harder and sometimes easier. If you think you best friend is a vampire then you will be thinking a lot about that in his company and at night, but maybe a little less when he isn't there in broad daylight. If you think you're being followed then people can follow you wherever you are. Paranoia tends to be "always on" when unwell but up and down a little, and ideas of reference happen when they happen.

The negative symptoms tend to be pervasive. Just like you won't be able to run if you have a broken leg, you won't be able to magically improve concentration or clarity of thinking if they're impaired.

Then throw in medication side effects - sedation, muscle stiffness. Generally, if you get them and you continue taking medication then you get used to them a bit but they usually manage to have some impact on functioning.

There's also an informal rule of thirds. Roughly a third of people will have one episode of psychosis and then get well and remain well. Roughly one thrid will get completely well between episodes of illness but continue to have relapses. Roughly one third will either slowly deteriorate or manage to get well between serious periods of illness, but lose a little more functioning every time and so slowly go downhill in stages.





Would it be realistic for this character to start "slipping" (having paranoid thoughts, etc) after a few months of relative stability, but then successfully pull himself out of it by taking his meds?



More than realistic. Almost the norm, although it's unlikely that his medication would have been stopped by his doctor, and generally when people are ill, they go the other way and resist taking their medication more. It's generally easier to get someone who is at the beginning of a relapse to take medication then someone who's more unwell.

Craig

backslashbaby
02-28-2011, 05:21 AM
That has not been my professional experience. They can be helped to realize their delusions aren't real as they gain insight, but in most cases their inclination is to believe the paranoia or to question the validity (is this real or symptomatic?) For a teenager, insight into schizophrenia is going to take a while and lots of treatment, trials and errors of going off meds. Even getting the right initial dosages can take a long time. With auditory hallucinations you might see the person quickly turn his head as if to see where the voice is coming from- at that point they may realize they are having a delusion if they are high functioning, but they will initially respond. With visual hallucinations the same thing.

Oh, definitely those folks have been in therapy a very long time for their illnesses. My phrasing probably made it sound easier than it must have been/be for them. Even with all of that, and the meds working to such a great extent, you can tell they still face so much a healthy person doesn't. They don't really believe the delusions aren't real, but they trust that they should believe it, if that makes any sense. Some days nobody could make them start to believe it (again).

PinkAmy
02-28-2011, 07:25 PM
Oh, definitely those folks have been in therapy a very long time for their illnesses. My phrasing probably made it sound easier than it must have been/be for them. Even with all of that, and the meds working to such a great extent, you can tell they still face so much a healthy person doesn't. They don't really believe the delusions aren't real, but they trust that they should believe it, if that makes any sense. Some days nobody could make them start to believe it (again).

Yes. The have to face a lot, including that some of the newer meds can cause liver damage so they might have to stop using a med that has been help and not have a comparable alternative due to health concerns. I feel very sorry for anyone who has to deal with this and equally as sorry for parents, siblings, and (hopefully not) children of these folks.

veinglory
02-28-2011, 07:30 PM
I worked for a while at a schizophrenia drop in centre and I must say that some of the pop-ins seemed completely normal to me when I saw them in the context or bumped into them at other time. We had one case who had one acute break in his twenties and eventually went off meds with the support of his psychiatrist and functioned normally--he was a volunteer not a participant. You could argue he was schizotypal not actually schiozophrenic but it was his diagnosis at the time.

Wiskel
03-01-2011, 11:49 AM
I worked for a while at a schizophrenia drop in centre and I must say that some of the pop-ins seemed completely normal to me when I saw them in the context or bumped into them at other time. We had one case who had one acute break in his twenties and eventually went off meds with the support of his psychiatrist and functioned normally--he was a volunteer not a participant. You could argue he was schizotypal not actually schiozophrenic but it was his diagnosis at the time.

The problem with asking about "schizophrenia" is that the very term implies someone has had either a number of psychotic episodes or that they've never got fully better from the first.

Schizophrenia is a psychotic illness, not all psychotic illness is schizophrenia. If you meet someone who has had one or two psychotic episodes but regained full functioning afterwards you might never know it unless they tell you.

Most psychiatrists wouln't dream of using the term until someone had had a few periods of illness. until then someone would have had a psychotic illness.

Craig

PinkAmy
03-01-2011, 09:00 PM
Schizophrenia is a psychotic illness, not all psychotic illness is schizophrenia. If you meet someone who has had one or two psychotic episodes but regained full functioning afterwards you might never know it unless they tell you.

Right- a young person isn't just going to be slapped with the label schizophrenia because of one episode.
Piggy-backing on this-
severe bi-polar disorder can have a psychotic element during manic episodes,
schizoaffective disorder is schizophrenia with a mood disorder like depression/anxiety
psychotic disorders NOS (not otherwise specified)
some physical illnesses can cause psychosis (brain injury or tumors on certain parts of the brain)
some folks experience psychosis following drug use as vein said or withdrawing from drug use.

boletusedulis
03-02-2011, 10:43 AM
Most psychiatrists wouln't dream of using the term until someone had had a few periods of illness. until then someone would have had a psychotic illness.

Craig

This is the missing link! I know my character has only had one psychotic episode, but I didn't know the right word for that. I think I'll stay away from the word "schizophrenia" then, especially since the character is young.

I've been doing lots more research and am really glad I asked before going ahead with my revisions. This has been very helpful. Thanks everyone!