Disturbances and Relapse Signs

Self-directed Harm

It is a troublesome reality that suicide rates are high for people who experience serious mental illness. Although it is hoped that medication improvements will have a positive impact in this area, families and friends must never ignore warning signs.

It is possible the troubled family member has been thinking of ending his or her life. Take any of the following signs seriously:

C expressing (verbally or in writing) no hope for the future

C thinking they are worthless or have committed an unforgivable act

C hearing voices telling them to hurt themselves or others

C experiencing visual or other hallucinations that provoke terror

C writing or talking of self-destructive plans

C selling off or giving away personal possessions

C endlessly repeating any threatening statement

C alarming changes in mood

If the family member says he or she is thinking of suicide, act quickly. Take the person to a community hospital emergency room with a crisis center or a psychiatric facility. It the person is uncooperative, extremely agitated, or showing no interest in helping himself or herself, call 911 or your local police. When there are threats of violence, the situation is clearly beyond discussion and intervention must be sought.

Aggressive Behavior Toward Others

If a family members behavior is verbally abusive, move away from him or her. Allow time for the individual to try to gain some self-control. That may be all it takes. The majority of people with serious mental illness are not prone to violence.

However, there are exceptions. Should your family member attempt to strike or use any instrument to attack you, defend yourself and other family members. Getting away from that person is the best choice if possible. Call for help immediately---911 or your local police. Do not assume that you can manage the situation yourself.

Mood Swings

Moods or outbursts of temperament are exaggerated and prolonged emotions, usually alternating between severe depression and extreme elation. In the depressive phase the individual may:

C have no energy or enjoyment in living

C state that a black curtain has come over his or her life

C feel completely worthless

C be unable to get out of bed for days at a time

The elation phase is just the opposite but also disturbing. The person may:

C see great worth and joy in otherwise ordinary things and activities

C have an extremely high energy level

C stay awake for long periods at a time before returning to more regular sleep/wake cycle or crashing into depression

C engage in reckless spending

C exercise poor judgement and lack impulse control

This is commonly known as manic depression or bipolar disorder. Rapid-cycling bipolar disorder means just that---the person swings back and forth frequently between extreme highs and lows several times per year. Any type of bipolar disorder---whether accompanied by hallucinations or delusions or not--- requires medical management.

If your family member is already under treatment for a serious mental illness and starts showing these symptoms, check to see if the medication routine has been broken. Call your family member’s treatment contact as soon as possible. Emergency treatment possibly followed by inpatient care may be necessary to help get the individual moving back toward wellness.

Bizarre Speech and Actions

Frequently people heading for a relapse give clues that they are in distress by an odd---and uncharacteristic---manner of speech or behavior.

Language and Speaking Disturbances

If a family member begins sentences and does not finish them---or talks all around a subject without identifying it---you may be witnessing a relapse sign. Sometimes new words or even whole languages are invented. A rush of words with no context (word salad) or extremely slow (vegetative) speech is another clue.

Uncharacteristic and Odd Behavior

Similarly, when a family member acts in ways that are out of character, relapse may be at hand. Examples vary, but some common ones include a refusal to talk, talking too much, talking to people who are not present, talking back to the radio or TV, pacing or an inability to stay still, praying or singing out loud at inappropriate times, withdrawal to a room, public masturbation, and a significant lapse in grooming or hygiene habits.

If your family member shows any of these signs, alert the treatment team. Also explain the social consequences of these action: they won’t be understood if they use words other people dont recognize; talking during a movie upsets people trying to enjoy the film; it makes other people uncomfortable if they touch themselves in public, etc. Try to be nonjudgmental and to stay calm.

Forgetfulness

Forgetfulness can be a problem for anyone. It is generally a sign that one is either preoccupied or has too much going on to remember everything. But if a pattern emerges, such as forgetting usually remembered places, persons, or things, it may be time for a neurological or psychiatric evaluation. A family doctor can make a referral for this. If the individual is already being treated for mental illness, this may be a relapse issue. Contact a treatment team member to discuss the forgetfulness.

Memory problems and physical difficulties may accompany clinical depression. Evaluation and testing can help the specialist to learn if the underlying problem is a consequence of diseases, such as AIDS or Alzheimer’s. The cause might be some other condition, such as improper nutrition or inadequate blood supply to the brain. Chances are good that some improvement may be made with proper treatment including medications.

