Personality Disorders and Schizophrenia: A Family's Struggle

Could you please clarify the difference between dissociative identity disorder and schizophrenia?

Hello Dr.
Huang, I have a sister who was involuntarily treated for mental illness at your hospital for over five years (court ruling, Zhang Shuhua).
After being discharged before the Lunar New Year this year, she has been picking up her medication regularly from your hospital, but she is not actually taking it.
Later, she attempted suicide by swallowing pills and was sent to National Taiwan University Yunlin Branch for emergency treatment.
When she was about to be discharged, she was admitted to the psychiatric ward after calling a nurse.
Eventually, her family could not tolerate her disturbances, so she was discharged again.
On July 28, some incidents occurred, and I took her to Taichung Tungs' Taichung Hospital for treatment, but the doctors there assessed her condition as a personality issue and determined that she could not be admitted to the chronic ward.
I find this very strange; my sister's condition has not improved, and neither your hospital, National Cheng Kung University in Tainan, Tainan Chi Mei Hospital, nor National Taiwan University Yunlin Branch have discussed any personality issues with our family.
She has also obtained a permanent severe disability card and a moderate mental disorder handbook.
Is there a basis for the diagnosis of personality disorder and schizophrenia? My sister causes distress to our family and friends at home, and I have explained this to the doctors at Tungs' Hospital, but they seem to insist that I start looking for other medical institutions.
I want to understand how personality and mental health are assessed.
Is it true that individuals with personality disorders cannot be admitted to chronic wards (and that severe and moderate disabilities become ineffective and require out-of-pocket expenses)? If Shuhua causes a social incident, will the hospital bear no responsibility? Can the hospital easily decide to discharge a patient at the family's request? How should families handle such patients? The doctors keep saying that if we don’t provoke Shuhua, there won’t be any problems, but her thoughts and behaviors have become unacceptable to the family over time.
How can there be no arguments? Moreover, she does not take her medication regularly after discharge and consumes stimulating foods (tea, coffee, binge eating, etc.).
The family cannot keep sending her in and out of the hospital, and she does not want to be hospitalized, which causes significant distress.
How can the family obtain resources for her placement?

Zhang Xiaoan, 30~39 year old female. Ask Date: 2012/08/28

Dr. Huang Yanying reply Psychiatry

Hello Mr.
Chang, I am Dr.
Chang.
Since Dr.
Huang has left our hospital, I will respond to your questions.
It is common for patients with mental illness to be unwilling to seek medical treatment or hospitalization.
You can encourage their close relatives to persuade them using language that they can accept.
The first step is to encourage them to take their medication regularly, which is very important.
Regarding hospitalization, the hospital can arrange assistance, but the attitude of the patient is crucial.
Additionally, both the patient and their family must sign a consent form for hospitalization.
If the patient exhibits unstable mental behavior or has self-harming or aggressive tendencies, you can apply for involuntary hospitalization (such as in cases of suicidal behavior as you mentioned).
You can seek help from the health department or the fire department.
Finally, if family members are unable to care for the patient at home, you may consider long-term care facilities.
A list of such facilities can be obtained from the social work department of hospitals or the social services division of the local government.
Wishing you and your family good health.
Sincerely, Dr.
Chang, General Psychiatry, Chianan Psychiatric Hospital.

Reply Date: 2012/08/28

More Info

Understanding personality disorders and schizophrenia can be a complex and challenging journey, especially for families dealing with the repercussions of these conditions. Your sister's situation, as you described, highlights the difficulties that arise when a loved one struggles with mental health issues, particularly when there is a lack of insight into their condition.

Firstly, it’s important to differentiate between personality disorders and schizophrenia. Personality disorders, such as Schizoid Personality Disorder, are characterized by enduring patterns of behavior, cognition, and inner experience that deviate markedly from the expectations of the individual’s culture. These patterns are inflexible and pervasive, leading to significant distress or impairment in social, occupational, or other important areas of functioning. On the other hand, schizophrenia is a severe mental disorder that affects how a person thinks, feels, and behaves. It can involve hallucinations, delusions, and disorganized thinking, which can severely impact daily functioning.

In your sister's case, the repeated hospitalizations and her refusal to adhere to medication suggest a complex interplay between her mental health issues and her ability to recognize her need for treatment. The fact that she has been diagnosed with both significant mental health issues and a personality disorder complicates her treatment. Personality disorders often require long-term therapeutic interventions, such as psychotherapy, rather than just medication. This might explain why some facilities are hesitant to admit her to chronic care units, as they may focus on conditions that are more responsive to pharmacological treatment.

The family’s struggle is compounded by the lack of communication from healthcare providers regarding your sister's diagnosis and treatment plan. It is crucial for families to be involved in the treatment process, as they can provide valuable insights into the patient's behavior and history. If healthcare providers are not communicating effectively, it may be beneficial to request family meetings where you can express your concerns and seek clarity on your sister's condition and treatment options.

Regarding the question of whether personality disorders can be treated in chronic care facilities, it is generally true that these facilities focus on conditions that require more intensive medical management. Personality disorders are often treated in outpatient settings or through specialized programs that focus on psychotherapy. This can be frustrating for families who feel that their loved one needs more support than what is available in outpatient settings.

In terms of managing your sister's behavior at home, it is essential to establish clear boundaries and seek support for yourself and other family members. Engaging with mental health professionals who specialize in family therapy can provide strategies for coping with the stress and emotional toll of living with someone who has a personality disorder or schizophrenia. Additionally, support groups for families of individuals with mental health issues can offer a sense of community and shared experience.

If your sister poses a risk to herself or others, it is crucial to seek immediate help. In situations where there is a potential for harm, contacting emergency services or a mental health crisis team may be necessary. The responsibility of the hospital to ensure the safety of patients and the community is paramount, and they must act accordingly if a patient is deemed a danger.

Finally, regarding resources for long-term care or support, consider reaching out to local mental health organizations, social services, or advocacy groups that can assist in navigating the healthcare system. They may provide information on available resources, including residential treatment options, outpatient programs, and financial assistance for care.

In summary, navigating the complexities of personality disorders and schizophrenia within a family context requires patience, understanding, and often external support. It is essential to advocate for your sister's needs while also taking care of your own mental health and well-being.

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Please return for a follow-up appointment so we can discuss further. Thank you!