How Can I Help a Friend With Paranoid Schizophrenia?

Reader’s Question

I have a childhood friend who became paranoid schizophrenic as an adult. Her case is severe and from time to time she contacts me to tell me about her delusions and ask me if I think they are real or not. The contacts are in flurries and then a long interval, sometimes years, will follow. I am concerned that she must not be on the right medication and/or dosage because she is continually tormented by her delusions and is unable to work or maintain a conversation about anything other than her fears. She drifts off in the middle of conversations and forgets what she was doing. She says the medication makes her sleepy and reduced her sex drive so much that it contributed to her losing her long time boyfriend. She is unable to advocate for herself in this state and her family seems to just accept her condition. Is there anything I can do to help her?

Psychologist’s Reply

Is there anything you can do to help her? You already are doing something. Your experience with your childhood friend is very common. Individuals with Paranoid Schizophrenia have exacerbations/increases in their psychotic symptoms, often as a reaction to stress in their life, changes in their schedule, or changes in their medications. In delusions (false beliefs), medication often prevents “new” delusions from forming but doesn’t erase the old delusions. It’s like telling you now that you didn’t go to your high school — that it was all a delusion. For this reason, while hallucinations may decrease or stop and no new delusions develop, the old delusions remain quite active. In times of crisis, she may contact you just for support. During these difficult times, she needs your help to stay grounded in reality as she may be unable to separate new delusions from real life. She may trust your judgment more than those of other people around her. At the same time, when the crisis is over, she returns to her own world until the next episode.

In talking with her, I’d recommend:

  1. Don’t be afraid to tell her something sounds like a delusion — she already suspects it and that’s why she’s calling you. Asking someone about delusions doesn’t make them more psychotic.
  2. Discuss the fact that new delusional thoughts may be related to an increase in stress, change in medications, or other events. If situations are present that may have increased her delusions — focus on those issues rather than the delusions.
  3. Recommend that she maintain regular contact with her treatment professionals (psychiatrists, psychologists, clinics, etc.).
  4. If she has independently reduced or discontinued her medications — urge her to immediately notify her psychiatrist. Discontinuing antipsychotic medication can be very serious and could prompt an emergency psychiatric hospitalization.

You can read more about schizophrenia in an article I’ve written entitled Chemical Imbalance on my website at www.drjoecarver.com. This website also has additional information on both schizophrenia and psychotropic medications.

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