ISO info on psychosis in late teens/early 20s.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The questions I would ask your cousin:
1. Did this seem to come on quickly?
2. What was happening in the days before? Any unusual behaviors, colds, etc?
3. Did they do a spinal tap and an mri to check for inflammation in the brain and spinal fluid?

My daughter has autoimmune encephalitis. It's relatively new but its symptoms mirror many of schizophrenia. Anti-NMDA is one type of AE. There are many others and most don't have an identified antibody, so ruling it out can be tough. But I would at least do some research and mention it to the drs.

"AIE commonly presents as new onset of memory loss, psychosis, altered mental status, or seizures, with the presentation taking place over a few weeks to three months. AIE involves several parts of the nervous system, including the limbic system, the spinal cord, and/or the entire neuraxis. AIE can be confirmed by multiple modalities, including laboratory testing (antibody detection), neuroimaging, and electrophysiological studies (electroencephalogram)."

https://www.ncbi.nlm.nih.gov/books/NBK578203/#:~:text=AIE%20commonly%20presents%20as%20new,and%2For%20the%20entire%20neuraxis.

Did your DD have any symptoms for the encephalitis?

Yes, seemed to come on quickly. Cousin said her DD was a little hyper/manic in the weeks leading up but not with grandiose thoughts. Don't think she mentioned colds. Her DD doesn't have any physical ailments now or not that she is mentioning.

All best to your DD.

She had mania and hallucinations a few weeks before. And irritability. And was sleeping poorly.
At the very least, your sister should request either an mri or catscan to check for brain inflammation and/or a spinal tap to see if there are signs of infection or inflammation, ESPECIALLY if this is her first episode. I believe someone posted this link earlier, but please forward it to your sister. https://www.washingtonpost.com/wellness/2023/06/01/schizophrenia-autoimmune-lupus-psychiatry/

TY!

[Anonymous]

Has she been using marijuana? This increases possibility of psychosis.

Next look into brain inflammation, look up PANDAS. Schizophrenia doesn't usually pop up in a weekend. There is a decline in functioning and paranoia before it occurs.

[Anonymous]

Anonymous wrote:

Anonymous wrote:If this came on over the course of weeks definitely needs anti-nmda receptor (and other autoimmune encephalitis) work up. The typical course for schizophrenia is more indolent, though bipolar can certainly present as he emergence of mania seemingly out of the blue. Is there a family history of bipolar or schizophrenia?

According to cousin, came on over a weekend with no real indicators. What do you mean by indolent regarding schizophrenia?

Family history of depression, maybe some hypomania, but no meds for that (only for the depression).

DP. FWIW, in a person who is bipolar, treatment for general
depression with an antidepressant can trigger or worsen the bipolar. It is not uncommon that a person who is truly bipolar presents as someone who with (unipolar) depression because the depression is obvious to the patient and family - they are down and withdrawn - whereas the mania feels good, like they are doing well, energized, excited, full of plans, etc. This is particularly true where the "mania" is not "frank mania" ( the kind of mania where one is clearly disconnected from reality) and is instead "hypomania" which is mot disconnected from reality but nonetheless the person needs less sleep, is more active, a bit grandiose or paranoid, etc. The bipolar with frank mania is "Bipolar I" and bipolar with hypomania is "Bipolar II".

My MIL had Bipolar (not sure of type) and she had psychosis at times - in mania psychosis could appear as paranoia. In depression she had catatonic psychosis.

My now ex DH had bipolar II with periods of hypomania, misdiagnosed as depression and experienced the worsening mania exacerbated by mis-prescribed anti-depressant. This type of anti-depressant triggered many can include psychosis (although it didn't in my ex DH's case).

By contrast, schizophrenia usually has a period where the patient becomes more withdrawn, "flatter" emotionally and only later experiencing psychosis.

NIMH has a website with good descriptions of schizophrenia and bipolar depression. https://www.nimh.nih.gov/health/topics/schizophrenia

Not make it even more confusing but I know people diagnosed as "bipolar with schizoaffective disorder" which broadly speaking is schizophrenia combined with elements of mood disorder.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I’m very sorry your family is having to deal with this. They will probably want to do a full neuropsych test to help with a diagnosis. Generally, I think the earlier they catch these disorders, the better the prognosis - you might look up first time psychosis programs. If she needs to go to residential treatment you might want to Google around to find which ones around here have the best reputation. ERs often have to just send teens to wherever there is an empty bed - try to see if you can get her in to a good one. It’s good your cousin can talk to you, these situations can be so isolating. You’re doing great helping her out by researching for her.

curious on why you suggest neuropsych. my ds has done them and we learned about his ADHD, but cousin has never mentioned this for her dd.

