Q. Hello, Just recently my sister had what I believed to be a mental breakdown. After a few visits to the emergency room we decided that involuntary commitment to a mental health facility would be the best for her. While she was at the mental facility she was diagnosed as Schizoaffective. She had an extremely hard time with the staff there and one of the other patients raped her (yes, it has been proven). So we promised never to send her to that hospital again.

Because of the rape she was not able to fully recover from her first mental break and relapsed. This time we sent her to a different mental health facility in which she also disliked but we knew that she was safe. There they diagnosed her as having a Psychosis but never gave her a technical diagnosis. When I talked to her doctor he said that he would not say that she is schizoaffective but that only time will tell.

Since being home she has only told me of one incident that she experienced. She thought that the TV was sending her messages but, she was mentally clear enough to say this is not real and walk away. She still believes that all the hallucinations that she experienced and the messages she was receiving were real. She still believes that there was reason for her extreme paranoia and panic.

Is this a sign that she is getting sick again? Now that we are all at home I am the only person that has contact with her everyday. I was wondering what signs I should look for to warn me of another break and what should I do if I think she is having one.

Also, are there differences that I should know between the two disorders that I should also look for? I want to be able to tell the doctor about her behaviors at home so that we can find the right diagnosis.

Lastly, since the rape occurred she has been unable to move past it and wants to sue everyone who was involved. We have talked to lawyers and the state that we live in has made it almost impossible to sue any hospital for any reason. They say that she is not accountable as a witness because she was mentally ill. How do I help her get past this? Is this normal, not to be able to see when people are telling you no? Should I support her in her endeavor to sue even if it’s not a realistic possibility? Sorry about all of the questions, I just can’t seem to find the answers anywhere else. Thanks.

A. I am glad that you wrote. Your situation is complicated and I will try my best to answer all of your questions. I wish to also say that your sister is lucky to have you helping her through this challenging time.

How can I tell the difference between a mental breakdown and schizophrenia?” With limited information, it is difficult to know just what she is suffering from. A mental breakdown is a very generic term. Based on what you have relayed to me in your letter, my sense is that she has had a psychotic episode, however, without knowing her full history, I cannot know this for sure. To be diagnosed with schizophrenia or schizoaffective disorder, she would to have had experienced more than one psychotic episode within a six month period. It is not clear from your letter that she had more than one episode.

An individual can have a psychotic episode and never have another, and this would be called “Schizophreniform disorder.” A person can also have a psychotic episode and receive a diagnosis of “Psychotic Disorder NOS” (not otherwise specified). In my experience, it all depends on the doctor doing the diagnosing. I do not know her diagnosis but the fact that she had experienced hallucinations, paranoia, and believes that she has received messages means that at the very least, she has experienced a psychotic episode, and this may be what you mean when you say “mental breakdown.” Whether or not the psychotic episode is part of a schizophrenic or schizoaffective disorder remains to be seen, and, as the doctor says, will only be known in time.

What also complicates this matter greatly is that she believes that she was raped. Given her already mentally vulnerable status, it is imperative that she connect with a therapist. Not only can this help her but a therapist can advise you about how to best support your sister.

With regard to supporting her lawsuit, if she has consulted with legal counsel and they believe that she has no case, then it would not make any sense for you to put time and energy into an endeavor that you know beforehand is not feasible. Where your energy may be better spent is trying to get her into counseling to help her grapple with the trauma associated with her being raped. Again, the therapist may also be able to assist you in helping your sister understand that it is not possible to sue the state.

She still believes that all the hallucinations that she experienced and the messages she was receiving were real. She still believes that there was reason for her extreme paranoia and panic. Is this a sign that she is getting sick again?” That depends. Families who live with loved ones who suffer from psychosis or schizophrenia say that they know when their loved one is getting sick before the full blown psychotic break actually occurs. Family members say that they notice personality changes and other behaviors that are subtle, and that these subtle changes are often precursors to an impeding psychotic episode.

For instance, a family that I worked with said that when their mother with schizophrenia was starting to “get sick,” she would stop smoking. Now, stopping smoking is not a sign of psychosis per se, but for this particular family, stopping smoking was a sign. My point here is that as a family member, if you think about it, you may already know some of the idiosyncratic signs that indicate that your sister is getting sick again. Subtle changes in an individual’s personality and behavior before a psychotic episode, by the way, is technically known as the prodromal phase, and this phase can last for two to four weeks, on average. Generally speaking, if your sister is paranoid, panicked, and relays to you that she is experiencing hallucinations, this is a good indication that she is either on the verge of, or in the midst of, another psychotic episode.

The best way to prevent psychotic episodes is to ensure that your sister takes her prescribed antipsychotic medication. You did not mention in your letter whether she takes her medication. Medication is the most effective way to prevent future relapses. I hope that your sister has found a medication that she is willing to take.

Also, are there differences that I should know between the two disorders that I should also look for?” If you mean to ask if there are their differences between schizophrenia and schizoaffective disorder, the answer is yes, but in practical terms, there is not that much difference. Schizophrenia disorder is a thought disorder and schizoaffective disorder is a thought disorder and mood disorder. Schizoaffective disorder is like having schizophrenia and bipolar disorder simultaneously. Both are treated with antipsychotic medication, and in some cases, doctors will also prescribe a medication to help stabilize an individual’s mood, in the case of a schizoaffective diagnosis. I am not sure it is necessary for you to make this distinction between the two disorders. My advice is that when you meet with her doctor, tell him or her about all of her symptoms, and let him or her decide on her diagnosis and medication treatment.

I hope that I have helped answer your questions. If you need clarification, have further questions, or have follow-up questions, please feel free to write again. Lastly, I would also suggest that you connect with the local National Alliance of the Mentally Ill (NAMI) group or visit them at their website at www.nami.org. These groups are composed of family members experiencing many of the same issues that you are facing with your sister. I would encourage you to look into contacting these groups. Take care.