I might be suffering from Borderline Personality Disorder, but I don’t know. It might be Bipolar Disorder as well. I have a lot of mood swings, that can last a week at least, and sometimes a month. My moods varies between depression/anxiety with extreme suicidal thoughts and self-harm tendencies and “normal” episodes when I’m mildly happy and enthusiastic, but some other days I can be normal, not really depressed nor euphoric or something, but it generally doesn’t last much. The other day I may wake up depressed as well as enthusiastic and full of hope. It’s not stable at all.
You may say that I have the typical signs of a Bipolar Disorder, but my mood swings doesn’t last much you know, I mean today I’m happy the next day I’m sad and life goes on. My happy moments are usually alternated by sad moments when I feel like crap or when I’m extremely irritable and nervous. They say that Bipolar disorder usually works through episodes that last from 6 months to a year, literally, and that’s what makes me quite suspicious.

I looked through Wikipedia and social forums for Borderline personality disorder and it appears to be that I have many symptoms of the illness, including fear of abandonment, chronic feelings of emptiness, impulsivity, risky habits (alcohol, drugs, cigarettes, sex, wasting money) rage and anger.
I also have dissociative syndrome where I don’t know who I am anymore, I feel as if I’m getting out of my body, I sometimes feel very distant, too. Like a ghost. Like I’m not sure if I’m actually HERE or not, ALIVE or not. It’s really stressful. I also confuse my dreams with reality and have paranoid tendencies.

A: Of course it would not be possible to make an accurate diagnosis via an email query, but I am glad that you are taking the time to ask about your well-being. I can understand the concern and think getting a professional—a psychiatrist or psychologist –to help you sort through the symptoms would be a very good idea. The find help tab at the top can be of help in locating someone in your area.

But I would also want you to be aware of your strengths. You have listed the symptoms that trouble you and the possible diagnoses, but what are the strengths you have that have given you the resilience to cope and to seek answers to help you heal? While you are looking for a label for the condition I would also invite you to look at your strengths. Here is a link to the VIA character strengths survey which is free and can help you identify these features in your life.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

Hello my name is luke, my mother is going down hill fast including anti social and chucking items away and not eating she has been diagnosed with schizophrenia and other things in life and it is getting to the point where i’m ripping my hair out from stress.I woke up this morning to find the coffee table has been chucked away all my stuff from the lounge room is gone I brought her a new bed and she doesn’t want to sleep in it she sleeps on the lounge from about 10pm to 1pm no movement she doesn’t go out or do anything she won’t help her self or let anyone help her. i’m 20 looking after my mother and the house I have no life. I can’t have a girlfriend and if I have friends over she gets angry at them. what should I do? Move out and let her be by herself? or put her back in mental hospital???

A. While I understand your frustration, I would advise against moving out and “letting her be by herself.” I also don’t think putting her “back in the mental hospital” is advisable or even possible unless there is evidence that she is in grave danger because of her behavior or illness.

You mentioned that she wasn’t sleeping and eating, two signs which may be indicative of a psychotic episode. The fact that she’s not eating may mean that she does need to be in the hospital to protect her safety. If that is the case, then it is imperative that you call emergency services or do what is necessary to ensure that she is evaluated at a hospital.

Your mother needs more help than you or any other family member can offer. That seems clear.

If this is not an emergency situation, then contact the local community mental health center, the local hospital, her doctor if she has one, or any other psychiatric or medical professional who you think could refer you to the proper services. There may be home health care services that could assist in your mother’s care. There may be residential living facilities or group homes in which she could be better cared for by a trained, professional staff. Your goal at this point should be to find the best possible treatment for your mother.

Also consider contacting other family members who may be able to assist you. I hope that you’re able to find the proper assistance for your mother. She is clearly not well and you shouldn’t be managing this problem alone. Utilize the assistance of others if possible. I sympathize with your situation. Caring for a family member with a serious mental illness can be an overwhelming task and few lay people realize this. You almost have to live through it to know what it is like. I know that you did not exaggerate when you said you “have no life” of your own.