DP - one who is a mental health professional - a lot of people not in the field don’t realize that neuropsych testing is used primarily for assessing cognitive abilities. In children, that’s mostly around learning disorders/disabilities and ADHD. In adults, it’s mostly used to assess potential dementia, memory loss, etc. Rarely are they conducted as part of a comprehensive psychiatric diagnostic process. It would be close to worthless (and, frankly, cruel) for someone who is floridly psychotic, although once the psychosis has remitted, could be helpful in identifying any related cognitive concerns. Same with mania: you can’t conduct a valid neuropsych battery in someone who is actively manic.

[Anonymous]

TY to (nearly) everyone who weighed in here - really appreciate your insights, questions, and suggestions as does my cousin.

The last few days have seen some improvement and we are all praying for continued progress.

[Anonymous]

Anonymous wrote:TY to (nearly) everyone who weighed in here - really appreciate your insights, questions, and suggestions as does my cousin.

The last few days have seen some improvement and we are all praying for continued progress.

PP directly above you - you’re welcome and good luck. I was thinking about your niece and wanted to check back in. I’m glad there’s been some improvement. We know a lot now about how to support people with serious mental illness (if that’s what it is), so there’s reason to hope. Sending good wishes for the best possible outcome!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Cousin just called and told us that her DD/our niece has been admitted to a psych ER - has been there for a few days. While the diagnosis is not conclusive, cousin is sharing that the doctors on duty are talking about psychotic disorder, schizophrenia, etc. We are close - more like siblings - and she is asking me to find out anything I can. Have come to this forum for other questions as folks here tend to be more gentle as well as helpful. I would appreciate any information people can share. Cousin told me they are doing tests, but sounds like they do not think this is a drug-induced psychosis as of now.

TIA.

Late teens and 20s are a common time for schizophrenia diagnosis. I am not sure what state your family member is in but some states have increasingly focused on creating supports specific to "first episode psychosis" because it is thought that psychosis causes some damage to the brain that "kindles" further episodes. Early treatment is key.

Here is an example in Maryland of a "First Episode" Clinic -

https://www.mprc.umaryland.edu/Clinical-Care/First-Episode-Clinic/

You might want to have your family member ask about this kind of resource in their state.

Also, I don't know the age of the niece, but if she is in school, the IEP or 504 process can be used to help her while she is recovering and finding proper treatment.

If you want to know more about schizophrenia, Ellyn Saks has written a good memoir about her experience of the illness.

TY!

I see you mentioned she is 19 - so I want to adjust what I wrote - IEP and 504 processes only apply to public schools up to 12 th grade. BUT, private schools at any grade or colleges and universities must accommodate (under the ADA) serious illnesses like schizophrenia, which are considered long term disabilities even when well-treated because sudden relapse is possible.

If your niece is in college, her family can contact the Office of Disabilities and ask to meet with someone who can help explain what the process is for notifying professors she is ill, providing information about how to and by what dates request to withdraw, request incompletes or extensions on work. Schools (like Yale and some other Ivies) sometimes have unfair, discriminatory policies about re-admitting students

If the family bought "tuition insurance", they need to read the plan carefully and see if new onset mental illness is covered (it is on our university's plan).

I know it seems like it might create pressure to refer to school, but IME, kids really feel like this kind of mental health crisis is destroying their perception of what their life could be, which is a huge stressor. Parents can also be under financial pressure because losing a semester's worth of tuition can be a huge financial burden.

Finally, even without a signed healthcare form or school release form, you can sometimes navigate "consent" issues. Consent doesn't have to be a particular signed form (although that's helpful). A good healthcare worker can often frame an oral question to the patient in a way that encourages them to provide oral consent. Schools have to tell you about process even if they can't tell you about a particular child. School websites for the disability and registrar's office often have a lot of good information about these policies.

I know it's not the point of this post, but Yale finally caved to alumni pressure & now kids who voluntarily withdraw for mental health reasons have automatic readmission rights!

