December 4th, 2013

[ANON POST] Responding Well to Schizophrenia Medications/Symptom Intensity

Setting: New England, 2011-2012

Character: Is a 15/16 year-old male with early-onset schizophrenia, and ADD. Has recently been diagnosed with early-onset schizophrenia, and is presenting with positive symptoms (http://www.nimh.nih.gov/health/publications/schizophrenia/index.shtml) (link to the NIMH page for what distinguishes positive from negative symptoms).

Search Efforts: I've tried terms like "schizophrenia", "schizophrenia medication", and "responds well to"/"reponds well to medication" and many combinations of those together, but it hasn't yielded the kind of details that I'm looking for. I also tried searching "delusions" and "hallucinations", "frequency" and "intensity" for my second question, but couldn't find exactly what I was looking for in that regard either. I looked at the NIMH website, as well as a number of mental health/schizophrenia forums to look for first-hand accounts.

#1: Basically, my understanding is that people with positive schizophrenia symptoms have a tendency to respond to medication better than those with negative symptoms (please correct me if I'm wrong). But what constitutes as "reponding well"? How frequently might symptoms occur? At what intensity? Would any efforts to medicate the ADD interfere with that? I know that these answers might end up being broad because everyone responds to medication differently and everyone's individual symptoms may vary, but I'm looking for a picture of what would fall into the realm of realism.

#2: I think this might also be something that varies. Essentially, the character's primary, most noticeable symptom (prior to treatment and possibly after depending on the answer to #1) to be delusions (namely, paranoid ones). According to that NIMH article, delusions fall under the heading of positive symptoms. However, the article also says that hallucinations (particularly auditory ones) are very common. I just want confirmation, would it be realistic to say that the character doesn't really have a great deal of hallucinations, and that his biggest problem is the delusions?

Thanks for any help. I really want to make sure that I avoid falling into any overused tropes with this.

stroke leading to Capgras (“impostor”) delusion

Setting: [Alternate universe version of] present-day northeastern United States

A character in my WIP is a sixty-something-year-old woman who gets a right-hemisphere stroke leading to the Capgras delusion (she believes that her loved ones have been replaced by impostors). Her relatives want to believe that after a year or so of rehab, this woman will not just get over that specific delusion, but be able to resume the work and family responsibilities she had before the stroke. Her nephew, a neurologist, could spin a plausible-to-a-layman story about how this might happen, but in his heart he knows that his aunt’s mental disability is permanent; she might recover enough to feed and dress herself and so forth, but never enough that, for example, she could be trusted to manage someone else’s investments.

I know that brain damage is not tidy enough to give someone one particular picturesque syndrome and leave everything else alone, so I would like to know what other physical/mental/emotional changes someone with this level of dysfunction might have, and how much they would be alleviated after a few weeks or a few months of treatment. Also, I would like to know roughly what the “yes she can recover” and “no this is permanent” arguments would look like. (Imagine a court hearing with duelling expert witnesses.)

I have Googled terms like “Capgras syndrome prognosis” and “right hemisphere stroke prognosis” and the main things that I learned were (a) lots of things can cause the Capgras delusion, and (b) the effects and prognoses for strokes can be all over the map. I found the NIH Stroke Scale and similar metrics, but it looks like when people talk about how those metrics correlate with prognosis, they are talking about prognosis over a term of a few months rather than years.

Thanks in advance.