Hopefully, your mother will improve. You should see a counselor to help you through this process and period in your life. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

I had the diagnosis of paranoid schizophrenia with depressive affects and I am still on medications, but I am seeking help to stop my weird behaviors as well as emotional hypersensitivity. I like being requested to go for counseling/ therapy/ medical interviews/ check-ups/ pressured into sex (I will even daydream about the process), I am an obsessive knuckle and joint cracker for no reason (whether in public or private), I get anxious or excited easily, I self-pity sometimes and enjoy it, and I always weep when I am alone after being criticized (should I try not to). Am I lonely and why? (Does that mean I need more emotional attachment and should seek marriage) Hope to get some input and advice from you. Thank you very much.

A. Perhaps some of your behaviors could be considered “weird” but some would not. You like being requested to attend treatment and being pressured into sex. What exactly do you mean by “being requested?” It may be that when someone requests that you attend treatment, you interpret it as them caring about you.

You also characterized your desire to “be pressured into sex” as being “weird.” Sometimes people have fantasies about being the submissive partner during sexual relations and this fantasy is relatively common. If I were interviewing you in person, I would ask you to explain in more detail what you meant by “being pressured.” Without that information I cannot characterize your behavior as being “weird” or not.

Obsessively cracking your knuckles and joints, being anxious and easily excited and crying alone after being criticized, may be indicative of anxiety. I would need to know how often these issues arise and in what situations, to determine if they are outside the norm. For instance, what do you mean by obsessively? Every day, all day? Only when interacting with certain people?

Without being able to gather more information about the aforementioned issues, it is difficult to provide an accurate assessment of the problem. I would recommend talking about this with your mental health professionals to determine if there is a problem. Only a mental health professional who interviews you in person could answer your specific questions and determine whether or not there is a problem. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

My 8 year old adopted daughter has had 4 different therapists including neurotherapy. She has yet to have someone really diagnose or help us with exactly her problems. She was adopted at 2 years old and spent the first 2 years of her life being seriously neglected and abused.

Up to this point we have treated each behavior problem individually but recently my husband and I realized they are ALL connected. She exhibits a disconnected behavior from her mind/body. In that she doesn’t seem to care if she is uncomfortable or in pain. She urinates herself at night but also daily. She doesn’t seem to care and yesterday even walked around with feces in her panties. She will wear her pants backwards and will not tell an adult if she is hurt. She will not wipe her face or complain of bad smells. She would sit in the bath and burn herself if the water was too hot rather than complain or try to get out of the bath. She seems to have very little conscience when it comes to other people’s feelings.

One therapist diagnosed her with RAD and another with ADD. She is very manipulative and passive aggressive. My question is without knowing all the other details what type of mental disorder(s) would cause a mind/body disconnect? She seems to not feel pain physically or mentally. She can feel physical pain but does not react to it in a normal way. Please help!

A: How very, very sad. I agree that everything you are observing is connected. What concerns me beyond the lack of reaction to pain is the apparent regression to very primitive behavior.

It is indeed possible that she has reactive attachment disorder. When a child doesn’t have the nurturing and care they need when very little, the child doesn’t have a model for caring, for self-care and for socially normative behavior.

Unfortunately, it’s also possible that your daughter has another mental disorder. Autism, intellectual disability, childhood disintegrative disorder and childhood schizophrenia all include some of the symptoms you describe. That’s just to hazard a few guesses.

Without a clear diagnosis, therapy can’t be helpful. The therapist doesn’t know what should be treated. I urge you to take your daughter to a medical facility that specializes in childhood psychiatric problems. First, she should be thoroughly checked for any medical condition that may be contributing to her behavior. Then she needs to be screened by specialists in childhood psychiatry.

Having a chronically ill or mentally ill child is as stressful as it gets. I hope you and your husband are also getting help for yourselves. Ask your doctor for information about support groups for parents. Often other parents are the best source of information, support and practical help.

