What can you tell me about psychosis? in young people?

[Melissa Louise]

Someone (not in my family) needed help last night when a young person with mental health needs escalating over the last month  went missing. 

They later returned but were exhibiting extreme agitation, hallucinations, grandiosity, aggression, and delusions. It was the first time I had observed the yp since he became unwell, because of Covid. It was pretty confronting. 

The person I was helping was like a frog in a boiling pot, because it turns out she's been dealing with this intensity of symptoms for days. I had concerns for safety of everyone in the house. Young person was eventually admitted to hospital. 

99% sure no drugs involved.

I know a lot about mental health here but nothing about this type of illness. 

Speaking generally, what might my friend expect to happen from here with a loved one with that type of presentation? 

 

 

[freesia]

Oh, no! I’m so sorry. I don’t really have an answer, although schizophrenia comes to mind, but I’m not an expert. I hope your friend and the young person get all the help they need. 

[Drama Llama]

.  . . 

Edited October 28, 2021 by Nothingtoseehere

[Melissa Louise]

4 minutes ago, BaseballandHockey said:

I don’t know a huge amount, but I do know that aggressively treating a “first episode” of psychosis produces much better results than waiting and seeing.  Here in the US there are programs targeted at identifying people early in their first episode and getting them onto meds fast. 

So the fact that he is admitted is probably a good thing.

That's good to know. Makes me feel better about strongly encouraging friend to get the ambulance out. 

[PeterPan]

1 hour ago, Melissa Louise said:

unwell, because of Covid.

Covid delirium and covid psychosis do happen. https://www.biausa.org/public-affairs/public-awareness/news/biaa-issues-guidance-on-covid-19-vaccines-for-persons-with-brain-injury  This is a site for brain injury, but the idea is still the same with the inflammation targeting the weakest point. 

Also, if the person already had that chemistry bent (toward schizophrenia, bipolar, etc.) they could add to it the chemistry imbalances that occur when sick. My ds is typically more dangerous with ANY bug/virus/illness at first and then as the fevers fully kick in it passes and he chills out (which is also a chemistry thing). 

So yes they made the right call transporting. Safety is always the right call.

Fwiw, the person I know who developed covid delirium has improved as their covid has improved. So I think she could hold out hope that the person will return to close to their baseline as they heal from the covid. I'm sure the doctors will have an opinion on that. 

Edited August 31, 2021 by PeterPan

[ktgrok]

I had a friend in highschool who had an episode like that - she was diagnosed bipolar. Since then I've known other bipolar people to act like that when off meds too long. 

[TheReader]

I keep coming back to this, although I don't have a lot of answers, at all, but just wanted to say medications can help, the hospitalization will absolutely suck horribly for the parents, even if it ends up being the right thing for the young person (and maybe moreso now with covid rules about visiting and all), and if you can support this person (the parents) in any way during -- meals, a listening ear, dropping off groceries, anything at all that says "you are not alone and forgotten, and I know this is hella scary, and all kinds of stigma, and sucks beyond anything ever imagined, but I am here and you are not alone" then that would be amazing. 

I was pretty open when our son ended up in the hospital the January before Covid hit, and his issues weren't this, but that word was tossed around and all I know is it was the most terrifying thing I've gone through in my life ever. And I'm still a little shell shocked, even though he's improving.  In his case, "so much better" is still not "how he was Before" but I don't know if that's normal, or odd, or ??? I don't know enough to have any kind of clue about that. So much better is pretty good, though. 20 months ago, I didn't know what his future would ever hold. Now he's taking a full load at the community college again, and only has to speak to his doctor every 60 days.

Anyway, I just mostly wanted to say I'm very sorry for this young person, and your friend, and will say a prayer for them all. It's a hard and lonely thing. That much I do know. 

[GoodGrief3]

That's so difficult. Hard to know what the process might be, as it can vary depending on community resources. Hopefully hospitalization will be a vailable while they firm up the diagnosis and (likely) meds. Schizophrenia commonly presents in the late teen/young adult years. To help, I'd probably focus on immediate physical needs for the family while they are coping with this, and helping to identify community support resources.

