Asked by Debra, United States
My 18-year-old daughter has been repeatedly hospitalized. There is a definitive family history of bipolar disorder on the paternal side. She has OCD behaviors and much of her conversational speech is off-topic and inappropriate. The medical team is unable to stabilize her. She was recently found to have schizoaffective disorder. Will she ever be functional?
Mental Health Expert
Dr. Charles Raison
Emory University Medical School
The most truthful answer to the question of whether your daughter will ever be functional is "maybe."
Different studies find slightly different things, but in general psychotic disorders probably follow what we sometimes call the "law of thirds." This means that 1/3 of patients will recover and lead fairly normal lives, 1/3 will stabilize but not return to normality, and 1/3 will have a progressive and downward course.
A quick note about schizoaffective disorder for our readers: While a little oversimplified, it is pretty accurate to say that this diagnosis was created to give a name to people who showed symptoms halfway between schizophrenia and bipolar disorder. People with schizoaffective disorder have more chronic psychotic symptoms than do people with bipolar disorder (or psychotic depression). And they have more depressive/manic symptoms than do people with schizophrenia.
No one has a crystal ball, so it's not possible to say what will happen to your daughter with any certainty.
However, there are some general trends that predict good or bad outcomes in patients with schizophrenia, schizoaffective disorder and bipolar disorder.
Bad outcomes are predicted by an early age of disease onset, a gradual onset, having lots of troubles prior to the first episode of psychosis (i.e. odd behavior), and by being a man.
Good outcomes are predicted by having a later age of onset, a very sudden onset of psychosis, having a lot of mood symptoms along with the insanity, having a high level of functioning before getting sick and being a woman.
You mention OCD, or obsessive compulsive disorder. Sadly, it is very common for people who develop psychosis to also suffer with OCD, either before becoming psychotic or at the same time.
Your daughter's situation is obviously quite dire. I am concerned by the fact that she is so young to have already undergone multiple hospitalizations. I'm even more concerned that she has not responded to treatment.
I say this because we now know that most of the damage to the brain caused by psychotic conditions such as schizoaffective disorder happens in the first years of the illness. This is also when treatment seems to have the most powerful -- and beneficial -- long-term effects.
People who take medications and whose symptoms go away appear to do much better over the long run than people who either don't stay on medication or who don't respond.
Here is the bottom line: Now is the time to do everything in your power to get your daughter in the best psychological shape possible. The clock is really ticking on this one, I'm sorry to say, because the longer she is psychotic the more her brain will be damaged and the worse she will do long-term.
Please be as bullish as you possibly can be in terms of trying to get her the most help you possibly can, and quickly.
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