I wish you well.
Dr. Marie

Diagnosed with paranoid schizophrenia at age 15 but the doctors at the mental hospital did not even bother to look into the problem very well they just diagnosed me after my 2nd admission because i was hearing voices and seeing demons in the dark. Now im 19 years old and its gotten a lot worse but its not just paranoia and hallucinations anymore now i also seem to have hard time understanding things i could be told one thing and i will understand it all wrong and by the next week i will have completely forgot it and i have extremely hard time learning.I also cant seem to remember anything about my own life recently i started having visions of my past and not being sure if its real or not i ask mother and she verifies that it did happen exactly how i saw it so is my memory returning and why in visions? I now remember i always had this memory problem since a child but not to such a severe extent also showed many of the childhood schizophrenia symptoms but everyone always just passed it off as normal child behavior so i never got the treatment that could of prevented this.I seem to do unusual things like repeat a series of movements over and over completely unaware of it while its going on until i finally realize what i’m doing and stop or i will just begin to repeat weird sounds out loud over and over for absolutely no reason then stop and carry on like nothing happen until days later i’ll realize what i did.And i have these delusions that seem so real i jump from delusion to delusion from thinking im being watched by everyone in the world threw cameras in home and being listened to threw bugs in my phones and t.v, thinking tv shows are based on my life thinking music artist music is based on me or made to send me a secret message, Or thinking im the devils son and its my rightful place to rule the underworld and because i’m his son i have been given the gift of telepathy this ones hard for me because i will hear voices of loved ones talking to me as if i really am talking to them they have their personality and everything so i believe i have this unique power no one has because i’m the devils son. its all so real it has me left confused what is real and whats not i get reality confused with none reality and vice versa i also cant show emotions correctly if i show them at all.Also ever since i was a child always been very anti-social i was forced to socialize at school but rarely hung out with people outside of school until i was expelled then it all went down hill because i was always alone they began telling me to do awful things to others so that caused to pull away from others even the slightest thing would throw my mind into sick mood were demons would graphically explain to me what to do to the individual i began to like the idea of doing these things so i withdrew from everyone for everyone including my own safety it helped to stay away after awhile it went away but now i’m used to being alone but its not healthy i dont even trust my own family very much because of what the voices tell me and it seems like when they tell me something they have so much prove on the delusion if its even a delusion.I have been able to master the skill of hiding this disorder i could be losing my mind inside and hide it so it appears nothings going sometimes i will show no symptoms besides not having the ability to learn and understand the world around me but it does not stay dormant very long. I need you therapists opinion what exactly is happening to me and how much worse will it get. oh and i didnt add the meds never really helped me all they did was sedate me severely to the point of me not functioning they said it would go away but i was on them for year and a half of nothing but switching them over and over.So all im asking for is an honest opinion on whats happening with me and maybe some actions i can take thank you.

A. I’m sorry you’re experiencing so much distress. It seems as though you are experiencing symptoms of psychosis. It’s not clear from your letter whether or not you are currently taking medication. You did say that you’ve been on and off of medication but nothing seems to have worked. If you’re currently not on medication, then in all likelihood it would be the case that you are experiencing psychosis. You have many of the signs including delusions, hallucinations, hearing voices, experiencing paranoia, and so forth. These symptoms need to be controlled. Medication is typically needed to decrease or eliminate symptoms of psychosis.

I understand that medication can make you feel sedated. Many people have this complaint. It is a matter of finding the right medication in the right dosage. For many people, this takes time and a concerted effort on the part of the treating physician and the patient. My advice is to find a psychiatrist whom you trust and who is willing to take the time to find the right medication for you. Once you find the right psychiatrist, ask him or her to start you on a low dose of medication and adjust it accordingly, depending on your symptoms and how you react to the initial dose.

You may also want to consider going to the hospital. You may or may not be a candidate for admission but a hospital stay would allow a team of doctors to assess your symptoms, attempt various medications and adjust the dosage accordingly. The ultimate goal would be to stabilize your symptoms and find a medication that you could tolerate.

It’s also important for individuals with schizophrenia to live in a stress-free environment. Some theories of schizophrenia suggest that stress has the potential to cause psychotic episodes. We know that in many cases, it exacerbates one’s symptoms. Ideally, you should always be attempting to decrease or eliminate stress. You should also be searching for the right psychiatrist who could assist you in finding a medication you can tolerate.