[Anonymous]

Anonymous wrote:

Anonymous wrote:TY to (nearly) everyone who weighed in here - really appreciate your insights, questions, and suggestions as does my cousin.

The last few days have seen some improvement and we are all praying for continued progress.

PP directly above you - you’re welcome and good luck. I was thinking about your niece and wanted to check back in. I’m glad there’s been some improvement. We know a lot now about how to support people with serious mental illness (if that’s what it is), so there’s reason to hope. Sending good wishes for the best possible outcome!

TY for checking back in. Reports today are the best ever and continue to keep up hope!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Cousin just called and told us that her DD/our niece has been admitted to a psych ER - has been there for a few days. While the diagnosis is not conclusive, cousin is sharing that the doctors on duty are talking about psychotic disorder, schizophrenia, etc. We are close - more like siblings - and she is asking me to find out anything I can. Have come to this forum for other questions as folks here tend to be more gentle as well as helpful. I would appreciate any information people can share. Cousin told me they are doing tests, but sounds like they do not think this is a drug-induced psychosis as of now.

TIA.

Late teens and 20s are a common time for schizophrenia diagnosis. I am not sure what state your family member is in but some states have increasingly focused on creating supports specific to "first episode psychosis" because it is thought that psychosis causes some damage to the brain that "kindles" further episodes. Early treatment is key.

Here is an example in Maryland of a "First Episode" Clinic -

https://www.mprc.umaryland.edu/Clinical-Care/First-Episode-Clinic/

You might want to have your family member ask about this kind of resource in their state.

Also, I don't know the age of the niece, but if she is in school, the IEP or 504 process can be used to help her while she is recovering and finding proper treatment.

If you want to know more about schizophrenia, Ellyn Saks has written a good memoir about her experience of the illness.

TY!

I see you mentioned she is 19 - so I want to adjust what I wrote - IEP and 504 processes only apply to public schools up to 12 th grade. BUT, private schools at any grade or colleges and universities must accommodate (under the ADA) serious illnesses like schizophrenia, which are considered long term disabilities even when well-treated because sudden relapse is possible.

If your niece is in college, her family can contact the Office of Disabilities and ask to meet with someone who can help explain what the process is for notifying professors she is ill, providing information about how to and by what dates request to withdraw, request incompletes or extensions on work. Schools (like Yale and some other Ivies) sometimes have unfair, discriminatory policies about re-admitting students

If the family bought "tuition insurance", they need to read the plan carefully and see if new onset mental illness is covered (it is on our university's plan).

I know it seems like it might create pressure to refer to school, but IME, kids really feel like this kind of mental health crisis is destroying their perception of what their life could be, which is a huge stressor. Parents can also be under financial pressure because losing a semester's worth of tuition can be a huge financial burden.

Finally, even without a signed healthcare form or school release form, you can sometimes navigate "consent" issues. Consent doesn't have to be a particular signed form (although that's helpful). A good healthcare worker can often frame an oral question to the patient in a way that encourages them to provide oral consent. Schools have to tell you about process even if they can't tell you about a particular child. School websites for the disability and registrar's office often have a lot of good information about these policies.

I know it's not the point of this post, but Yale finally caved to alumni pressure & now kids who voluntarily withdraw for mental health reasons have automatic readmission rights!

That's so terrible that it took Yale so long when many top schools have readmit rights if student able to demonstrate, in concert with mental health professionals, a plan for return.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Cousin just called and told us that her DD/our niece has been admitted to a psych ER - has been there for a few days. While the diagnosis is not conclusive, cousin is sharing that the doctors on duty are talking about psychotic disorder, schizophrenia, etc. We are close - more like siblings - and she is asking me to find out anything I can. Have come to this forum for other questions as folks here tend to be more gentle as well as helpful. I would appreciate any information people can share. Cousin told me they are doing tests, but sounds like they do not think this is a drug-induced psychosis as of now.

TIA.

Late teens and 20s are a common time for schizophrenia diagnosis. I am not sure what state your family member is in but some states have increasingly focused on creating supports specific to "first episode psychosis" because it is thought that psychosis causes some damage to the brain that "kindles" further episodes. Early treatment is key.

Here is an example in Maryland of a "First Episode" Clinic -

https://www.mprc.umaryland.edu/Clinical-Care/First-Episode-Clinic/

You might want to have your family member ask about this kind of resource in their state.