[Jean in Newcastle]

Was the hospital admission voluntary?  In the US an involuntary hold has very strict standards. It’s so much easier if it’s voluntary. I would expect that the first thing that they will do is to find the right medications and the right dosage. (And the first thing I thought of was a manic episode- part of a bipolar diagnosis). 

[Katy]

IDK how your mental health system works, but if possible have them run an autoimmune panel immediately.  There are autoimmune conditions that attack the brain, are totally reversible with an immediate course of steroids, but create lifelong conditions if not caught within days or weeks. One of the doctors in my extended family studied this for a while.  It's particularly common in young women.

[Melissa Louise]

1 hour ago, Jean in Newcastle said:

Was the hospital admission voluntary?  In the US an involuntary hold has very strict standards. It’s so much easier if it’s voluntary. I would expect that the first thing that they will do is to find the right medications and the right dosage. (And the first thing I thought of was a manic episode- part of a bipolar diagnosis). 

No. Not voluntary. 

[SeaConquest]

As I recall, you are not in the US, so I don't know what your laws are. Here, a person would be brought in on an involuntary hold for a short period (in CA, it is up to 72 hours for the first hold). First, we triage the patient to see if there are any underlying medical issues that could be causing the psychiatric issue. If medical issues are ruled out, then they would see the psychiatrist for an evaluation. From the little you described, it sounds like schizoaffective disorder, which is sorta like bipolar with psychotic symptoms of schizophrenia mixed in. The differential from bipolar is that, with bipolar, you do not lose touch with reality (ie there are no psychotic symptoms like delusions, hallucinations, etc.).

Recognizing that I am a not a provider, typically, a person with that dx would be given an antipsychotic medication, perhaps a mood stabilizer as well to calm the mania, and usually something to get the immediate symptoms under control. We use a lot of Haldol, Ativan, and Benedryl combo in our emergency psych unit to stabilize patients and then switch to scheduled medications longer term if they are admitted beyond 24 hours. Normally, we try to get patients to take these medications orally. If they are violent, worst case scenario, we are forced to restrain them as a last resort and give them injections. Obviously, we do everything we can to avoid that.

We also swab them for Covid, for females we check for pregnancy, a breathalyzer, and we also run a urinary drug screen to see if the symptoms could be drug related (our panel covers A LOT of different drugs). Then, they are moved to their room and we try to get them to chill. Psych is mostly about therapeutic communication, so we have social workers that round, physicians, special program coordinators to put people in touch with community resources, and obviously psych nurses check vitals, administer meds, and work with the patients to try to get them stabilized to either discharge them back to their home or families (connected with meds and next-day follow up appointments) or, if they need more treatment, we move them to our inpatient units for the remainder of their hold.

If they need additional treatment at the end of the hold, there would be a court hearing and the physician would testify as to why the patient needs to stay longer (danger to self/danger to others/gravely disabled). The patient has the right to a patient representative and can appeal the ruling with a writ of habeas corpus, which would enable them to have a public defender represent them in Superior Court. This continues all the way until something called a permanent conservatorship (a la Britney Spears), where the patient essentially would lose all of their rights to make their medical decisions. This is usually reserved for patients who are generally too ill to be out in the community and simply cannot be placed in any facility (too violent, completely unable to function, etc.)

Most people do not even get close to this level. They come on a hold and are gone within 24-72 hours. Often people become frequent flyers at our facility because they do not go to their appointments and do not take their meds. It's completely possible to have a full and normal life with that diagnosis, but you need to follow the treatment plan, have support, and take your meds. I am happy to answer any questions that I can. Sending much love.  

