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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by tancu on September 13, 2002, at 20:38:07
I fear that a very close friend is experiencing the onset of psychosis...I've noticed distinct changes in the appearence of her face...is this common?
Posted by Mark H. on September 14, 2002, at 0:51:00
In reply to facial features/psychosis onset , posted by tancu on September 13, 2002, at 20:38:07
I haven't noticed changes in the facial features of those who are experiencing psychotic onset, so I would guess that it is not particularly common. However, sometimes those who suffer from psychosis will perceive changes in the features of others. It is the nature of psychosis (as I understand it) to seem utterly believable to the person experiencing it, which is one of many reasons why it is so distressing.
It might help to check other things besides facial features, such as (possible) history of psychosis, changes in personal grooming and attire, irrational beliefs or highly disorganized conversation, reactions to recent stressors, and so forth.
Also, if your friend has had episodes of psychosis in the past, what treatment or help worked for your friend? Is there a therapist or psychiatrist this person already sees? Would your friend be open to a friendly suggestion to make an appointment to check in with this care provider? Timely intervention can save a lot of grief, especially given some of the wonderful newer anti-psychotic medications that are available today.
It's always best to ask the person directly, if you can, rather than to speculate. I suspect that your kindness and concern will be well received.
I hope that some of these ideas will be useful to you.
With kind regards,
Mark H.
Posted by tancu on September 14, 2002, at 8:55:35
In reply to Re: facial features/psychosis onset , posted by Mark H. on September 14, 2002, at 0:51:00
Thanks for your reply Mark H. This is such a delicate matter because the close friend is my wife. I was a psyc major at a school of science many years ago, and I have this vague memory of facial features sometimes being affected by psychosis. To answer a few of your questions--yes, she has, in my opinion, had psychotic episodes in the past. These were all drug/alcohol and sleep-deprivation induced, complete with both auditory and visual hallucinations. You see, I have young-onset (at age 34) parkinsons, and my doctors have prescribed various meds to improve the quality of my life while holding off the admistering of sinemet--because of it's horrible long-term use side-effects. Believe me, it's quite a struggle for me to NOT take the few sinemet that I have remaining from a script given to me in Jul 01' basically as a final test to confirm what was already plainly evident. I agree that we need to hold off on the sinemet for as long as possible. But I digress. It's the various meds intended to improve the quality of my life that my wife helps herself to whenever she can "find" them. These include amphetamine--so I can make it through the work day, as well as any family outings, darvocet for pain, remeron for depression and insomnia, and ambien for when I'm too exhausted to sleep. These "feel-good" drugs maintain and regulate my "quiet desparation"--thus keeping it from becoming full-blown despair and major depression because of all that I have already lost--my physique, my ability to play music, my confidence, over 15K$ in savings due to lost work, etc. As I have lost these things and have become saddened, my wife has also lost them and become saddened. She too is being treated for depression, but she isn't doing well at all. She sneaks into my "feel-good" meds, washes them down with a little liquor, and feels great--until she reaches a point of complete exhaustion--which brings on the psychotic episodes. She has had maybe ten of these episodes (auditory and visual hallucinations, some violent behavior, some calm almost child-like behavior, disorganized speech, irrational thoughts) in the past 6 months. I have had to miss work in order to watch over her after these episodes. Prior to any of the episodes I noticed subtle but very distinct changes in the appearance of her face. I don't believe they're the result of normal aging. People don't age that quickly. She has always fought depression. Now she is further saddened and distraught over slowly loosing her once strong husband. She even partially blames herself for my disease, and she feels helpless to do anything that might help us. I'm tired...gotta get some rest...Any advice?...thanks.
Posted by xjs7 on September 14, 2002, at 20:42:03
In reply to facial features/psychosis onset , posted by tancu on September 13, 2002, at 20:38:07
Hi tancru,
When I was diagnosed with schizophrenia, I presented with what psychiatrists call "inappropriate affect"--meaning that my emotional expressions (such as smiling or looking sad) did not match to what I was saying. So, for example, when I said something sad I would have this big grin on my face, and I would look like an extremely happy person.
Affect changes like this are extremely common in the psychoses, and psychiatrists are trained to look for them. Many people with schizophrenia present with what is called "flat affect", meaning that no emotion is expressed when the person is speaking.