Also, I don't know the age of the niece, but if she is in school, the IEP or 504 process can be used to help her while she is recovering and finding proper treatment.

If you want to know more about schizophrenia, Ellyn Saks has written a good memoir about her experience of the illness.

TY!

I see you mentioned she is 19 - so I want to adjust what I wrote - IEP and 504 processes only apply to public schools up to 12 th grade. BUT, private schools at any grade or colleges and universities must accommodate (under the ADA) serious illnesses like schizophrenia, which are considered long term disabilities even when well-treated because sudden relapse is possible.

If your niece is in college, her family can contact the Office of Disabilities and ask to meet with someone who can help explain what the process is for notifying professors she is ill, providing information about how to and by what dates request to withdraw, request incompletes or extensions on work. Schools (like Yale and some other Ivies) sometimes have unfair, discriminatory policies about re-admitting students

If the family bought "tuition insurance", they need to read the plan carefully and see if new onset mental illness is covered (it is on our university's plan).

I know it seems like it might create pressure to refer to school, but IME, kids really feel like this kind of mental health crisis is destroying their perception of what their life could be, which is a huge stressor. Parents can also be under financial pressure because losing a semester's worth of tuition can be a huge financial burden.

Finally, even without a signed healthcare form or school release form, you can sometimes navigate "consent" issues. Consent doesn't have to be a particular signed form (although that's helpful). A good healthcare worker can often frame an oral question to the patient in a way that encourages them to provide oral consent. Schools have to tell you about process even if they can't tell you about a particular child. School websites for the disability and registrar's office often have a lot of good information about these policies.

I know it's not the point of this post, but Yale finally caved to alumni pressure & now kids who voluntarily withdraw for mental health reasons have automatic readmission rights!

That's so terrible that it took Yale so long when many top schools have readmit rights if student able to demonstrate, in concert with mental health professionals, a plan for return.

I think most of the mental health community has very little understanding of chronic, severe mental health issues. The patient may say they’re ok, and todays too agreeable therapists will follow the patients wishes. But some bipolar and schizophrenic students will never return to the original mental state. Current drugs don’t cure mental illnesses, only cover up a few of the symptoms. I think a long break is needed for severe cases.

[Anonymous]

As others have said, definitely reach out to NAMI .

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Cousin just called and told us that her DD/our niece has been admitted to a psych ER - has been there for a few days. While the diagnosis is not conclusive, cousin is sharing that the doctors on duty are talking about psychotic disorder, schizophrenia, etc. We are close - more like siblings - and she is asking me to find out anything I can. Have come to this forum for other questions as folks here tend to be more gentle as well as helpful. I would appreciate any information people can share. Cousin told me they are doing tests, but sounds like they do not think this is a drug-induced psychosis as of now.

TIA.

Late teens and 20s are a common time for schizophrenia diagnosis. I am not sure what state your family member is in but some states have increasingly focused on creating supports specific to "first episode psychosis" because it is thought that psychosis causes some damage to the brain that "kindles" further episodes. Early treatment is key.

Here is an example in Maryland of a "First Episode" Clinic -

https://www.mprc.umaryland.edu/Clinical-Care/First-Episode-Clinic/

You might want to have your family member ask about this kind of resource in their state.

Also, I don't know the age of the niece, but if she is in school, the IEP or 504 process can be used to help her while she is recovering and finding proper treatment.

If you want to know more about schizophrenia, Ellyn Saks has written a good memoir about her experience of the illness.

TY!

I see you mentioned she is 19 - so I want to adjust what I wrote - IEP and 504 processes only apply to public schools up to 12 th grade. BUT, private schools at any grade or colleges and universities must accommodate (under the ADA) serious illnesses like schizophrenia, which are considered long term disabilities even when well-treated because sudden relapse is possible.

If your niece is in college, her family can contact the Office of Disabilities and ask to meet with someone who can help explain what the process is for notifying professors she is ill, providing information about how to and by what dates request to withdraw, request incompletes or extensions on work. Schools (like Yale and some other Ivies) sometimes have unfair, discriminatory policies about re-admitting students

If the family bought "tuition insurance", they need to read the plan carefully and see if new onset mental illness is covered (it is on our university's plan).