[ktgrok]

My understanding (and experience with multiple people) is that bipolar CAN have manic episodes with hallucinations/psychosis, if they are not sleeping.I've known two people who had it happen. One was waving and talking to people that were not there. Both were spouting weird conspiracy theories, talking about the people out to get them, etc.  https://www.healthline.com/health/bipolar-disorder/bipolar-psychosis#symptoms

[Jean in Newcastle]

46 minutes ago, ktgrok said:

My understanding (and experience with multiple people) is that bipolar CAN have manic episodes with hallucinations/psychosis, if they are not sleeping.I've known two people who had it happen. One was waving and talking to people that were not there. Both were spouting weird conspiracy theories, talking about the people out to get them, etc.  https://www.healthline.com/health/bipolar-disorder/bipolar-psychosis#symptoms

My experience as well. 

[EKS]

1 hour ago, ktgrok said:

My understanding (and experience with multiple people) is that bipolar CAN have manic episodes with hallucinations/psychosis, if they are not sleeping.

There is also something called schizoaffective disorder that is like a combination between bipolar and schizophrenia.  I had a friend who had it, and it originally presented with the symptoms in the OP's post when he was 19yo.

[Melissa Louise]

3 hours ago, SeaConquest said:

As I recall, you are not in the US, so I don't know what your laws are. Here, a person would be brought in on an involuntary hold for a short period (in CA, it is up to 72 hours for the first hold). First, we triage the patient to see if there are any underlying medical issues that could be causing the psychiatric issue. If medical issues are ruled out, then they would see the psychiatrist for an evaluation. From the little you described, it sounds like schizoaffective disorder, which is sorta like bipolar with psychotic symptoms of schizophrenia mixed in. The differential from bipolar is that, with bipolar, you do not lose touch with reality (ie there are no psychotic symptoms like delusions, hallucinations, etc.).

Recognizing that I am a not a provider, typically, a person with that dx would be given an antipsychotic medication, perhaps a mood stabilizer as well to calm the mania, and usually something to get the immediate symptoms under control. We use a lot of Haldol, Ativan, and Benedryl combo in our emergency psych unit to stabilize patients and then switch to scheduled medications longer term if they are admitted beyond 24 hours. Normally, we try to get patients to take these medications orally. If they are violent, worst case scenario, we are forced to restrain them as a last resort and give them injections. Obviously, we do everything we can to avoid that.

We also swab them for Covid, for females we check for pregnancy, a breathalyzer, and we also run a urinary drug screen to see if the symptoms could be drug related (our panel covers A LOT of different drugs). Then, they are moved to their room and we try to get them to chill. Psych is mostly about therapeutic communication, so we have social workers that round, physicians, special program coordinators to put people in touch with community resources, and obviously psych nurses check vitals, administer meds, and work with the patients to try to get them stabilized to either discharge them back to their home or families (connected with meds and next-day follow up appointments) or, if they need more treatment, we move them to our inpatient units for the remainder of their hold.

If they need additional treatment at the end of the hold, there would be a court hearing and the physician would testify as to why the patient needs to stay longer (danger to self/danger to others/gravely disabled). The patient has the right to a patient representative and can appeal the ruling with a writ of habeas corpus, which would enable them to have a public defender represent them in Superior Court. This continues all the way until something called a permanent conservatorship (a la Britney Spears), where the patient essentially would lose all of their rights to make their medical decisions. This is usually reserved for patients who are generally too ill to be out in the community and simply cannot be placed in any facility (too violent, completely unable to function, etc.)

Most people do not even get close to this level. They come on a hold and are gone within 24-72 hours. Often people become frequent flyers at our facility because they do not go to their appointments and do not take their meds. It's completely possible to have a full and normal life with that diagnosis, but you need to follow the treatment plan, have support, and take your meds. I am happy to answer any questions that I can. Sending much love.  

Thanks, this is very helpful to understand the ways in which a patient like this might be medicated. 

My dd has been involuntary once, so I kinda have some experience of that. I'm having a bit of trouble being triggered by this incident with the friend's son reminding me of our trauma around that. 

