F.E.A.S.T's Around The Dinner Table forum

Welcome to F.E.A.S.T's Around The Dinner Table forum. This is a free service provided for parents of those suffering from eating disorders. It is moderated by kind, experienced, parent caregivers trained to guide you in how to use the forum and how to find resources to help you support your family member. This forum is for parents of patients with all eating disorder diagnoses, all ages, around the world.

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Juno
Posting for a friend whose child is in crisis. She's at her lowest weight and inpatient at ERC. They said that she was barely above the level to be sent to ACUTE. She's eating since she arrived but has also been experiencing psychosis. She mistakes fellow patients for childhood friends and seems otherwise disoriented. She has been in treatment (first diagnosis 3-4 years ago) and has never experienced this before. She did have some substance use before and this may play a part. When at a higher weight, she struggles with anxiety and depression.

ERC is considering moving her to a psychiatric hospital for treatment. Given her low weight and the distance of ERC from home, this is a frightening prospect for the family. I've suggested advocating for her to stay as the low weight makes it difficult to discern other psychiatric concerns and it would be risky for her to be anywhere that wasn't focused on her ED. Does anyone else have any thoughts?
Mom of a younger outpatient
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tina72
Hi Juno,
just an idea but the son of a friend of mine (no ED) hat a severe psychosis after only a few joints and the team in the psychiatric hospital here told her that this is not rare with cannabis when they are under 18 and the brain is not grown out or when the brain is malnurished because of a diet (that might be the case here). Do you know what the substance use was? Maybe cannabis?
Keep feeding. There is light at the end of the tunnel.
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scaredmom
I would suggest she stay at the ED hospital, until her weight is up. Psychosis is real with low weights ( rule out substances/toxins etc too and electrolyte issues). 
http://www.scielo.br/pdf/rpc/v45n1/0101-6083-rpc-45-01-0015.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274583/

https://link.springer.com/article/10.1007/BF03327812

I hope some of this helps.
XXX
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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Juno
Thanks! Experiences and articles can be really helpful in making a case to professionals.
Mom of a younger outpatient
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deenl
Hi Juno,

I agree with the points above; low weights can lead to psychosis as can marajuana use, no doubt. I do not want to put a damper on things but there also seems to be a link between schozophrenia and eating disorders. (we have both in our extended family) I do think a responsible psychiatrist will consider all possiblilities, athough I found our psychiatric team were not very knowledgeable about the biological effects of malnutrition on the brain.

https://www.psychiatrictimes.com/schizophrenia/eating-disorders-schizophrenia/page/0/1
https://www.hindawi.com/journals/schizort/2014/791573/
https://www.ncbi.nlm.nih.gov/pubmed/22290030

Wishing them strength and courage

D
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, stable but no progress. Medical hosp to kick start recovery Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal.
  • We cannot control the wind but we can direct the sail.
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Kali

Hi Juno,

I and sorry that your friends daughter is going through this and I will weigh in as the parent of one child who had an eating disorder and another who had an episode of psychosis. It is very distressing for a parent.

Here are some of the things I learned about psychosis:

Early intervention is very very important. The best outcomes for psychosis are when a patient is treated quickly. There is a class of drugs called atypical antipsychotics which have proven to be very effective. So, as opposed to anorexia, there are real drugs with have had evidence based studies and have a track record, which can actually help. For first episodes of psychosis, especially in cases where drug or alcohol abuse have played a part, sometimes there only needs to be a short course of the atypical antipsychotics ( a couple of months for example) for them to work. And a person can make a full recovery. That was our experience. Please make sure to mention that to your friend. It can also take awhile before the brain is back on track after such an episode.


Experiencing an episode of psychosis does not mean you have bipolar or schizophrenia, it merely means an individual is experiencing some things that they may or may not realize are not real. It is a symptom and can be triggered by medication, malnutrition or a brain based issue. The diagnosis for those conditions only comes if the psychosis is prolonged, usually after 6 months or so.

The vast majority of people who are genetically unlucky enough to experience psychosis are not a danger to others.


It seems to me that your friends daughter could benefit from being evaluated by a dr who is expert in treating psychosis AND from having her weight brought up by the folks at ERC as quickly as possible. If the parents are far away from the ERC their daughter is currently at, it might be a good idea for them to go out and monitor what is going on to make sure they are comfortable with the decisions being made on their daughter's behalf and get a chance to spend time with her and meet with her team and see what they think. If ERC feels that handling psychosis is beyond their expertise (and thus the suggestion that they place the daughter in a psych ward) can the parents advocate to have a professional who is an expert in psychosis brought in for an evaluation for their daughter and to work with the eating disorder team and set up a plan? It does seem inappropriate, given the low weight of the patient, to be moving her out of the specialized eating disorder unit. Whether her psychosis is caused by the eating disorder or not, and it is hard to know for sure, IMO they both need to be addressed.

Here is a link to a NIMH fact sheet about first episode psychosis.

https://www.nimh.nih.gov/health/topics/schizophrenia/raise/fact-sheet-first-episode-psychosis.shtml

Hoping for the best for your friends daughter,

Kali

 

Food=Love
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mamabear
My daughter was psychotic when severely underweight. She had auditory and visual hallucinations of "the blackness". She described it basically as a black formless figure she would see in corners and in her closet etc. She also said it would tell her in a "scary man's voice" that it would only leave her alone if she was dead. 
When she was admitted to an inpt ED unit on her paperwork they listed her diagnosis as "psychosis, possible schizophrenia, and anorexia nervosa". Also of course depression and anxiety. And extreme exercise compulsion. 

Turned out for my daughter it was "just" anorexia. When she gained weight over those first few weeks that psychotic part went away completely. The rest of it all went away with weight and time. My daughter never took any medications. Food was the medicine. Of course this is complicated and different in each situation, but just wanted to share my experience. 
Persistent, consistent vigilance!
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Ellesmum
mamabear wrote:
My daughter was psychotic when severely underweight. She had auditory and visual hallucinations of "the blackness". She described it basically as a black formless figure she would see in corners and in her closet etc. She also said it would tell her in a "scary man's voice" that it would only leave her alone if she was dead. 
When she was admitted to an inpt ED unit on her paperwork they listed her diagnosis as "psychosis, possible schizophrenia, and anorexia nervosa". Also of course depression and anxiety. And extreme exercise compulsion. 

Turned out for my daughter it was "just" anorexia. When she gained weight over those first few weeks that psychotic part went away completely. The rest of it all went away with weight and time. My daughter never took any medications. Food was the medicine. Of course this is complicated and different in each situation, but just wanted to share my experience. 



Yes, similar to you Mamabear, my d also had audio and visual hallucinations at her lowest point, she had no idea who I was and just sat huddled up in a corner screaming at some unseen scary thing.  She had this a couple of times and it was terrifying, she thought she could make things move with her mind and thought the stairs were rising up (like they were breathing) 
I actually put this behind me and buried it as we’re now doing so well but typing that has just given me palpitations, such a terrible memory.
Ellesmum
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alfalfa
Please tell your friend to fight ERC on that. I know from personal experience (and the experiences of friends) that the the psych hospital ERC usually sends patients is NOT equipped to handle eating disorders (or suicidal ideation, but that’s another story). If a patient refuses meals, the staff merely asks once if the patient would like a Boost. If ERC insists on transferring her, they might want to look for other eating disorder programs more suitedro her needs. 
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