Fortunately for me all these symptoms are a thing of the past; I improved dramatically with the addition of an antipsychotic agent, and am able to post here. I think the best thing for you to do is take your friend to a psychiatrist (this may mean going to the E.R.). Psychosis is an extremely serious medical condition and demands prompt diagnosis and treatment. I hope things work out for the best for you and your friend.
xjs7
Posted by Mark H. on September 15, 2002, at 0:55:10
In reply to Re: facial features/psychosis onset , posted by tancu on September 14, 2002, at 8:55:35
A few thoughts that might help come to mind.
A person once very close to me had two major schizogenic (psychotic) breaks during the six years that I knew her well, both of them in situations of rather extreme external stress (such as you and your wife are experiencing now). The first time she was hospitalized, and the second time she somehow made it through on her own. I know how painful this can be and how helpless you must feel at times to help her. My heart goes out to you -- and to her.
Early onset Parkinsons requires tremendous coping skills, and your medications are definitely *not* just "feel-good" drugs but tools to improve your quality of life. If you don't mind my saying so, I think it is important to consider the possibility of changing how you think about these medications, for her sake as well as yours.
There are amazing new medications available today that have revolutionized the treatment of psychosis, particularly of the type that you describe your wife as having. She really needs your encouragement to work with her doctor (preferably a psychiatrist) to get her OWN medications, rather than "borrowing" from you. Zyprexa, in particular, has had almost miraculous effects on me (for bipolar) and others I know, without the many dangers and side effects of the anti-psychotic medications that were around 25 years ago.
Also, if you view your adjunctive medications as semi-recreational and/or you feel guilty about having and taking them, then the message your wife *might* get from you is that you disapprove of their use. If she senses that it is "wrong" to take these adjunctive medications, then she will continue to "borrow" them rather than asking her doctor for the help she needs. And it sounds like she really needs help right now!
Sadly, self-medication -- while undeniably inappropriate under all but the most extreme circumstances -- is quite common and potentially very dangerous, as you know. If she were taking something prescribed for her that genuinely helped her to feel better, she would have less reason to seek out and misuse your medications.
I admire your courage and strength to endure not only your disability at such a young age but also your wife's periodic psychosis. Please encourage her to see her doctor and to ask for the help she needs. If she resists, then talk openly about her self-medication with YOUR doctor.
I realize you cannot force your wife to do anything. What I am suggesting is that you do what you need to in order to know in your heart that you've done what you can for her, given the limitations you both face at this time.
Three psychotic episodes in six months is quite serious, and you should not be trying to carry this burden of care and support by yourself. Find a way to share it with whatever medical and social service support resources are available to you in your community.
With kind regards,
Mark H.
Posted by judy1 on September 15, 2002, at 18:23:22
In reply to Re: facial features/psychosis onset , posted by tancu on September 14, 2002, at 8:55:35
My heart goes out to you and your wife. I've also experienced psychotic manic episodes and because of the rapid cycling nature of my illness, I have had several in the past year or so. I also feel guilt- mainly because i feel like a burden to my husband at those times, and i imagine with your own illness your wife feels even more guilt. taking 'illicit' meds that alter moods is a very common coping mechanism for me also. the action that has helped my family the most is we get group counseling in addition to my individual therapy sessions. i agree with Mark that this is too much for you to handle, and you definitely need to avail yourself of the help out there. if it's financial problems that are preventing your wife from getting this help, then there are clinics designed to provide services for little or no money. if she refuses to get help, then i strongly urge you to go and learn how to deal with her behavior. there have been a few times where my husband contacted my shrink and he was able to convince me to take my medication. take care, judy
Posted by tancu on September 15, 2002, at 21:14:58
In reply to Re: facial features/psychosis onset » tancu, posted by judy1 on September 15, 2002, at 18:23:22
Thank you Mark, xjs7 and judy1 for your kind and thoughtful replies. Actually, I hardly view any of my meds as "feel good" meds. I haven't felt "good" since 1996. The meds make an unbearable condition "tolerable". God, how I wish I "could" feel good. My wife liked my adderall so much that she got herself a diagnosis of ADDH and her own prescription of 1 10mg dose twice a day. It took her exactly one week to take the entire prescription--60 tablets. Then she wanted mine. If I don't hide them very well she'll find them after I go to bed. I have excellent insurance, so we are going to counseling. Because she recently tried to kill herself, the state is also offerring help. They're threatening to take our 14 yr old son because they're afraid she will hurt him. I find it very hard to believe that she is a threat to his physical being. I've seen her "slap" him maybe three times in his whole life. Thanks for your advice and concern. I'm going to contact her doc this week, and she is going to be re-evaluated soon. She can't hide her illness forever. I won't let it go on any further. I desparately need some relief, and so does she.
