Posted by Quintal on June 8, 2007, at 11:30:31
In reply to Re: Shades of Grey?, posted by linkadge on June 7, 2007, at 19:27:20
Certainly I think people who have psychotic disorders should have a say in their treatment (or lack thereof), but I've found through experience that there's sometimes a need for enforced medication and/or hospitalisation during crises. I looked after a friend who has Schizophrenia while her parents were away and it was a harrowing experience.
My friend started having paranoid delusions about her parents - that they'd been keeping her son (who died when she was 18) in hiding from her while conspiring with doctors to feign the death because they thought she was an unfit mother. There were many variations on this theme and most of the time she was incoherent and inconsolable with grief and rage. It was during one of these rages that she slammed her fist into a photo of her mother cutting herself badly. In the end I had to ring the doctor and ask for his advice because I couldn't cope any more after a few days with hardly any sleep (she kept doing other dangerous things like leaving the house in the night, and she had a habit of lying down in the road near where she lives - ostensibly because she could hear the breathing of a dying animal in the Earth, but I suspect she knew the risk and was trying to attempt suicide). Anyway, the doctor called an ambulance and we managed to get her into hospital under the premise of treating the injured hand, but of course she was kept under suicide watch on the psychiatric ward once she got there.
That was about three years ago and after that episode she was Zyprexa for a while. Last summer she gave birth to a baby girl after being medication free for a year (though she did have a relapse during the pregnancy). She seems to be doing fine now as a full-time mother without medication. Maybe she really needed the distraction and focus of having a child to fill the void left by the one she lost all along? It was never fully concluded whether she had Schizophrenia or recurring psychotic depression triggered by the loss of her first child, but when pressed her psychiatrist diagnosed Paranoid Schizophrenia. Things aren't that simple though.
She was shocked and remorseful about her behaviour during the psychotic episode, and agreed she did need to be hospitalised for her own safety. I think she actually was frightened by how she lost control of her mind and the risks she'd taken. So on that basis I think medication during a crisis helps the patient and the family cope (they also used large doses of lorazepam, not just Zyprexa, to calm her because she was so afraid and I think that really gave her some comfort). To me, simply letting people in my friend's position have complete freedom in their actions could amount to neglect. For example, would it be wise to allow an elderly relative who had senile dementia to wander the streets and roads alone at night if they so wished, out of respect for their personal freedom? Which should we respect more - their right to act on their own volition or their right to safety and care? That's what I mean when I say people who have psychotic disorders are more vulnerable and the decision to discontinue their meds needs extra care than the depressive who has never had a psychotic episode or attempted suicide.
I agree that while antipsychotic medication controls symptoms during a crisis, it usually prevents a full recovery when taken long-term. That's why I think it's important to allow people with psychotic disorders to come off medication if that seems prudent with regards to their history, circumstances and environment.
Q
poster:Quintal
thread:761591
URL: http://www.dr-bob.org/babble/20070604/msgs/761833.html