My girlfriend seems to always have something wrong with her. As soon as one thing stops hurting, the next day something else hurts. 4 months ago she started getting very queasy when she ate anything, and would vomit it up, eventually. She was only able to keep food down once a week or so. It got worse, where she couldn’t hold down water even. She stopped eating altogether. 5 trips to the emergency room only resulted in treatment for dehydration and instructions to feed her light or clear food. She still couldn’t eat. She’s lost 85 lbs. (She’s overweight to start with, but still unhealthy). We got a hospital to admit her, but nothing physically is wrong. But now she has become paranoid and psychotic, she’s sure everyone is plotting against her, even myself and her daughter. She’s been in the hospital 14 days now, transferred to the psych ward, and is on a hold for at least 2 more weeks. What’s happening? How did it get to this? Her physical symptoms seem to have gone away, maybe, but the psychosis is scary.

A. There are some psychotic disorders that begin as physical symptoms or complaints about physical symptoms. In clinical terms, they are called somatic delusions and their origins are poorly understood. Somatic delusions are associated with psychotic disorders such as schizophrenia, schizoaffective disorder, bipolar disorder, among others.

Her physical symptoms have subsided but the psychotic symptoms remain. Fortunately, she is receiving inpatient care where her condition is being monitored around the clock. The treatment team can observe her symptoms and determine the best treatment before discharge. Most likely they will recommend medication. If she follows their treatment recommendations, it significantly decreases the risk of re-occurrence.

For your part, encourage her to follow their treatment recommendations. Medication is highly effective for psychosis but it will not work if she stops taking it. Treatment adherence is paramount.

It is common for people with psychotic disorders to stop taking their medications. There are many reasons why they stop, including unpleasant side efforts or more commonly, because they feel better or don’t think they need it. Some people with psychosis are unable to recognize that they are ill. An inability to recognize one’s illness is considered a symptom of certain psychotic disorders such as schizophrenia. Do your best to convince her of the importance of medication. It is the best “insurance policy” for avoiding a relapse. Some research suggests that with each subsequent relapse it can take longer to recover. Thus, adhering to the prescribed treatment regime is the key to stability.

In the meantime, it would be advantageous for you to read about psychotic disorders. They are many resources for family members who are caring for a loved one with a psychotic disorder. Psych Central has great resources, as does the National Alliance on Mental Illness (NAMI), and the Treatment Advocacy Center (TAC). The more knowledge you have about psychosis, the more prepared you will be for caring for a loved one with a mental illness and supporting your family in the process. Please write again if you have additional questions. I will be glad to help in any way that I can.

Dr. Kristina Randle