Finally, I would also recommend gaining support. Is there a family member who could assist you? Try to gain as much support as possible. It might be difficult for you to navigate the mental health system when you’re experiencing symptoms of psychosis. Ask your family members or those who are willing to assist you to help you gain access to the proper mental health treatment. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

I hospitalized three times for attempted suicide. said bipolar 2 disorder, on meds for schizophrenia: I had what i term to be some sort of break down four years ago. I believed that the school system, my friends and family were trying to take my children from me. I would see random things like book titles that were laying around the house that led me to believe this to be true. I believed that songs that came on the radio were trying to warn me also. I quit showering, grooming and everything because I believed that there were video cameras that were placed throughout my house, in my car, and that i could be monitored throught the tv in my home or where ever i was by the police.Everytime i would see a police cruiser, i thought they were following me. I was seeing someone at the time,we were engaged to be married. I started believing my fiancee and my sister were secretly seeing each other and along with everyone I know and ever knew were trying to kill me by poisoning my food, drinks, or by doing/saying things to make me feel as is if I was loosing my mind. This lead me to barely eat anything for a period of three months. I tried talking to a few people as to what was going on, but only to have them think i was blowing it out of proportion, even my family doctor.I sat in my mothers living room at one time screaming and crying while home alone because i was surrounded by fire. I was convinced that my family was going to lock me in the basement and burn the house down to get my kids away from me. I would go outside and sit crouched facing the corner with a hood over my head just to smoke because i was so terrified. I tried to talk to my mom and aunt to tell them what was happening with me, to no avail. This lead me to try suicide on three seperate occassions within a year. I was hospitalzed on all three occassions being told i had bipolar 2 disorder. But one thing about that is, they had no clue of the things i was seeing/hearing. They never asked. Not one time. I have been placed on several different medications (9 at one time). we have tried depekote, and geodon but they just zombify me to the point where i can not function at all, just sleep. I fight insomnia but at the same time have days where i can not get to sleep. I have rapid thoughts that lead into anger and just break down and cry, even at work. My doctor has placed me on latuda to try and control the symptoms. But the research i have done says that this medication is for schizophrenia and is not approved for bipolar disorder. I dont really know much about schizophrenia and when i try to talk to my doctor about my diagnosis whether it be the bipolar or schizophrenia, he has just asked me why i would want to label myself. I don’t, i want to know more about the conditions so as to educate myself and how to control and recognize what the symptoms are to get a handle so i know what to do and how to recognize when im coming into a crisis situation, i do not have a support group, im on my own with this. My question is, does the bipolar 2 disorder have this sort of symptomology, or is this more leaning toward the paranoid schizophrenia? the Latuda does help control the delusional thinking to a point, but the paranoia is very hard to keep at bay. I just need a better understanding of what is going on with me. Thyroid has been ruled out, but the seratonin levels are all out of whack. Thank you ahead of time for your time and understanding.

A. It is difficult to know precisely which disorder you may have. It’s possible that you have schizophrenia but another possibility is schizoaffective disorder. Schizoaffective disorder is loosely a combination of bipolar disorder and schizophrenia. In many cases, finding the right treatment is more important than pinning down a diagnosis.

What may be happening in your case is that you withheld information from your prescribing doctor, and were given an ineffective medication. To the best of your ability, it’s important to report all of your symptoms so that you can receive the most appropriate treatment. My advice is to contact the prescribing physician, report every symptom and be as honest as possible. Given new information, your doctor may prescribe a different medication which could significantly reduce your symptoms. Having the right medication could be the difference between having controlled and uncontrolled symptoms.

You also stated that you have no support. Is there a support group in your local community? Are friends and family willing to assist you? At this point in time, you need as much support as possible.

You’ve been through a lot. You have been battling significant mental health symptoms for at least four years and you refuse to give up the fight. I admire your determination and persistence. Having the proper medication could greatly assist you in reducing or potentially eliminating your symptoms. Talk to your doctor and hopefully, a change can be made immediately that would bring you relief. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice

Son being content with no outside life ;no work no friends does not go anywhere/ He was diagnosed at 18 with schizophrenia.. he could not hold a job down.. he self medicated got caught went to prison and since prison no meds he is quite content just exercising and listening to head phones..he thinks when his parole is over he can in the army my fear is… Is that going to make him finally realize he is sick or will it cause him to go back to psychosis or depression ..I am just trying to prepare myself..

A. He may want to join the army but if he’s actively symptomatic he may not be eligible. At this point, it’s unclear what will happen to your son. Without more information, it is difficult to know.

Generally speaking, among individuals with schizophrenia, changes in life circumstances can trigger psychotic episodes. For instance, a death in the family, moving, beginning college, and other stressful situations have been associated with an increased likelihood of psychotic episodes among individuals with schizophrenia. Not taking medication can also increase the likelihood of psychotic episodes.