Posted by judy1 on September 15, 2002, at 23:22:22
In reply to Re: facial features/psychosis onset, posted by tancu on September 15, 2002, at 21:14:58
I'm really glad you are going to the dr. this week- for yourself, your wife and your son's well-being. thanks for posting your decision and i hope all goes well. take care, judy
p.s. my drug of choice was opiates and i also went through my husband's scripts, just to let you know you're not alone.
Posted by caml on September 20, 2002, at 13:17:41
In reply to Re: facial features/psychosis onset , posted by Mark H. on September 14, 2002, at 0:51:00
Those who are experiencing a psychotic episode, or about to, often have very tense facial muscles. They can often also grimace a little, or a lot, in repsponse to hallucinations . If their insight exists re this muscle tension, or the facial grimacing,the stress can exacerbate the muscle tension. This often means that the person can be perceived as having slightly altered facial features.
I have also been aware of those who have required to have their muscle contraction(s) released through chemical means.
Therefore I would suggest that knowing your partner intimately may mean you pick up "alteration to facial features" which may indicate a psychotic episode long before a clinician . Indeed, as many clinicians spend only short periods with their clients they are liable tomiss these indicators altogether.caml
Posted by Mark H. on September 20, 2002, at 20:27:59
In reply to Re: facial features/psychosis onset » Mark H., posted by caml on September 20, 2002, at 13:17:41
Caml,
Thank you for the additional information. I appreciate it.
Mark H.
Posted by URCONFUSED on September 21, 2002, at 18:52:46
In reply to facial features/psychosis onset , posted by tancu on September 13, 2002, at 20:38:07
> I fear that a very close friend is experiencing the onset of psychosis...I've noticed distinct changes in the appearence of her face...is this common?
Yes this is true. People with psychosis generally come acrossed as "flat" in the face, flat as in expression and emotion are devoid. They can develop a mechanical, robot type look. Also, inability to concentrate well like commonly occurs in psychosis may result in changes in the way the eyes appear. They are just "there" looking. Also, many psychosis are accompanied by depression to some degree or other and depression can change the way the face looks. Such as resulting in a tired, haggard, worn out look with dark rings under the eyes.
Combine it all and you have what psychosis "looks" like oftentimes, not pretty stuff.
URCONFUSED
Posted by tancu on October 26, 2002, at 23:23:50
In reply to Re: facial features/psychosis onset , posted by URCONFUSED on September 21, 2002, at 18:52:46
thank you all for your replies...things are getting worse...I have no idea "why", but, she's now in the habit of pulling out her eye-lashes--all of them, top and bottom...she's easily provoked into fits of rage--struck me while I was laying in bed...I don't know what I can do to help.
Posted by Eilidh on October 27, 2002, at 5:33:03
In reply to Re: facial features/psychosis onset , posted by tancu on October 26, 2002, at 23:23:50
You obviously need the support and assistance of professionals at this point. If your friend has been prescribed psychotropic medication over the past month the dosage,or indeed the medication itself, requires review. If she has not yet been formally assessed this is your goal. If she refuses to be assessed by psychiatric professionals perhaps you could arrange a joint appointment with your genaral physician to discuss the recent difficulties you are both having. Airing the situation in a formal arena would permit the doctor to hopefully assess whether or not to initiate the psychiatric assessment process.If your friend has little or no insight into the situation, and it is not yet considered severe enough for the psychiatric services to insist they assess her, you may have to consider your position in the ralationship at this time. If you feel that your safety may be compromised you may have to offer support from a different position. If you think your friend's personal safety is at risk you could try contacting her general physician at the time when she is in obvious difficulty in an attempt to initiate assistance for her.
What does appear to be the case, without meaning to be alarmist, is that her behaviour is escalating to the point where she may pose a risk to her own safety or yours, and requires professional assessment.
You have provided as much support as you can so please do not think you haven't. Her presentation now needs to be assessed for approriate professional assistance to be offered. No one can expect you to do more than you are.
