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We have had many in-depth conversations with his previous caregivers and all say the same thing, he's sweet and innocent outside the home. He's had many loving guardians, including ourselves, but he always has the thought that he doesn't deserve it, so he tries to screw it up with his behavior. He has exhibited the EXACT same behavior with every single person...to the T.

Again, speaking purely from a non-expert perspective, that doesn't sound like schizophrenia to me. It does sound like a repetitive trauma pattern.

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The Compulsion to Repeat the Trauma: Re-enactment, Revictimization, and Masochism
Bessel A. van der Kolk, MD*

During the formative years of contemporary psychiatry much attention was paid to the continuing role of past traumatic experiences on the current lives of people. Charcot, Janet, and Freud all noted that fragmented memories of traumatic events dominated the mental life of many of their patient and built their theories about the nature and treatment of psychopathology on this recognition. Janet75 thought that traumatic memories of traumatic events persist as unassimilated fixed ideas that act as foci for the development of alternate states of consciousness, including dissociative phenomena, such as fugue states, amnesias, and chronic states of helplessness and depression. Unbidden memories of the trauma may return as physical sensations, horrific images or nightmares, behavioral reenactments, or a combination of these. Janet showed how traumatized individuals become fixated on the trauma: difficulties in assimilating subsequent experiences as well. It is "as if their personality development has stopped at a certain point and cannot expand anymore by the addition or assimilation of new elements."76 Freud independently came to similar conclusions.43,45 Initially, he thought all hysterical symptoms were caused by childhood sexual "seduction" of which unconscious memories were activated, when during adolescence, a person was exposed to situations reminiscent of the original trauma. The trauma permanently disturbed the capacity to deal with other challenges, and the victim who did not integrate the trauma was doomed to "repeat the repressed material as a contemporary experience in instead or . . . remembering it as something belonging to the past."

...

Many traumatized people expose themselves, seemingly compulsively, to situations reminiscent of the original trauma. These behavioral reenactments are rarely consciously understood to be related to earlier life experiences. This "repetition compulsion" has received surprisingly little systematic exploration during the 70 years since its discovery, though it is regularly described in the clinical literature.

Source: The Compulsion to Repeat Trauma


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The last straw in his stay with his caretakers consists of running away, asking to be beat up, telling people he's been beat up, skipping school and threats of suicide.

Is the "beating up" behavior consistent as well? Has he been "beaten" in the past? What's coming through for me is a seeming desire for self-punishment.

After speaking with the psychologist and psychiatrist he's working with now, they believe he does in fact have positive symptoms as well. I have never noticed this...Should I have been paying more attention?

Positive symptoms can be more subtle in the prodromal phase but are generally impossible to miss during a state of active psychosis (or "altered state of consciousness" for those who may prefer the distinction). Some examples of positive symptom behaviors might include intense fear, a sense that the larger world is communicating with you through messages on the radio or television, self-identification with a religious figure or myth, etc. Psychosis can be a component of post-traumatic stress disorder so it's good be to aware of those links. This thread may be helpful: PTSD and Schizophrenia.

I will also ask your question that you posed to me again, "at what point does typical teenage behavior turn into schizophrenia?" I have no idea, but I'm assuming any doctor with half a brain would know the difference between the two.

As a general rule, doctors don't come up with a diagnosis of schizophrenia first and this is because a specific pattern of behavior over a period of at least six months is required to make the diagnosis. Individuals diagnosed as schizophrenic may have received a number of diagnostic labels before they get that one. For example, just yesterday someone joined this site who had previously been diagnosed as schizophrenic but the diagnosis had since been changed. Misdiagnosis is common.

It's also worth noting that teens in particular are gaining increasing attention in the field. There are some who believe that symptoms of schizophrenia can be recognized and identified in the prodromal phase, and possibly halted before a full-blown case of psychosis becomes reality. I'm wondering if this is the case with your brother's brother because you've made no mention of symptoms that would indicate an active psychotic state. Maybe the docs are concerned that he's in a prodromal phase and are hoping to catch it early. While there does seem to be some evidence that this has helped some teens, studies indicate that many of the teens identified as "at risk" did not go on to develop schizophrenia and therefore, were exposed to the significant risks associated with anti-psychotic medication as a means of appeasing the fears in those around them. Although the intentions of many may be good it cannot be ignored that psychiatric medication for children and teens has become big business supported by equally big marketing campaigns.

Three articles that may provide you with more insights in that regard:
[*] Schizophrenia Risk Factors Identified in Teens
[*] Psychosis Prevention Program Gets Press
[*] Suicide Risk Tests for Teens Debated

By the way, the doctors have just put him on Clozapine. Does anyone have any experience with a person who's on this medication?

That seems an unusual first line of attack. You may want to ask the doctors why that specific drug was chosen. Clozapine is usually a drug used as a last resort. According to epocrates.com clozapine is restricted to use with severe schizophrenia in those who have been treatment resistant to other anti-psychotic medications.

Some of the risks of clozapine include reduced white blood cells (Agranulocytosis) seizures, fatal myocarditis, cardiac failure, tardive dsykinesia and diabetes. According to this report from the FDA, clozapine was associated with 7,665 deaths between 1998 and 2005.

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Clozapine (sold as Clozaril, Leponex, Fazaclo, Froidir; Gen-Clozapine in Canada, Klozapol in Poland) was the first of the atypical antipsychotics to be developed. It was approved by the United States Food and Drug Administration (FDA) in 1989 and is the only FDA-approved medication indicated for treatment-resistant schizophrenia and for reducing the risk of suicidal behaviour in patients with schizophrenia.[dubious – discuss]

Clozapine has been shown to be superior in efficacy in treating schizophrenia. Were it not for its side effects it would be first line treatment; however the rare but potentially lethal side effects of agranulocytosis and myocarditis relegate it to third-line use. Furthermore it may rarely lower seizure threshold, cause leukopenia, cause hepatic dysfunction, weight gain and be associated with type II diabetes. More common side effects are predominantly anticholinergic in nature, with dry mouth, sedation and constipation. It is also a strong antagonist at different subtypes of adrenergic, cholinergic, histaminergic and serotonergic receptors.

<font color=red>Safer use of clozapine requires weekly blood monitoring for around five months followed by four weekly testing thereafter. Echocardiograms are recommended every 6 months to exclude cardiac damage.</font>

Source: Wikipedia: Clozapine


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Do you see why it's curious that clozapine might be the first anti-psychotic drug he was put on?

You may be able to find more information in the Drug Questions forum or through a good search engine. Do be aware that of all the medications out there, anti-psychotics carry some very significant and very risky side effects. It's worth the time and trouble of investigating what those are.

My continued best wishes that you're able to find the answers that will help your fiance and his family.