Stuck Within A Psychiatric Institution

Psychiatric patient standing on gray mesh surface

Imprisoned By Your Mind

To be institutionalized means that a patient has been in a psychiatric institution for such a long period of time that they have become used to it. They no longer have any interest in leaving the hospital because they have become too comfortable; their family has become the staff working on the unit.

Even if a psychiatric patient is qualified for discharge, they still may not want to leave; it just doesn’t matter anymore. Too much time has passed; they have lost the sense of what it feels like to live in society. The thought of leaving their comfort zone sounds terrifying; they prefer to remain locked up.

Imagine the government banging on your door and saying, “we are knocking down this house, you need to pack your bags and go. You have one week!” This is how some psychiatric patients feel when discharge becomes an option. Even though they may be asymptomatic and functional, they view the idea of discharge as “packing up my bags and starting from scratch.”

Most if not all psychiatric patients enter an institution with displeasure and discomfort. Their daily goal is to get one step closer to discharge; every day brings new hope. But there is a threshold upon which a patient has either lost hope or has become too comfortable with their new environment; this is the point of no return.

Once a patient crosses this invisible line, it becomes very difficult to get them to accept the idea of discharge. Some patients will actually regress and become symptomatic again in order to avoid being released. Some even start to improve and then will say things such as, “I don’t want this treatment anymore because I want to remain psychotic.”

Some patients have been mentally ill for so long, that if they start seeing their symptoms go away, they become uncomfortable. Their mind has become so used to their illness that they view sanity as a threat; an unfamiliar territory. So they start to become noncompliant with medications, forcing psychiatrists to obtain court orders.

The reality is that for many chronic psychiatric patients, they want to remain psychotic and institutionalized. This is their reality; their way of viewing the world. They have established their routines and their way of living. And if you step inside their world and start making plans for them, they start to see you as an intruder who is interfering with their life.

The dim reality as viewed by one person is paradise as viewed by another.

Are you Ready? (This is Defeating Stigma Mindfully)


Brief Psychotic Disorder

Grayscale photography of man experiencing brief psychotic disorder

Brief And Limited Psychosis

Brief psychotic disorder is a mental illness that lasts anywhere from one to thirty days. It is more common in women and usually occurs after someone has experienced a very stressful situation or trauma, such as a natural disaster, assault or the death of a loved one. It is also common postpartum and in geriatric patients due to their fluctuating hormones and mental status, respectively.

The symptoms may include: hallucinations, delusions, confusion, mood changes, disorganized speech and behavior and catatonia. These symptoms may promote violence or suicide, depending on the severity. As previously stated, it can occur in the elderly, but the majority of cases present in the second and third decades of life.

Brief psychotic disorder is not triggered by drugs or alcohol abuse. If drugs or alcohol are involved, the correct diagnosis is substance-induced psychotic disorder. The prognosis of brief psychotic disorder is generally good but there is always the chance of it progressing over one month; the disorder is then changed to schizophreniform. If schizophreniform progresses over six months, the disorder is then changed to schizophrenia.

Treatment may include antipsychotics, antidepressants and psychotherapy. Psychotherapy helps the patient understand the nature of the illness, what may have caused it and how to adjust to it psychologically. Regardless of the symptoms, psychosis is very unpleasant. Imagine being detached from reality, not being able to properly answer questions, hearing voices in your head telling you to harm yourself and no longer taking care of your appearance.

Psychosis presents itself differently in many individuals depending on their personality, past history, current situation and resilience. It is not a uniform presentation in which every person is painted with the same color of symptoms; some presentations are more vibrant than others. But regardless of the symptoms, each individual must be treated with love and given the proper attention and respect; behind each psychotic mask lies a human being who was once a normal child!

Are you Ready? (This is Defeating Stigma Mindfully)

Into The Mind Of A Schizophrenic Patient

Schizophrenic patient with inappropriate laughter

Psychosis Meaning

Psychosis is a mental disorder in which thoughts and emotions are so impaired that contact with external reality is lost. Patients with schizophrenia either have hallucinations, delusions or disorganized thinking; usually multiple symptoms are present.

