I am the sole friend and now carer of a 45 year old male schitzophrenic. Ed(psydonym) has had cancer for the last four year. Initially it was discoverd in his sinuses. A legacy to his three packs a day cigarette habit. Several bouts of radiatiion therepy have given Ed more time than any of us would dare to dream of four years ago.
Alas he has reeived his maximum radiation dose and chemo has been unsuccessful so he is loosing strength against the ever increasing, unrelenting pain. COnsequently Ed is taking up to two gms of MS CONTIN a day. He also takes anti-nausea, anti-biotics and other lesser symtomatic reliefs. His paranoid schitzophrenia has been successfully managed with Modacate. The dose size I don't know but he receives it intramuscularly once per fortnight.
Things have been stable with Ed until the last week. Since then he has talking a great deal about how he is being assulted 'spiritually' by the likes of his father, leaders of certain Australian political parties and Hitler. Yesterday this psychosis progressed to action. I had not heard from him all day till he phones me from the local airport at 6:00PM. It seems the night before he'd received some telepathy from kindred spirits in Sydney. He was required by them imeadiatly. A sixteen hundred mile round flight from where we live.
Can I expect Ed's schitzophrenia to become more active as death and the resulting fears and doubts many of us may face at such a time? Is the ever increasing analgesia the cause? Should he be re-assesed by a psychiatrist for possible meds modification? And finally, being cancer in the head, as it moves more into his brain can we expect further psycological instabillity.
I relise this letter is an enormous request but it is a last resort to get some help. I haven't found one sentence on the topic on the web.
Yours Faithfully, Robert.
Dear Robert!
Actually, I do not know much about the specific changes of schizophrenia and cancer. But I know that any psychological disorder is strongly influenced by stress and environment. This is especially true for chronic schizophrenia. Any marked changes of his normal daily routine can trigger a new psychotic episode. But it might also be an independent event. Maybe caused by some other factors or maybe an insufficent antipsychotic medication at this time.
We do not know. I do not think it is a general rule that you would have to expect a worse outcome of his psychiatric disease now. But he will need a stronger antipsychotic medication and acute crisis intervention of the acute psychosis. This should be done right now and might require inpatient therapy. The i.m. antipsychotic medication is a good choice but sometimes not as effective as regular pills. So maybe a combination with a new atypical neuroleptics would be an options.
So he needs to see his doctor right now to consider a change of medication. Any help to reestablish his old structure and support would be fine to cope.
Martin Winkler