Schizophrenic Brother Talks to Himself

By Kristina Randle, Ph.D., LCSW

I am sending this message hoping that you will be able to help, or at the very least offer advice about my brother’s condition. My brother was socially awkward from youth, and eventually became depressed at an early age when he was put in the “special classes” back in elementary school. His depression grew with him throughout high school. At approximately 16, he stopped going to classes and isolated himself from the world. He would not be in contact with anyone, gave up his friends, and eventually stopped communicating with his own family. At one point about 2 years later, we found him lying in a bathtub speechless in a state of catatonia. We later found out that he had developed catatonic schizophrenia. We had no choice but to hospitalize him so that he could eat, sleep, shower, and do activities that he was unable to do in his catatonic state. He was given high doses of ativan coupled with resperidal and celexa. (during junior and high school, he was prescribed antidepressants, but they were ineffective.) Unfortunately, these medications began to wear off, so we swtiched medicatons, trying different types of atypical antipsycotics, such as seroquel, invega, and even saphris. NOTHING worked. Some even caused dangerous side effects, such as an involuntary head jerk. So we returned to resperidal and lexapro. Unfortunately, about a year ago, he began to develop a very serious and uncontrollable case of talking to himself. This goes on throughout the day, and when he speaks to himself, it is as if he is in a trance. He is unresponsive, and usually angry. He also yells obscenities, sometimes yelling inappropriate things in public. We recently switched medications to Latuda, assuming that the resperidal was responsible for his speech problem, but it made his problem worse, so we switched back to risperidal. We don’t know what to do at this point because we cannot see him in this state, but at the same time, we fear that removing him from medication will cause him to fall back into a catatonic state. It is a very sad case because he was normal growing up. Unfortunately, his problem is growing with him and we can’t even find treatments. If you know of any specialist in the New York area who would be willing and able to treat him, please let us know. We would greatly appreciate it.
All the best.

A. I am sorry but I do not have any specific physician referrals for your brother. My general recommendation is to have him evaluated by multiple psychiatrists and neurologists. I am suggesting that you consider neurologists because of the nature of your brother’s symptoms.

Some of his symptoms may be characteristic of schizophrenia, including talking to himself, unresponsiveness and emotional instability. Others may not be characteristic of schizophrenia, including yelling obscenities and doing so in public. The latter symptoms may be more characteristic of Tourette syndrome. Tourette syndrome is a nervous system disorder that often begins in childhood between the ages of seven and 10 years old. It affects males at a higher rate than females. Characteristics of this syndrome include repetitive, involuntary movements and vocalizations, called tics. It is possible that your brother is experiencing tics and cannot control his behavior.

Alternatively, it may be that his involuntary symptoms are related to schizophrenia or they are side effects of his psychiatric medication. Having so little information makes it difficult to discern the cause. That is why it is important that he’s evaluated by multiple types of specialists. I would recommend speaking to his current prescribing physician about a referral or several referrals to highly trained specialists.

I would also recommend conducting Internet research regarding the best specialists in the New York area. You may want to start at the Columbia University Medical Center website which can be located here. Their psychiatry department offers a toll-free referral line. That may be a good place to start.

Another good resource may be The National Alliance For Mental Illness in New York. They too offer a helpline and Internet resources that may be of assistance to you. Their website is located here.

I am sorry that your brother and your family are experiencing such distress. It is difficult to watch a loved one suffer. It can be a helpless feeling. Your brother is fortunate to have a loving and caring family who are concerned about his well-being. I sincerely hope that you can find the proper help for your brother. Please take care. Best of luck to you and your family.

Dr. Kristina Randle

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Last reviewed: By John M. Grohol, Psy.D. on 5 Dec 2011

APA Reference
Randle, K. (2011). Schizophrenic Brother Talks to Himself. Psych Central. Retrieved on December 18, 2014, from http://psychcentral.com/ask-the-therapist/2011/12/05/schizophrenic-brother-talks-to-himself/