Taking the time to listen to a schizophrenic patient will give you a glimpse into their world; their eyes are the windows to their psychotic reality. When you listen to a schizophrenic patient describe their reality, you will come to realize how different they view the world.

They may hear voices in their head that are “half animal and half human;” can you imagine how frightening this must be for any person? Their entire psychological well-being is disturbed; it feels like a living nightmare. They may also experience bugs crawling on their skin; this is known as tactile hallucinations.

A schizophrenic patient may be very disorganized in their thoughts, often interpreting reality in a distorted way that does not make sense to others. They may believe that their family has turned against them, that people are after them and stealing their clothes or that their mind is being controlled by the government.

It is very sad to obtain a glimpse into the world of a schizophrenic patient; your heart just melts when you come to the realization of how distorted their reality has become over the years. You want to help them as much as you can and you hope that when you come in to work the next day, the patient will be in a better place psychologically; sometimes they are, but other times the rabbit hole became deeper overnight.

We need to come together and be supportive of schizophrenic patients; the mental health stigma must end! They are often very loving and creative individuals; just because they have “lost their mind” does not mean that they should lose our support! We have a responsibility to help our fellow human beings come back on a level playing field and join us in a healthy state of mind!

Are you Ready? (This is Defeating Stigma Mindfully)

Alcohol-Induced Psychosis

Blue alcoholic drink in martini glass

Alcoholic Rabbit Holes

Alcohol-induced psychotic disorder (AIPD) is not a primary organic psychotic disorder like schizophreniform or schizophrenia; it is due to the substance itself, in this case, alcohol. Psychosis is a disorder that involves hallucinations, delusions or disorganized thinking; it classically is known as having a “break with reality.” AIPD can occur during an acute intoxication, withdrawal or chronic long-term use.

AIPD is more common in individuals struggling with alcohol dependence or addiction. Once a person develops AIPD, the psychosis may last anywhere from 1-6 months. If it is secondary to alcohol withdrawal, it usually clears up within one week.

AIPD Secondary to Acute Intoxication

When a person consumes a very large amount of alcohol in one sitting, they may develop AIPD. Some of the symptoms include: aggression, hallucinations, delusions, amnesia and impaired consciousness. The condition usually ends during hospitalization when the alcohol is cleared from the body, but the person is still at risk for alcohol poisoning, which must be monitored for to prevent death.

AIPD Secondary to Withdrawal

Also known as alcohol withdrawal delirium, this occurs when a person drinks a large quantity for a long period of time and abruptly stops drinking all together. Because the body becomes physically dependent on the substance, it starts to experience side effects when alcohol is no longer present in it.

Some of the symptoms include: agitation, anxiety, chest pain, irregular heart rate, headaches, mood changes, nightmares, hallucinations, delusions, delirium, fever, seizures and involuntary muscle contractions. The symptoms progress in severity from time to last drink, starting as early as 6 hours since the last drink and even continuing 48 hours later; hallucinations and seizures are the last symptoms to appear.

AIPD Secondary to Chronic Use

After long-term heavy alcohol use, a person may develop alcohol hallucinosis, paranoia or Wernicke-Korsakoff syndrome. Alcohol hallucinosis manifests as: auditory or tactile hallucinations, delusions and rapid mood swings. It can appear in a person who has a clear thought process but has been drinking heavily for many years. Alcoholic paranoia manifests as: extreme anxiety and the fear that others are after you.

Wernicke-Korsakoff syndrome is caused by a lack of vitamin B1 in the body secondary to poor nutrition in heavy alcoholics. It manifests as: the inability to form new memories, confabulation, confusion and hallucinations. There is no recovery from Wernicke-Korsakoff syndrome, as the mammillary bodies of the hippocampus have been severely damaged.

It is important to moderate your alcohol intake and never cross the invisible line leading into addiction territory. Alcohol was responsible for over 85,000 deaths per year from 2006-2010 in the United States; why lose your life over a substance? Always drink responsibly and remember that there is no substance that can ever replace natural happiness obtained from healthy relationships!

Are you Ready? (This is Defeating Stigma Mindfully)