I think this is a difficult issue...I guess I would relate from my experiences with my mother - she has had schizophrenia as long as I recall (first hospitalisation occurred when I was 10 years old, but piecing together reports from other family members over the years, it seems likely that she had had this for much longer). My father is an alcoholic who was either absent or when he was present, was prone to aggression and violent outbursts. It is only in late mid life recently that he has been diagnosed with Bipolar disorder (we have minimal contact in part due to my parents going through a very acrimonious divorce when I was a young child).
From my childhood up until about 2013 was characterised by dealing with my mother's recurrent relapses and episodes resulting in hospitalisation. Since that discharge late 2013, she has been under the care of a psychiatrist who was quick to remove her ITO and reduce her medication. Since that time until now, she is no longer the person that she once was. There has definitely been deterioration, both cognitively and in terms of persistent paranoid ideation, panic attacks, and anxiety.
Prior to the that relapse, my mother was working in gainful employment, had studied at TAFE, had close contact with peer groups and a number of active social contacts. Now she cannot even maintain a normal conversation (staying on the phone for 5 mins. is an exercise in patience as she repeats the same stories over and over each time, exhibits derailed thought and persecutory delusions, and starts ranting about her perceptions of being wronged by people in her distant past as if it happened yesterday). She has also had panic attacks, depression, and has lost her confidence to do the most basic tasks (e.g. catch public transport), and has not maintained or mostly avoids her previous social contacts. It is apparent that she is in her own world, defensive, and has little empathy for others. She continues to state (erroneously) that her last admission was voluntary, as she was not mentally ill, but merely needed a "rest".
My younger adult brother lives with her and appears to have now taken over much of the household management and basic tasks. This is somewhat of a relief, however, beyond that he is not much help as he avoids dealing directly with my mother as much as possible (he has his own issues and was traumatised by both my parents, which included child abduction when he was about 6 or 7 years old).
My concern, particularly apart from psychosis, is the very obvious cognitive decline. These concerns started at the commencement of her last hospital admission where she frequently appeared severely confused and disoriented. The registrar would only state that ..."schizophrenia causes cognitive decline".
My mother has a history of severe episodes from which she would eventually make an almost full recovery after a lengthy hospital stay. This time she has not "bounced back". There has been little improvement over nearly 4 years. My aunt and I have called or written letters to her psychiatrist previously, who seems indifferent about this issue, as long as the 'evidence' [blood tests] indicate that she is still taking her medication.
I spoke to my GP last year who suggested a geriatrician do an assessment, as I am concerned about whether these above issues are due to poorly managed/treatment resistant schizophrenia or some sort of early onset dementia. I suspect both would be difficult to disentangle from each other. Of course, there is no way my mother would consent to that, as she believes that she does not have a problem.
Others here in the forum raise the issue of what the purpose or intended outcomes of differential diagnosis would be - I guess for me it would be knowing if there was more we could do to help her mental functioning improve - the guilt about whether I should be doing more about this is still gnawing away at me.
Has anyone else been through somethign like this?
