Mental Health: Navigating Schizophrenia and Depression Challenges

Depression or schizophrenia?

My brother has been suffering from a mental illness for five years.
He is currently 30 years old.
Initially, the doctor diagnosed him with schizophrenia, but about six months later, a different doctor said it was early symptoms of depression, including auditory hallucinations and delusions.
Over the past two to three years, he has become unable to go out, often hesitating and spending most of his time lying in bed.
When he takes medication, he can generally manage to live a somewhat normal life, but he occasionally goes through periods where he stops taking his medication.
Recently, he has been taking his medication regularly for the past month or two, but I still feel that he has other issues.
I wonder if he should undergo a brain examination, as I have a sense that there may be some brain damage.
He has never used drugs, but his unusual behaviors include:
1.
Lack of resistance to certain activities:
- Soliciting prostitutes: He has spent all the money he earned previously and sometimes even borrows money to spend.
The most concerning part is that he doesn't even set a password on his phone, and our family is aware of his actions.
- Smoking: He now insists on having cigarettes when taking his medication and has started smoking at home, which he didn't do before.
Initially, I thought he might be concerned about what others think when going out, but he sometimes goes out alone at night, so that doesn't seem to be the reason.
- Betel nut chewing: He didn't have this habit before; he likely picked it up from previous jobs.
Whenever he has a little extra money, he buys some, consuming only one or two pieces, but ends up making a mess of his clothes.
He doesn't actually know how to chew it properly.
2.
He seems to be controlled by music.
Before his illness, he had a phase where he enjoyed going to nightclubs.
Now, he plays nightclub music at home and dances alone.
Even when guests come over, he continues to dance.
The last time we went to a night market, he started dancing to upbeat music, completely out of control.
3.
His work history has been sporadic; he has had various jobs but none lasted long, with some lasting only a day.
Since I don't live at home, my parents take him to see the doctor.
They might mention recent events, but the clinic doctor usually only adjusts his medication.
Additionally, he has a history of self-harm but no record of actively harming others.
When I bring up life issues, he tends to change the subject.
If I am a bit firm with him, he might raise his voice, especially when it comes to cleaning up his clutter (though it's not excessive).
Returning to the question, what kind of examinations should he undergo, or where should I inquire about this? Thank you, doctor.

LIN, 20~29 year old female. Ask Date: 2023/04/25

Dr. Li Guanying reply Psychiatry

From your letter, it is clear that you are concerned about your family's depressive symptoms and the stress of mental health issues.

1.
Facing an uncertain future, mental disorders are common in modern society and are chronic conditions that require long-term treatment for recovery.

2.
Mental disorders are chronic illnesses characterized by episodes of exacerbation, remission, recovery, and relapse.
More than half of patients may experience a recurrence of symptoms even after they have remitted.
Due to individual differences in constitution, your friend's situation requires medical attention, and it will take time to determine the appropriate medication.

3.
Regarding medication treatment alone, each primary medication requires 4 to 6 weeks to assess its efficacy.
It is advisable to note the duration and frequency of any discomfort symptoms you may experience.

4.
In addition to medication and psychotherapy, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, anesthesia-free, highly safe treatment option that does not require hospitalization and can improve anxiety and depressive symptoms.

Please encourage your family member to discuss their mental health condition thoroughly with their physician during follow-up visits.
Our clinic is open for outpatient services Monday through Friday, both in the morning and afternoon.
We recommend considering a visit to have a physician personally assess your symptoms and collaboratively discuss the best course of action for you.

Wishing you mental and physical well-being.

Reply Date: 2023/04/25

More Info

Navigating the complexities of mental health, particularly in the context of schizophrenia and depression, can be challenging for both the individual affected and their family members. Your brother's situation, as you've described, raises several important considerations regarding his mental health and the appropriate steps to take moving forward.

Firstly, it’s essential to understand that schizophrenia and depression can often co-occur, leading to a range of symptoms that can significantly impact daily functioning. The symptoms you've mentioned, such as hallucinations, delusions, and a lack of motivation, are common in schizophrenia, while the depressive symptoms may manifest as lethargy, hopelessness, and withdrawal from social interactions. The fact that your brother has been diagnosed with schizophrenia and later with early symptoms of depression suggests a complex interplay between these conditions.

Given that your brother has been experiencing these symptoms for five years, it is crucial to ensure that he is receiving comprehensive care. This includes not only medication management but also psychotherapy and possibly other therapeutic interventions. Medications for schizophrenia, such as antipsychotics, can help manage symptoms like hallucinations and delusions, while antidepressants may be necessary to address depressive symptoms. However, medication alone is often not sufficient; therapy can provide him with coping strategies and support.

The behaviors you've described, such as engaging in risky activities (like soliciting sex, smoking, and using betel nut), indicate a potential decline in judgment and impulse control, which can be associated with both schizophrenia and the effects of certain medications. These behaviors may also reflect an underlying struggle with mental health that needs to be addressed. It’s important to approach these issues with empathy and understanding, as they can be manifestations of his mental health struggles rather than mere choices.

Regarding your concern about possible brain damage or other neurological issues, it is reasonable to consider a comprehensive evaluation. A neuropsychological assessment can help determine if there are cognitive deficits that need to be addressed. Additionally, brain imaging studies, such as an MRI or CT scan, can rule out any structural abnormalities that may be contributing to his symptoms. These assessments can provide valuable information to his healthcare providers and help tailor his treatment plan more effectively.

It is also vital to ensure that your brother is consistently taking his medications as prescribed. Non-adherence to medication can lead to exacerbation of symptoms and increased risk of hospitalization. If he is experiencing side effects or feels that the medications are not effective, it is crucial to communicate this to his healthcare provider. Adjustments to his medication regimen may be necessary to find the right balance that minimizes side effects while effectively managing his symptoms.

In terms of seeking help, it may be beneficial for you and your family to engage with a mental health professional who specializes in schizophrenia and mood disorders. This could be a psychiatrist, psychologist, or a licensed clinical social worker. They can provide guidance on how to best support your brother, facilitate family therapy sessions, and help address any concerns about his behavior and mental health.

Lastly, it’s essential to foster an environment of support and understanding at home. Encourage open communication, and let your brother know that it’s okay to express his feelings and struggles. This can help reduce feelings of isolation and stigma, which are often prevalent in individuals with mental health conditions.

In summary, your brother's situation requires a multifaceted approach that includes medication management, therapy, and possibly neurological assessments. Engaging with mental health professionals who can provide comprehensive care and support is crucial. Your family's involvement and understanding will also play a significant role in his recovery journey.

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