Ask the psychiatrist...

How long does an episode of psychosis last? Is it weeks, months or years?

This is quite variable depending on whether this is a first episode and the type of psychosis. The majority of first episodes last a matter of weeks or a couple of months at most, but recurrences tend to be longer. Around a fifth of patients suffering from schizophrenia will experience continuing symptoms for years.

Are there any known links between severe pre-menstrual tension and bipolar disorder? Has there been any research studying this matter?

Pre-menstrual tension is a common condition that affects many healthy women. It is characterised by a cyclical pattern of mood disturbance and physical discomfort. Although around 2/3 of women with bipolar disorder report a worsening of mood with pre-menstrual symptoms, it is difficult to prove a definite link, partly because PMT is so common. There is research but this is still inconclusive. For example, in an intensive study of 17 women suffering from bipolar disorder, Rasgon et al (2003) measured daily mood symptoms, menstrual data and life stress over a 3-month period and found that the majority of women reported significant mood changes across the menstrual cycle. However, all the women were on psychiatric medication and a third were also taking oral contraceptives which complicate the interpretation of the results

Rasgon et al 2003 Menstrual cycle related mood changes in women with bipolar disorder. Bipolar Disorders 5: 48-52

My daughter has been diagnosed with schizophrenia but I don’t trust the psychiatrist. Can I get a second opinion and how do I go about getting one?

There is no automatic right to a second opinion but it would be very unusual for this request to be refused. Of course if your daughter is an adult you need to have her consent before anything further can be done. I am assuming you would not wish the opinion to be provided by one of the psychiatrist’s colleagues in the same Trust in which case your daughter’s GP is in the best position to refer to a different hospital service for the second opinion. He/she will have to state that this is for a second opinion as it may be necessary to access the original assessments.

Our niece (age 19) was sectioned (2) and admitted to a psychiatric hospital after a psychotic crisis.

She opposed her section and asked me to be present at the tribunal, which I did. Her appeal was refused and she had to stay in the ward, but was allowed up to 2 hours leave with a relative. I visited her several times alone or together with my wife. The first visit of her parents took place 10 days after her section and they wanted the section to be lifted and to take her home to Scotland, to a tiny hamlet, where the parents moved only in Jan 2010 and where she has never lived and does not know anybody. She opposed this with the help of her psychiatrist.

Although she consented that I could be given information about her diagnosis and treatment, the (new) psychiatrist refused and told me he would prefer to inform the wider family through the parents. The parents arrived and took her back to Scotland to their home.

Her initial medication was olanzapine and diazepam, which seemed to stabilise her, but I don't know the dose. The medication was changed from olanzapine to aripiprazole, continuing with diazepam, both at quite a high dose. On my visits with my wife she was extremely sedated and subdued. I don't suppose that her condition had changed a lot when the parents came and picked her up, 5 days after a change of medication.

What I don't understand, is the fact that she has was released so shortly after a change of medication, where a result couldn't possibly be already achieved, and to a place where she continuously during her hospitalisation refused to go.

It is not possible for me to comment without knowing the clinical details for the individual and the discussions between the psychiatrist, the patient and her parents that led up to her discharge. In terms of the medication change, it is possible that her condition was already improving with the olanzapine but that there were side effects that meant a switch to an alternative drug was necessary.

Is it sensible for me to want to make something of my life? I'd like to study and become a hygienist, but is it ok and realistic?

I am a 38-year-old female and over the past 10 years, my life has turned 360 degrees. I was a student in dentistry, my parents were going through a divorce without telling me and I found this out. My grandparents died shortly before and I was abused when I was 6-7 yrs old. It was just too much. I went downhill so much so that I was sent to hospital. I was diagnosed first with depression, then post traumatic stress followed by episode of psychosis, and finally schizoaffective disorder. I am stable and take 30mg paroxitine and 10mg aripiprazole.

Yes of course you should want to make something of your life. If you are stable and feel ready to study then there is no absolute reason why you should not. The benefits are obvious. However the condition that you are suffering from is sensitive to stress so there are risks that can be anticipated and hopefully reduced. For example, you may well need to stay on medication and I would suggest you seek advice not only about the best way to maintain your health but also on the selection of the course and on what to disclose to the college/university about your health so that proper educational support is available to you.

Can you explain tactile hallucinations? Most of the literature available to us focuses on hearing voices.

Tactile hallucinations are feeling that something or someone is touching you when there is nothing external to explain the sensation. A broad range of sensations are included such as burning, crawling, stinging etc and they are usually accompanied by a delusional explanation, such as a belief that the sensation is being caused by an invisible ray or other electronic gadget.

The normal sensation of touch originates in a pressure receptor in the skin and travels as an electrical impulse up nerves to the brain where it activates special sensory brain cell pathways. It is known that if these sensory cells are stimulated directly (during brain surgery, for example), the person feels the sensation at the location where the nerve to those cells originated (ie in the skin). Tactile hallucinations are an instance of spontaneous activity of these brain circuits.