Many people with schizophrenia live successful, productive lives but it is a struggle. Given his diagnosis, and his refusal to take medication, he is at risk for psychosis. Individuals with schizophrenia who do not participate in treatment have more psychotic episodes than individuals with schizophrenia who actively participate in treatment. In that regard, you should be prepared for the possibility that he will have additional problems.

Continue to encourage him to accept treatment. It would also be advantageous to connect with others who have schizophrenic family members. People in similar situations can provide emotional support and may be able to share strategies to help with your son. You should also educate yourself about the disorder. I would highly recommend the book “I’m Not Sick I Don’t Need Help” by Xavier Amador, and other similar materials. The book might help you to better understand why your son refuses treatment and what you can do to help. If I may be of additional assistance, please don’t hesitate to write again. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

My sister is a married 42 year old mother of 2 girls. All of her life is has been a bit paranoid. A few years ago, she began taking drugs and drinking. When she got a full time jib, things seemed to return to normal. For the last year or so she has been really stressed out with work and family issues. Her paranoia has gotten to the point that she hears voices and sees things that aren’t there. She sees messages written in the grass, swears that her phone is sending her messages that her husband is trying to destroy her, a neighbors house burned down and she thinks her husband caused it because he’s part of some mafia, she believes her husband is having an affair with women he has never met, she has even started accusing her 14 yr old of conspiring with her father. She thinks my mom is in on this plot to destroy here. She honestly believes all this and more “out there” things. I do know that she has been prescribed Suboxone. She has sent me pictures of scratches in her furniture that she believes are messages from people. I see nothing. She refuses the idea that she may be wrong. I know that I can’t force her to go to a dr, but I really don’t know how to approach her about going to see someone. She doesn’t trust her husband, so I feel like its a bad idea for him to say anything. What can I do? I am terribly scared for her! She has never been diagnosed with schizophrenia, but it’s the only thing I can think of. PLEASE HELP!

A. It’s not clear whether she has schizophrenia but she does have symptoms of a psychosis. It can be immensely difficult to convince someone who is psychotic to seek help. As you have noted, she is paranoid. She thinks people are attempting to harm her. She has difficulty trusting even the closest members of her family. Many people describe the experience of psychosis as being horrific and frightening.

You cannot force her to seek treatment but you should encourage her to do so. Utilize the help of your family. Perhaps if your family banded together and suggested that she seek help, she may be willing. It’s unlikely, but it’s worth a try.

If she will not comply, then you may have to involve mental health professionals or the local crisis team. In your community, there may be a local crisis team who can evaluate your sister in her home. If they feel that she is a danger to herself or others, or is in grave danger of decompensating to the point where she can’t care for herself, they may be able to force her into the hospital temporarily. The hospital can keep her safe, evaluate her condition and provide her with the appropriate treatment and medication.

In the meantime, I would encourage you to contact the local National Alliance On Mental Illness (NAMI) organization. Virtually every community has a NAMI organization. You can call their local offices, discuss her case and ask for advice or a referral.

I would also urge you to call the doctor who is prescribing your sister’s medication. He or she may not be able to provide you with information about her case, but there’s no law against you reporting her symptoms. Perhaps her doctor and her treatment team may be able to provide you with assistance in this situation.

Undoubtedly, you’re faced with a difficult situation. The situation you have described, where someone is actively psychotic but refuses to seek help, is one that many families face on a regular basis. Utilize the help and support of NAMI, the local mental health crisis team, her prescribing doctor and the local emergency room if necessary. I hope this situation can be resolved successfully. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice Blog

For about two years I have sort of thought that people can hear the thoughts in my head and recently I also feel like God, Jesus, demons and the devil talk to me in my head and I talk with them. I have started to feel more important than everyone else, I have started to think some people don’t deserve to be on the same planet as me. All my life when I have watched shows about killers I hated them and wanted to torture and kill them but I feel like I am different and I should be able to kill because I know wrong from right better than everyone else really, I would kill people who deserve to die and go to hell. I also have opposite thoughts, I obsessed with and sexually attracted to Jeffry Dahmer, I have repeated dreams about being back in time and changing his sexuality to like women and killing with him even though I know it is all wrong and strange. I am starting to become scared of myself. Do I need help?