Acute Sleep Disturbance

A significant sleep disturbance is also a possible warning sign of relapse. When an individual does not sleep, agitation and exaggeration may follow.

C Elation---the “up” part of the mood swing---may be a driving force.

C Overwhelming stress or anxiety could be the problem.

C Use of street drugs, such as amphetamines, can prevent sleep.

C The return of voices and visions may be the culprit.

If your family member denies using drugs and has had no substance abuse problems previously, chances are that the prescribing mental health specialist may order a sleep medication.

If the sleep disturbance is longer term, the treating physician may wish to explore other options. Recommendations include medication changes, additional medications, or sleep studies.

Chemical, Alcohol, and Stress Factors

When a family member abuses his or her own prescription or uses medications prescribed for someone else, a relapse is likely. Relapse potentials also exist when the person begins to drink routinely---especially if consumption is heavy---or to smoke marijuana. The use of street drugs is sure to derail a person from wellness.

In all cases of chemical or alcohol abuse, the behavior must be addressed. Check with treatment team members. Learn if they have contacts with specific self-help groups or if they think it is time for a structured substance abuse program. This could include hospitalization for detoxification and medication monitoring.

Excessive stress in the life of a person who is trying to recover from serious mental illness can be especially harmful. It can:

C trigger the return of primary symptoms

C produce agitation, restlessness, and forgetfulness

C promote the use of alcohol or street drugs

C cause wear and tear on the body

C disturb sleeping and eating patterns

C disrupt personal hygiene routines

C produce inappropriate or exaggerated reactions to events

The family initially may not be aware of the stress overload. However, always pay attention to overreactions in a troubled family member.

In the presence of stress, family intervention and discussion can be helpful. Reorganization of priorities may be needed. Think about delaying the completion of a goal or lightening the task load. Try for a significant drop in the family member’s stress level. Temporary help from the treatment team with relaxation medications or short-term use of anti-anxiety agents could also be of value.

Interactions With Authority

Better medications and treatments are now opening up more choices for individuals who might have had limited social interaction in the past or whose illness interfered with development of a social conscience. The transition to a more normal life will be supported by an acceptance of appropriate rules and authorities.

Understanding Appropriate Behavior

Positive family roles include teaching members with mental health challenges to appreciate and understand acceptable and appropriate behavior. This is especially important when the illness has interfered with interpreting social cues others take for grated. Having respect for others as well as self-respect is a good starting point. In addition to this, fostering healthy relationships with authority figures should be encouraged.

In the family system, parents pass on rules of behavior. As authority figures, they can best help children and adolescents--with or without a mental illness---to buy into appropriate behavior by establishing a structure for the family without being dictatorial. Family discussions of values, rules, and courtesy teach members that group living is built on trust and caring. Hopefully all members---including those trying to manage mental illness---will become appropriately self-directed.

When the situation involves a grown child caring for an elderly parent with mental challenges, familiar roles may be reversed. The child may need to teach and reinforce appropriate behavior to the parent.

Recognizing Rules and the Role of Authority

Responsibility and authority are linked. People with responsibility in given situations should generally have their authority respected. This applies to teachers, police, judges, and other authority figures. The family member managing mental illness needs to understand this.

Breaking rules---or feeling they don’t apply to you---isn’t part of acceptable behavior. It can result in trouble with authorities, such as the police or school administration. It’s important that a mentally ill individual learns, if possible, that actions have consequences. A supportive family helps reinforce this notion both by example and discussion.

Navigating the Legal System

If a family member with serious mental illness finds himself or herself in violation of the law, the family should get involved. However, if the person has been experiencing primary psychotic symptoms along with law breaking, expert legal advice may be needed.

Some treatment teams can direct family members to lawyers who have expert knowledge about mental health issues. These may be private attorneys or public defenders. Another resource for a family is to call the local bar association or community legal aid society. Organizations such as NAMI also may be able to refer you to a legal advocate in your area.

For more information on Mental Illness, CALL:

NAMI of Greater Chicago

1536 West Chicago Avenue

Chicago, IL 60622

(312) 563-0445