At what point should there be hospitalization for psychosis

so son no.2 was hospitalized last week for mania and psychosis. He is very clever and managed to get a release after 5 days last Thursday, but he is still very delusional. Government control, he is part of some big plot etc. He seems to believe his father is controlling him (in delusional ways) he has told his father he really hates him and his actions show contempt. At what point would it be a good time to rehospitalize him? He is also unable to attend school because he thinks they are controlling him and he would become destructive if frightened. (he caused $20,000 worth of damage in a hospital last year with psychosis)

I'm sorry your son was let out before his psychosis let up. I think many patients are let go too early, and yet I wouldn't want the total opposite, either.

I'd keep a very close watch on your son. If he seems like a violent threat to anyone, call the police asap. It's ashame it has to get to that point, though.

Am I right to assume he isn't taking medications now that he's home? If not, maybe a depo medication shot would be a good option to consider if it gets to the point where he can be given one.

That's terrible that he was left to the point of causing such extensive damage at the hospital. They should have isolated him and/or given him a shot, if they didn't. Once I was also followed by the ward security because of violence risk.

I know I've not given you much of the advice you were likely seeking. I'm sorry. Just be sure you communicate this whole history loud and clear to a psychiatrist.

So here my take. I’ve only been hospitalized twice and both times were in the last 4 years. Up until 4 years ago I was in a near constant psychosis, sometimes better, sometimes worse. I had a really good psych team who kept me out of the hospital and respected my fear of antipsychotics. I’d do anything to have that team back. I saw a therapist weekly and my pdoc monthly. I wrote to my therapist every day though. We would discuss the highlights when I came in. Now I see a psych nurse 4x a year. If I need anything then the hospital’s my only option and I’ll wait it out before going back there.

It depends the level of support you can get/give. Is he alone at any time? Can you handle his concerns in a constructive way? Are you able to secure all harmful items in case he gets impulsive? Are the other kids scared? Is there a day program he can go to? Is the school coming in with a tutor? Does he have a “rescue” antipsychotic?

I now deal with only low level of psychosis which heighten when I’m alone. It’s a stressful world I live in but it’s better than the med side effects. I have no access to sharp objects and am really not left alone very often. If you can set up your home to be safe while he rides it out and you have outside support then keep him home. If you can’t then hospitalization is needed.

He has been good about taking his meds for one year. He was taken off Saphris and kept on Lamictal in June and there was some deterioration. He was put on 400 mg Seroquel 2 1/2 weeks ago, I just don't think it is working at all

School triggers him even though he has one on one tuition in a small private school, and his father triggers him to the point that we don't know what he will do to allay his fears. The school did have to call the local police department to have him escorted off the property for being loud and doing some damage, but the police officers said he showed exemplary behavior! Sometimes he is really sweet and other times he is unpredictable and scary. He is on an antipsychotic. He won't tell me the level of his psychosis because he is aware that I may stick him back in hospital. FYI, he is very bright.

He may need back on Safris. I recently ran but had a prescription on file. But my insurance required pre-approval. It was a big ordeal. But, my husband started noticing me deteriorating. Once I got back on it I leveled back out.

Is there danger in your home?
Do your son's delusions about his father controlling him place your husband at risk?

If/when your son poses a risk of harming himself and/or others, he needs a hospital. The same goes if/when he is unable to care for himself.

Thanks for being a loving mum. My heart goes out to you and to yours.


WC