A. Much of what you are feeling is abnormal. It’s especially concerning that you hear voices. You also described feeling “more important than anyone else.” From a clinical perspective, you may be experiencing grandiosity which occurs when an individual has an exaggerated belief about their abilities. Both hearing voices and experiencing grandiosity are signs of a possible psychotic disorder.

Your beliefs that you “should be able to kill” and that you would “kill people who deserve to die an go to hell” is also concerning. It’s also abnormal to obsess and to be sexually attracted to Jeffrey Dahmer. Jeffrey Dahmer was a cannibal who murdered people. He destroyed the lives of many families. There’s nothing romantic or intriguing about him. In the view of the majority, he is an immoral individual who deserved to be incarcerated for the rest of his life.

Yes, it would be in your best interest to seek help. You stated that you’re “scared of yourself” which means that you may be losing your ability to control your behavior. See a mental health professional immediately. If you feel you cannot control your behavior and that you are at risk of harming someone, it is imperative that you go to the hospital or call 911. Don’t ignore this problem. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice

I married into my husband’s family who is relatively closed about mental illness. I now know his two sisters (both over 45) have schizophrenia. My mother in law is 76 and keeps them home. One daughter can sometimes be violent and the other daughter constantly talks to herself (I think she is hallucinating). Supposedly they are both medicated, but I’m not sure if my mother is keeping them medicated. I have two questions. Shouldn’t the anti-psychotics stop her voices/delusions if she’s on proper meds? Also, my mother in law fully expects us to keep them out of homes when she passes? They require so much care. How do families handle this?

A. It is possible to continue experiencing mild psychotic symptoms when taking antipsychotic medication but generally it is a sign that the dosage needs to be adjusted or that the patient is not taking his or her medication. The fact that one or both of his sisters continue to have incidents of violence and continue to experience significant psychotic symptoms in all likelihood means that there is a problem with medication.

Approximately 50 percent of individuals with schizophrenia do not believe they are ill and refuse to consistently take medication. It is immensely difficult, and in many cases impossible, to force individuals to take their medication. Even patients in heavily supervised hospital settings are able to avoid taking their medication.

Your mother-in-law’s expectations are unrealistic. She made a decision to care for her daughters in her home but you are free to make a different choice. Ultimately, the choice is yours. Their disorders are not well controlled. They require the treatment of trained mental health professionals who have the knowledge and experience to properly care for individuals with serious mental illnesses. It is unrealistic to believe that you could properly care for them. I would strongly advise against it. Please take care.

Dr. Kristina Randle

I have been experiencing most of the negative symptoms of schizophrenia, except for depression, but I appear depressed to other people. I have some positive symptoms as well, like paranoia (which I’ve had for years) and acute senses. I’m more sensitive to noises, and on a couple of occasions have heard people I know say something or call me, when they claim they didn’t. I’ve also experienced some very mild perceptual illusions. I’ll think a shadow is a moving bug, and once I thought I saw smoke in the dining room, but nothing was cooking or on fire. I’ve also felt more violent, reclusive, and hostile, although my general mood is fine and even happy (especially when I’m daydreaming, which is often). My views regarding humanity and religion have gotten passionate and what others would call outlandish and cynical, but I feel like some renegade who’s smarter than all of them, and I don’t talk about aliens or anything that would be considered an overt delusion. I feel…pre-delusional sort of. I do know that my opinions are different and that logic could argue against them, but it doesn’t stop me from believing what I believe. My attention span and short term memory are terrible as of recently as well-my memory problems having started first.

A. It’s possible that you are experiencing early symptoms of a mental health disorder, potentially schizophrenia or a personality disorder: schizotypal disorder. Among psychotic disorders, early symptoms of psychosis are referred to as the prodromal phase. Research shows that the prodromal phase is characterized by changes in perception, beliefs, cognition, mood, affect and behavior. Nearly 80 to 90 perfcent of individuals who ultimately develop schizophrenia report experiencing early prodromal symptoms.

Many researchers and clinicians believe that patients experiencing prodromal symptoms should begin treatment immediately. The importance of early intervention among individuals experiencing early psychosis symptoms cannot be overstated.

Early treatment of psychosis can prevent the development of a full-scale psychotic episode. I would recommend seeking professional help immediately. Make an appointment with a mental health professional and report your symptoms.