I wish you both well.
Eilidh.
Posted by tancu on November 4, 2002, at 9:35:41
In reply to Re: facial features/psychosis onset » tancu, posted by Eilidh on October 27, 2002, at 5:33:03
hello Eilidh, and thanks for your kind and thoughtful words...about a month ago I did contact her (my wife) doc...we agreed that she needed inpatient care for re-assessment and meds adjustment...I had no problem convincing her to go that very same day...I simply and kindly explained to her that her meds weren't working, and that the doc needed to have her in the hospital in order to re-evaluate her condition...this was her 2d hospital stay this year...this time they decided she is bi-polar with explosive disorder, and of course they made some med adjustments--which don't appear to be working...she stayed for 10 days and didn't really want to leave--said she didn't feel "well enough"...she was supposed to have immediately started intensive out-patient therapy (9am-3pm daily) three weeks ago, but she keeps putting it off for "various" reasons...the adjustment to her meds is not helping--she stays in bed for days on end, she pulled all of her eye-lashes out which led to an infection, and she started swinging at me while I was laying in bed the other day...instinctively, I tried to grab her arm(s) and wound up with a sprained thumb that doesn't want to heal...I work with my hands--which means my thumb doesn't get much rest...I guess I'm going to call her doc again and see what he thinks should be done...thanks again.
Posted by Eilidh on November 7, 2002, at 4:33:40
In reply to Re: facial features/psychosis onset, posted by tancu on November 4, 2002, at 9:35:41
Your perseverance is admirable.You are right about having to return to the doctor again for further review with your wife.Although these symptoms are extremely uncomfortable for your wife,they also take a tremendous amount of your energy too. Not to mention the strain it may be having, or can have , upon the marriage. It looks currently as though responsibilty for keeping your wife's treatment under review is falling to you. I hope you have found a source of knowledgeable support for yourself to help prevent you burning out. You both need assistance to see this through.
If the "intensive daytime support" is seen as required by the professionals, and your wife finds herself unable to go to them, perhaps they could come to visit her at home. Even if for a one off visit to attemp to encourage her to attend their care programme. They ought to be aware of the non compliance issues relating to her specific diagnosis, and cannot surely expect not to have to provide outreach work of some description.Home visiting may be initially required to gain your wife's trust. It is arrogant of them to assume everyone will have no difficulty in coming to their project. Remember the old saying " If Mohammed won't come to the mountain then the mountain must go to Mohammed"
Meanwhile, good luck to you both.
Eilidh
Posted by tancu on November 7, 2002, at 6:27:29
In reply to Re: facial features/psychosis onset » tancu, posted by Eilidh on November 7, 2002, at 4:33:40
yes Eilidh, I do need some support...I recently went to my neuro (I have parkinson's) and told him of the situation, and asked if he thought I could use a few days inpatient for "stress"...specifically, I told him how I felt that I might be at a "critical" point of stress/anxiety because there were a couple occasions when I had clearly lost my patience/compassion for her condition...these occasions found me at my "worst"--I was most unkind and spoke to her like she was dirt...this was entirely uncharacteristic of my "usual self"...normally I'm thoughtfully kind and quiet...it really concerned me that I became so angry and uncaring, and that's exactly what I told my neuro...but, he pointed out that I needed to stay at home so my wife would not, in my absence, redirect her "explosiveness" toward our 14yr old son...then he gave me a script of xanex, told me to "stay neutral" in my wife's presence, and arranged for me to see a shrink in lieu of a few days inpatient for stress...meanwhile, she stays in bed, insisting that her doc says she has "intestinal flu"...I don't even believe she "went" to the doc...I think she's only saying she did so she can stay in bed and deny her depression...I'm going to call her doc today for sure...maybe he'll have an idea of what to do...
Posted by Tony P on January 17, 2018, at 19:17:48
In reply to Re: facial features/psychosis onset , posted by tancu on October 26, 2002, at 23:23:50
An old thread, but I thought I'd add my 2 bits worth.
When I was an inpatient, I noticed a couple of characteristics in my fellow patients which seemed to me markers of psychosis, especially some forms of schizophrenia (hebephrenic?). Inappropriate, out of the blue laughter is well known and well-documented. I also noticed that whenever one patient spoke in group, it was as though he were reading from a script, like a bad news-anchor.
This is the end of the thread.
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