I know it seems like it might create pressure to refer to school, but IME, kids really feel like this kind of mental health crisis is destroying their perception of what their life could be, which is a huge stressor. Parents can also be under financial pressure because losing a semester's worth of tuition can be a huge financial burden.

Finally, even without a signed healthcare form or school release form, you can sometimes navigate "consent" issues. Consent doesn't have to be a particular signed form (although that's helpful). A good healthcare worker can often frame an oral question to the patient in a way that encourages them to provide oral consent. Schools have to tell you about process even if they can't tell you about a particular child. School websites for the disability and registrar's office often have a lot of good information about these policies.

I know it's not the point of this post, but Yale finally caved to alumni pressure & now kids who voluntarily withdraw for mental health reasons have automatic readmission rights!

That's so terrible that it took Yale so long when many top schools have readmit rights if student able to demonstrate, in concert with mental health professionals, a plan for return.

I think most of the mental health community has very little understanding of chronic, severe mental health issues. The patient may say they’re ok, and todays too agreeable therapists will follow the patients wishes. But some bipolar and schizophrenic students will never return to the original mental state. Current drugs don’t cure mental illnesses, only cover up a few of the symptoms. I think a long break is needed for severe cases.

Why do you say that they have little understanding? Okay, that's right in many ways, but seems like they are pretty clear that "this is what we know, this is what we don't, and we have to rely a lot on observation/comparisons."

To return to school, I think students have to present info from psychopharmacologists not simply psychotherapists.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:We went through/are going through this with my brother. Unfortunately our experience is not good as my parents missed the signs when he was a teen... so my perspective is biased.

She needs to get on meds before she is 18. Preferably, the kind that is an injection (monthly) as opposed to a pill to take everyday. Many people will start to feel better and refuse to take meds. You can imagine what happens then. After 18, your sibling cannot make any decisions for their child. It is incredibly difficult to get them any help if they refuse after 18. It's not an easy road if they are not on meds. Hard to keep a job, and it is very very stressful on the family.

Alas, her child just turned 19.

When healthy, have them sign agreement that they can access medical records and even better to have medical power of attorney.

She's 19. No one can "have" her sign anything.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:We went through/are going through this with my brother. Unfortunately our experience is not good as my parents missed the signs when he was a teen... so my perspective is biased.

She needs to get on meds before she is 18. Preferably, the kind that is an injection (monthly) as opposed to a pill to take everyday. Many people will start to feel better and refuse to take meds. You can imagine what happens then. After 18, your sibling cannot make any decisions for their child. It is incredibly difficult to get them any help if they refuse after 18. It's not an easy road if they are not on meds. Hard to keep a job, and it is very very stressful on the family.

Alas, her child just turned 19.

When healthy, have them sign agreement that they can access medical records and even better to have medical power of attorney.

She's 19. No one can "have" her sign anything.

No kidding, But they can ask her to and the best time to do it is when they’re in a good mental headspace. I know that from experience. No need to be nasty on this thread.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I’m very sorry your family is having to deal with this. They will probably want to do a full neuropsych test to help with a diagnosis. Generally, I think the earlier they catch these disorders, the better the prognosis - you might look up first time psychosis programs. If she needs to go to residential treatment you might want to Google around to find which ones around here have the best reputation. ERs often have to just send teens to wherever there is an empty bed - try to see if you can get her in to a good one. It’s good your cousin can talk to you, these situations can be so isolating. You’re doing great helping her out by researching for her.

curious on why you suggest neuropsych. my ds has done them and we learned about his ADHD, but cousin has never mentioned this for her dd.

DP - one who is a mental health professional - a lot of people not in the field don’t realize that neuropsych testing is used primarily for assessing cognitive abilities. In children, that’s mostly around learning disorders/disabilities and ADHD. In adults, it’s mostly used to assess potential dementia, memory loss, etc. Rarely are they conducted as part of a comprehensive psychiatric diagnostic process. It would be close to worthless (and, frankly, cruel) for someone who is floridly psychotic, although once the psychosis has remitted, could be helpful in identifying any related cognitive concerns. Same with mania: you can’t conduct a valid neuropsych battery in someone who is actively manic.

+1

I had a neuropsych eval scheduled due to really bad brain fog with long covid. I have bipolar disorder and we had to reschedule it when I got some hypomania.