Another consideration is to contact a psychiatric hospital or a local university to determine if they have a “first episode” program. Around the world, there has been an expansion in the number of “first episode” and early psychosis programs. Researchers recognize that early diagnosis and treatment could prevent the development of psychotic episodes or assist individuals in recovering from their illnesses more quickly. Please take care.

Dr. Kristina Randle

When I was 21 years old I started having visions and hearing things that others did not. I thought and still do think, I am special because of it. However, I started to feel like I did not want to be special any more. I went to the doctor and was treated for depression…

I am now 35 years old. I am college educated, I had a great career…children and now everything is falling apart. I used to be able to drown out the voices when they became overwhelming. I am having trouble dealing with it. They call me names and scream at me. They used to be friendly and even helpful. I am also extremely worried that someone will hurt me and my children.

I started seeing a therapist in October but I could not tell him everything. I did not really trust him. I felt by the way he was speaking to me that he was trying to judge me. I was also very afraid that he would have me arrested and take away my children. I was taking medication, but the voices told me that if I continued to take them I would die…I thought it would be in my best interest to listen….

I have an appointment with a new doctor next month…what should I do? Should I tell the doctor everything? Is this normal? Am I suffering from a depression?

A. Yes, you should tell your doctor about the symptoms that you are having. Withholding information from your doctor makes it difficult for him or her to properly treat your problem. The fact the you withheld this information from previous mental health professionals means that they may have misdiagnosed you with depression. Nothing in your letter suggests that you have depression. Your primary symptoms seem to be delusions and hallucinations, neither of which are symptoms of depression. They are in fact symptoms of a possible psychotic disorder such as bipolar disorder or schizophrenia. I cannot say with certainty whether or not you have a psychotic disorder but it is a possibility. That is why it is imperative that you report all symptoms to your doctor so that he or she can treat your symptoms accordingly.

There’s no reason to believe that you will be arrested or that your children will be taken away from you. Your children are not in danger. The authorities only remove children from their parents in cases of imminent danger. You’ve done nothing to suggest that you might harm your children. Simply having symptoms of a mental health disorder does not make you a danger to your children.

I would encourage you to read the New York Times article by Elyn Saks entitled “Successful and Schizophrenic.” Elyn Saks is a university professor, a successful researcher and the recipient of the MacArthur Foundation genius grant. She has schizophrenia and has been wildly successful in her life. In the article, she describes some of the ways in which highly successful individuals with schizophrenia manage their delusions and hallucinations. Some utilize cognitive techniques. In one instance, one particular individual would ask the following questions of himself when he began to experience hallucinations: “what’s the evidence for that? Or is it just a perception problem?”

She describes another individual who would simply “blow off” their derogatory voices. Another individual identified their triggers for the purpose of preventing a “full blown experience of symptoms.” Others used techniques such as minimizing sensory outputs, exercising, focusing on work, getting proper sleep, healthy diet, avoiding alcohol, and prayer.

There are very effective treatments and strategies that you can employ to significantly decrease or eliminate your symptoms. The sooner that you report these symptoms to your doctor, the sooner your symptoms can be properly dealt with. Please take care.

Dr. Kristina Randle

About a year or two ago, I started to perceive what I thought to be speculation on my part as to what the future would hold in my dreams. Like conversations that I would have with my friends. But then they started to happen. I was able to quote what my friends would say before they would say it.

This problem is truly beginning to scare me, and has caused me many problems with retaining friendships and relationships. Recently, I was also diagnosed with a major case of Schizophrenia, and I have been on meds for it, but the dreams won’t stop. I don’t know if I am hallucinating or if I am demented, or if I really can tell the future. Can you help me?

A. What complicates this situation is the fact that you have schizophrenia. Schizophrenia tricks the mind into believing things that are not true. I’m not suggesting that having schizophrenia discredits your assertion about predicting the future, but it is possible that you are misinterpreting the predictions, which may be hallucinations.

The best way to determine if your dreams are accurate would be to write them down as they occur and to compare them to future events. Having your predictions in writing before a possible event will allow you to know whether you’re indeed predicting the future. However, I would not recommend doing this alone. You should do this in tandem with a mental health professional who can help you to determine what is real and what is not. It is always important to be grounded in reality and a therapist could assist you. If you’re not in contact with a mental health professional, then you should be. It is always wise after being diagnosed with a serious mental illness to undergo psychological treatment and not just medication alone. Please keep me posted on your progress. Please take care.

