'schizophrenia'

- a carer's journal

At the weekend Jane saw Sam on Friday and I saw him on Saturday. We had both last seen him the previous Saturday.

In those few days we were both astounded by how much weight he had put on. At least half a stone and probably more. He could not fasten his trousers and his face was puffy.

We each mentioned it to staff but they made light of it. They had not noticed. Well .. he eats a lot ... was their attitude. But the change in medication has increased his appetite. His named nurse lends him money for take-away pizzas. They think he is not well enough now to discuss healthy diet - they will wait until the medication has started to work on his mental state first.

We have been waiting for that for the last ten years.

In any case - by then if his metabolism has changed and he has put on a huge amount of weight the damage will have been done.

His current medication has previously affected his heart so that is being monitored carefully. Increase in weight can affect the heart. So is it not a good idea to monitor that?

They were not even weighing him before this week since we have asked. Where psychotropic medication is associated with serious weight gain surely this should be monitored. This is a hospital yet there seems to be little concern about serious weight gain - and we have found this on most of the psychiatric wards where Sam has been based.

It seems that serious weight gain is regarded as an acceptable consequence of trying to treat psychotic symptoms. So if he dies early from a heart attack or gets diabetes that is okay.

It is too close to the old joke about the treatment being a success but the patient died.

When Jane visited Sam last Friday he was in great form. He seemed really well and was discussing things he had been doing during the week in a positive way. He was friendly with her and things went swimmingly.

So I was surprised and disappointed on Saturday when I found Sam again antagonistic and angry with me. He was calm and not threatening but he was not well. He had seen me often on the television and knew I was evil. But each time I suggested I should go and come another time when he was feeling more positive he asked me to stay.

I stayed for a while but decided not to overdo it.

Later that evening Sam phoned me and apologised. He seemed to have got over whatever was troubling him.

I'm sorry I haven't written for a while ... I seem to have fallen into a stupour! Though I have also been less well. Since before Christmas my ME symptoms have recurred a little more strongly and more often. That in itself becomes depressing and I am in danger of getting into a downward spiral - though I am trying hard to not let that happen.

More tomorrow.

I promise.

In fact I will write it now ...

Sam called last night. Several times. He wanted us to call the olice for him. The emergency services number does not work on the ward payphone. I wonder what other payphones this number is disabled from?

He thought another patient had threatened his life. It was no good talking to staff -they would do nothing. He sounded very confused and mixed up and angry with us. We tried to calm him down and got him to talk to the nurse in charge.

I think our last call from him was about half past midnight. It was to tell us that at least his Granny and Grandad had been understanding and supportive when he had also called them twice - whereas we didn't seem to care!

Sam has kept telephoning recently - at about seven in the morning on Saturday and Sunday did not glean the most wakeful responses from us. Sometimes he has been quite calm and settled - but at others he has been very troubled and even antagonistic.

It has just reinforced to us how changeable Sam is.

So when we visited Sam we were shown in - after a long wait while he was woken up ... then got to walk round the hospital grounds with Sam. There was a well worn route - Sam knew the way well. It even went through the visitors' centre of the acute wards. This brought back old memories of when Sam had been there on previous occasions.

But the garden of the visitors' centre had been revamped very nicely. In a small area they had transformed it very imaginatively. In the summer it will be even nicer. But the nurse had no lighter and Sam wanted a cigarette - so we soon had to head back towards the ward. Sam had been quiet - but relaxed, more contented than we have seen him for a while.

Jane suggested that we ask if Sam was allowed a walk round the grounds then we might ask to accompany him on our visit at the weekend. The nurse she talked to said it was a great idea.

I was a bit surprised at my own reticence about it. It was a great idea. I just seem to have lost my confidence somehow.

Jane rang about Sam last night as we were still worried about how he was doing. Fortunately she got to talk with Sam's named nurse.

Sam has been well, taking his medication, he's been out with his named nurse twice ...

Often, Sam changes so quickly it makes any rational attempt at analysis impossible!

On Sunday he rang us in the morning. He hadn't slept, his ears were hurting, his jaw was aching so he couldn't eat his breakfast. He had demanded that they take him to the general hospital and was ringing us because they wouldn't. He was sure he had a tumour in his brain. But a doctor was coming to see him at lunchtime.

After lunch we phoned to see if the doctor had seen Sam. Sam was very dismissive of him and the nurse was very defensive. He hadn't examined Sam but just prescribed paracetamol. It might have been all that was appropriate but in treating a patient who believes he is dying of a brain tumour a few moments to examine Sam and to try to reassure him wouldn't come amiss. The fact that Sam has delusional beliefs should make this more necessary rather than less.

Sam was angry that we were not going to visit him that day. He was convinced he might die later that evening and that we might never see him again.

When we saw Sam on Saturday he was wearing two wooly hats. He said it was because he had ear ache.

He seemed pleased to see us at the start but soon got into his antagonistic mood about being locked away and it being our fault. He seemed very depressed about being locked up - and was at his most articulate describing it. He kept referring to the cage around him - he pointed out of the window at the fence to illustrate his point when Jane tried to describe his situation differently.

He was right. He is in a cage. We know that.

When Jane saw Sam last week he was very good and his named nurse said he was doing well. He'd taken Sam out for a walk and had enjoyed chatting wit him.

But since then Sam has started to deteriorate very quickly. He has been refusing his medication occasionally. He says it is very strong - he has just been started again on clozapine - but more slowly though than is the norm.

Perhaps it is the change in medication that will take some time to settle down. But with Sam it is difficult to tell. He is always so changeable.