Ask the psychiatrist...

What is schizotypy?

Schizotypy describes a set of personality traits that include eccentric behaviours and unusual thinking or mood that resemble the abnormalities seen in schizophrenia, but the full picture of schizophrenia does not appear. So people with these traits may be ‘cold’ or aloof, may tend to be suspicious or paranoid and have difficulty forming trusting relationships with other people. They may express odd ideas or magical thinking that is not clearly delusional but nonetheless strange and outside the beliefs of most people. There may be transient, more intense episodes with illusions or hallucinations. It is more common in relatives of people with schizophrenia and is thought to be part of the broad ‘spectrum’ of schizophrenia.

Are there any known reasons for relapse?

Yes, there is a lot known about this though the answer depends a bit on whether this is relapse from a first ever episode or in a condition that has had several relapses before.

For both, discontinuation of medication is the most common cause. Coming off medication should always be done gradually and with close supervision. For a first ever episode of schizophrenia, the advice is usually to remain on medication for at least six months (some would say longer) after a full recovery.

After two or three relapses, the risk of further episodes and the need for continued medication is much greater.

Relapse is also frequently triggered by ‘stress’. This may be through unexpected life events and abrupt changes in routine but also situations where there is a degree of low-level but persistent tension. Family intervention is a therapy with a proven record for reducing relapse that is second only to continued medication. It works by coaching family members in how to reduce stress by changing how they respond to the tensions that are inevitable in caring for someone with a severe mental illness such as schizophrenia.

Finally, there is little doubt that relapse can be triggered by the use of drugs such as cannabis and amphetamines.

How do I find out who ‘hospital managers’ are so that I can complain to them? I keep reading that complaints should be made to ‘hospital managers’ but no information is given on how to find out who they are. The staff definitely won't give me this information.

The term hospital managers can be used in two senses so it is important to know which you are referring to. First, when a patient has been detained under the Mental Health Act, they or their nearest relative can apply to 'Hospital Managers' for discharge. In the Act, these are people who are appointed independently of the clinical team and are specially trained in a way similar to lay magistrates to see that the implementation of the Mental Health Act is properly implemented in a NHS Trust, and particularly that no patient is illegally detained. They can be contacted via the Trust's Mental Health Act office. They do not deal with general complaints about the hospital, just issues that concern the Mental Health Act.

The second use of the term is probably the one you mean. Here the managers are the people responsible for the day to day running of the hospital. There may be several layers of management from, say, the ward manager for a particular inpatient unit, through a general manager for an entire hospital site and on upwards to the chief executive of the Trust. All Trusts have complaint procedures and have to be open about how patients and their families can make a complaint. The information should be available on the Trust website or by telephone to the Trust headquarters who will be able to advise who best to contact. As a last resort you might wish to write directly to the chief executive of the Trust.

I'm really worried about my son. He finished his A levels and is on a gap year. He was planning to travel but has decided not to. He has stopped seeing or going out with his friends and shuts himself in his room all day and all evening. I'm pretty sure he is hearing voices because he is talking to himself. If I ask him what's wrong, he shouts and me and pushes me out of the way. I've suggested we go to the GP because he might need help but he refuses to go and says he doesn't need any help. I'm at my wit's end and don't know what to do. He was previously a really friendly, happy boy with lots of friends. Is it possible he might have schizophrenia or a similar illness? How can I get help if he won’t go to the GP?

I think you are right to be worried. While he may not be suffering from schizophrenia or a similar psychosis, these behaviours are often reported as part of the early onset process. You should discuss the problem with your GP, who should be willing to do a home visit. The specialist early intervention teams will also do home assessments (see the Early intervention services pages on this website). Depending on your circumstances, they may do this without a GP referral, though they will prefer to have your GP involvement. Your GP will also have the contact details for your nearest early intervention service.

Is it okay to use ECT to treat psychotic depression?

Yes. Psychotic depression can be greatly helped by ECT.

My ex-wife was sectioned around 6 years ago but had recovered after a few months. However, I have had a few phone calls from some of her family and friends who think that she may not be well again because of the way she's been acting and talking, and some of the things she has been saying on Facebook. Also she has stopped answering her phone. I would like to know if there is a way that I can get a doctor out to visit her?

It would be reasonable to pass your concerns on to her GP (assuming you know who that is). He or she may be willing to do a home visit, or if your wife is still in contact with the specialist mental health team, her doctor might wish to pass your concerns on to them. He/she will have to weigh up the risk of missing the opportunity to intervene early in a relapse with the risk of alienating her and driving her further away from future help and advice should the concerns prove unfounded. It can be a difficult decision.

I’m hearing voices and I tried to get help from my GP. They said that someone will get in contact with me, but no one did. What should I do next?

Go back to your GP and ask to know who he has arranged for you to see. You can then follow up with a call to them directly.