Dr. Kristina Randle

I’ve been diagnosed with purely O OCD last month but I don’t know if my thoughts are obsessions or already delusions. I don’t know if I’m losing my grip on reality but just a good few hours ago, a random thought popped into my head: “What if everyone were cats or aliens and I’m just imagining them as people?” It never stops to bother me now and even though I know it’s completely ridiculous, I just can’t help but worry that I might start to believe it and see people that way. It’s like my belief systems are being challenged cause I don’t have a set religion as of yet. (i.e.: my OCD’s caused by some entity) and I don’t know what to do. I’ve always had faith in science and now it’s hit me that there’s probably some supernatural forces at work in my mind even though that sounds a bit absurd. I’ve found solace and comfort in the company of people when I have OCD panic attacks so maybe my brain did this for me to become more miserable. I just don’t know what to believe anymore. I’ve been on two meds and they helped me feel like myself again for two weeks but then it’s back to this situation as soon as I dabbled with the idea of something paranormal working against me. I just fear losing control and becoming clinically insane and non-functioning. :/ Do you think I’m slowly slipping into schizophrenia or insanity? Are these just obsessive thoughts or already delusions? I worry that I might convince myself into believing/doing these things and that horrifies me. Everytime I talk to someone now, a thought pops up in my head and says ‘Why am I talking to this alien?’ I know it’s too ridiculous but I don’t know what to do anymore. Please help ASAP! Note: I’m currently on Lexapro and Rivotril.

A. Individuals with a specific type of obsessive-compulsive disorder (OCD) commonly believe that they are developing a mental illness, often schizophrenia, because it’s considered to be the most severe and they fear it the most. They might become obsessed with the fact that they are going “insane” or developing psychosis. It is quite common. The thoughts that “pop into your head” are likely obsessions, a symptom of OCD. My sense of the situation is that your symptoms are most likely associated with OCD and not the development of psychosis but only an in-depth, psychiatric interview, with a mental health professional, could provide a diagnosis.

The fact that you have been diagnosed with OCD, and are being treated for OCD (rather than schizophrenia) increases the likelihood that your symptoms are not indicative of psychosis.

It is a concern that you are taking two psychiatric medications, yet continue to experience significant symptoms. It may mean that your medication needs adjusting. Report your symptoms to your prescribing physician who can then adjust your medications accordingly.

If you are not currently in psychotherapy, you should consider it. OCD is a complex disorder which often requires both medication and psychotherapy. One without the other is generally not recommended. Please take care.

Dr. Kristina Randle

I am 20 years old and since the age of 12 I’ve changed from curious to strange. I dropped out of high school at 11th grade, never worked a day in my life, and have zero friends. I’ve always been depressed for as long as I remember. I hate speaking and being around people (even family) and I’ve always had this interest in death whether I wanna kill others or myself. I see things all the time and when I double check, it’s gone and I always hear things from the voices of people I know but they never actually said them (like calling my name). I also do things I don’t ever remember doing and cannot concentrate on anything. I’ve been hospitalized 3 times, 2 for depression/suicide thoughts and one for wanting to kill a family member. I’ve been prescribed antidepressants and anti psychotic but never took them cause my mom n older sister doesn’t take me to get the message cause they think refuse to understand me.. Please help, I wanna stop hurting inside.

A. I am sorry that you are faced with this difficult situation. It’s unfortunate that your mother and sister aren’t supportive. In this case, I would advocate joining a support group. The local community mental health center might have a support group available to you. The National Alliance on Mental Illness (NAMI) likely also has support groups.

Another idea is to contact the hospital social worker, report your dilemma and ask what resources are available to you. For instance, many communities have mobile treatment teams, staffed by psychiatrists, social workers and nurses, who make daily trips to patients’ homes. They administer medication, assess the patient’s stability and ensure that their needs are being met. Perhaps such a program is available in your community. It would ensure that you receive your medication. It could also provide much-needed mental health and emotional support.

It is important that you do what is necessary to receive the proper treatment to improve your mental health. The fact that you are hearing voices is concerning. Medication could eliminate the voices and help you to feel better.

If your symptoms do not improve or if you feel that you might harm yourself or someone else, go to the emergency room or call 911 immediately. Emergency personnel will keep you safe until your symptoms are under control. Please take care.

Dr. Kristina Randle