Can I Rule Out Schizophrenia?

By Kristina Randle, Ph.D., LCSW

My son is 23 yrs old. He is completing a master’s program at the university in state. His father is BP/schizophrenic. My sons grandmother is also plagued with illness as well as great grandmother. I would like to know if there is a particular order of family members that maybe exposed to this as it is hereditary. My son has been drinking alcohol more frequently. His father is also an alcoholic. My son displays a lot of anger as well as difficulty communicating emotions. His personality has changed and I am concerned. Could this in fact qualify as schizophrenia? He is very, very mean to me. What could I do to rule out this illness? He would flip if I asked him to see someone. Thank You, Julie.

A. Dear Julie, it is difficult to know if he would qualify as schizophrenic because I have so little information about him. As you probably know, I would need to have much more information about him and his history to discern whether he has schizophrenia.

With regard to your question about heredity, there is no known sequence of family members that the disease is known to affect. Because he has a family history of schizophrenia, he is at an increased risk for developing the disorder. Generally, people who have schizophrenia are more likely to have offspring who also develop it. Also, more immediate family members have a higher probability of developing schizophrenia than non-immediate family members. A person who has a parent with schizophrenia has a 13-15 percent chance of developing it and the risk for grandchildren or cousins is even less.

Even though it’s not possible to determine your son’s diagnosis based on a short letter, you mentioned four aspects of his behavior that are concerning. They are his drinking, anger, change of personality and his difficulty communicating emotions. Communication and emotional difficulties are hallmark signs of schizophrenia. A change in his personality and behavior may signify that a psychotic episode may be on the horizon. Among those who develop schizophrenia, there is often a one or two year period (it varies for everyone) prior to a psychotic episode in which an individual begins actively experiencing symptoms such as difficulty making choices, anxiety or problems with concentration. Some people also become isolative and have problems communicating with others. During this phase of the illness, an individual’s symptoms are noticeable but usually are not severe. This period of time characterized by less severe symptoms is called the prodromal phase and it usually precedes a full-scale psychotic episode.

Your son may be in the midst of the prodomal phase of schizophrenia but there is no way to be certain of this because he is abusing alcohol. The alcohol use makes it impossible to know if his symptoms are being fueled by or caused by alcohol or whether he is drinking as a way to self-medicate and thus to feel better. The reality is that his use of alcohol greatly compounds this situation and makes it very difficult to know what is really going on.

You said that your son would not be amenable to seeking help. That is the case for many people with schizophrenia. Many people with schizophrenia do not believe they are ill. Their inability to recognize their illness makes it difficult for them to accept treatment. Ideally, once it becomes apparent that an episode has begun, treatment, usually in the form of antipsychotic medication, should begin immediately. Taking medication during the early phase of the illness when the symptoms are milder could prevent the occurrence of a full-blown psychotic episode.

Realistically, all that you may be able to do is to monitor your son to ensure that he is not harming himself or attempting to harm others. Given how the mental health system operates in most states, you might have to wait until he is severely ill before you can call for help. I have worked with people who have been extremely delusional and clearly in need of hospitalization but the commitment laws prevented that person from being admitted for care until they had literally attempted to harm themselves or others. Not all state laws are that strict and I would encourage you to call the authorities or a mental health crisis team if you feel it is necessary.

I would also encourage you to help your son to stop drinking and to seek help. Some families band together to send a unified message and this can work if everyone sends the same consistent and firm message. For instance, if your son drinks in the house, you can gather the family and decide that you will all enforce a new rule: that he will no longer be allowed to drink alcohol on your property and if he does, you will call the mental health crisis team. Sometimes, you need this extra leverage to control the behavior of a person who is psychotic and unable to think clearly.

I hope this answers your questions. Please take care.

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Last reviewed: By John M. Grohol, Psy.D. on 15 Dec 2008

APA Reference
Randle, K. (2008). Can I Rule Out Schizophrenia?. Psych Central. Retrieved on July 29, 2014, from http://psychcentral.com/ask-the-therapist/2008/12/15/can-i-rule-out-schizophrenia/