Helpfully, I also know the facility he's being transferred to from ED, once a bed opens up, from dd being there a couple of times, so I've been able to reassure my friend on that score (it's a good place). I suspect they'll keep him for a week or more. 

I assume he's had bloods done in ED. They were keeping him pretty sedated in ED last I heard. 

You might be able to answer this question - is it normal for a non-health care person to find the unwell person frightening? I was very frightened by the incident, though I was able to remain calm throughout. 

I feel bad about it. 

[TheReader]

3 minutes ago, Melissa Louise said:

Thanks, this is very helpful to understand the ways in which a patient like this might be medicated. 

My dd has been involuntary once, so I kinda have some experience of that. I'm having a bit of trouble being triggered by this incident with the friend's son reminding me of our trauma around that. 

Helpfully, I also know the facility he's being transferred to from ED, once a bed opens up, from dd being there a couple of times, so I've been able to reassure my friend on that score (it's a good place). I suspect they'll keep him for a week or more. 

I assume he's had bloods done in ED. They were keeping him pretty sedated in ED last I heard. 

You might be able to answer this question - is it normal for a non-health care person to find the unwell person frightening? I was very frightened by the incident, though I was able to remain calm throughout. 

I feel bad about it. 

re: your question.....don't feel bad at all. Yes, it's very very normal I would think. I have been, at a few times, frightened by my son. Not completely in a "he's going to hurt me" way, he's never had that kind of episode, thankfully, but in a "this is scary, what is happening" kind of way.  I would easily be afraid of him if he were acting violently due to a delusion or hallucination like you described. And I'm his mom. 

Completely normal reaction. And a million more hugs to you being triggered by this; I'm sorry you are familiar with the treatment facility as well. 

 

[Drama Llama]

...

Edited October 28, 2021 by Nothingtoseehere

[SeaConquest]

As the others have said, it's completely normal. Psychosis IS scary, not only for the people around the person, but very often for the person experiencing it. We often forget that part. People can be experiencing command hallucinations where voices are literally taking over their minds and telling them to do things that a part of them doesn't want to do. They can no longer distinguish reality. Imagine how frightening that would be for you if that happened to your mind. Or if you suddenly became paranoid to the point that you literally believed a delusion like your mother is trying to poison you. It's extremely scary, so I try to be a comfort to my patients while also protecting myself. It's a very fine balance, and I am used to psychosis, so it doesn't affect me as much (though things can still be hairy and I have been injured before). But, in the beginning? Heck yeah! It's extremely frightening to see a loved one or random person going through that as a layperson who has little to no experience with it. Please do not beat yourself up. At my hospital, we literally have techs who come for orientation and just leave after their first break. Just disappear. Psych is definitely not for everyone. 

ETA: Most of the people that work in psych (and want to be here) have some connection to psych. Either a family member or their own lived experience that draws them to the field. It's definitely a difficult field with a lot of residual stigma because it's only recently that we've really begun to talk about these issues. Historically, most people with psych issues were sent to asylums to be lobotomized or just locked away. 

Edited September 2, 2021 by SeaConquest

[ktgrok]

2 hours ago, Melissa Louise said:

Thanks, this is very helpful to understand the ways in which a patient like this might be medicated. 

My dd has been involuntary once, so I kinda have some experience of that. I'm having a bit of trouble being triggered by this incident with the friend's son reminding me of our trauma around that. 

Helpfully, I also know the facility he's being transferred to from ED, once a bed opens up, from dd being there a couple of times, so I've been able to reassure my friend on that score (it's a good place). I suspect they'll keep him for a week or more. 

I assume he's had bloods done in ED. They were keeping him pretty sedated in ED last I heard. 

You might be able to answer this question - is it normal for a non-health care person to find the unwell person frightening? I was very frightened by the incident, though I was able to remain calm throughout. 

I feel bad about it. 

Totally normal. I mean, on a primal level your brain is recognizing that his person is not acting right, and is potentially dangerous. You may logically KNOW they are not posessed or infectious or whatever...but that primal protective instinct is to flee. That's normal.