“Try not to challenge her. Listen, but keep your comments neutral and non-judgmental.”
It is distressing to see your teen suffering from mania or psychosis. The psychiatrist will make it a top priority to shut down the symptoms, but it may be up to you to get your teen through the days. Hopefully, you can be present throughout this time, even if it means working from home for a while. It is best to provide vigilant supervision since the teen’s behavior may abruptly change and worsen.
Stabilizing Mania
Teens with bipolar disorder often experience mania. The manic teen may have pressured speech in which you cannot interrupt them, or they may pace, not sleep, or carry on about ideas that do not make sense to you. They may overspend or indulge in some other activity to excess.
For now, remove your teen’s access to Facebook, e-mail, or any other media form in which they could write something they later regret. Hide all credit cards and debit cards. Since mania can lead to dangerous behavior, make sure their psychiatrist is monitoring their progress. Follow his orders and record your teen’s behavior every day so that you can give him specific examples of what you are observing. It is easy to forget incidents when you are in the midst of an emotional turmoil. A faithful record can also encourage you when you see that there is improvement.
One of the toughest features of mania is that it often feels good to the patient. For this reason, your teen may resist medicine. Remind them that a crushing depression awaits at the end of mania, if left untreated. Tell them that you are not trying to spoil their good mood but that you want to see their mood leveled out for the sake of their mental health. Try to avoid getting pulled into lengthy, circular discussions that do not lead anywhere. It is okay to say that you need to go do some work for the time being. If your teen wants to talk to you all day, designate a specific time for discussion, such as from three o’clock to four o’clock. If they have a lot going on in their head, encourage them to write about it in a journal. Do not allow your teen to exhaust you.
Managing a Psychotic Episode
Psychosis occurs when a person begins to lose touch with reality. It can include hallucinations (hearing voices, for example) or a delusion (believing that people are out to harm them, for example). It may be a symptom of bipolar disorder or schizophrenia, but it can also occur with depression. It can be brief or it may persist for years.
Some medicines can cause psychosis, so your teen’s doctor will ask for a list of any medicines your teen takes. Street drugs such as LSD and marijuana can cause psychosis. If your teen is paranoid one night and fine the next day, suspect drug use. Talk to them and let them know that if they continue the drug use, the paranoia may worsen and can persist even after the drug use is suspended.
Sometimes a teen becomes psychotic from using illegal drugs and even after they stop the drug, the condition continues and has to be treated with antipsychotic medicine. If your teen seems paranoid for any reason, or if they are saying things that do not make sense, they need to see a psychiatrist. During treatment, the doctor may prescribe an antipsychotic, and he may provide a benzodiazepine like Ativan for short-term use to briefly suppress the psychotic symptoms.
Meanwhile, you will need to deal with your teen, who may be frustrated with the effort to explain to you what is going on because you do not see reality the same way they do. Try not to challenge them. Listen, but keep your comments neutral and non-judgmental. Trying to convince them that they are seeing things wrong will make the condition all the more frustrating, making them feel desperate, misunderstood, and alone. They may decide it is necessary to hide their beliefs from you, and then you will not know if they are still experiencing psychosis.
Although you are listening to your teen, do not encourage them to keep carrying on about their belief. It will only further flame the delusion. Try to keep the environment calm and quiet. Turn off the television, since they may misinterpret what they see and hear. If they try to engage you in their thinking, you may find yourself walking a fine line. Do not indulge the delusion by saying things like, “It’s okay, honey. I’ve put this cross on the door and the aliens won’t be able to get past it.” Maintain a tone of neutral empathy. For example:
Your Teen: There are people out there who want to kill me.
You: I can see that you’re scared.
Your Teen: You don’t believe me, do you?
You: What matters to me is that you feel scared. It must be awful to feel this way.
Your Teen: But you don’t believe me.
You: I sympathize with what you’re going through. I want to reassure you that your safety and well-being are my top priority right now.
Your Teen: Lock the doors! They’re coming. You don’t understand. Let me explain this to you again…
You: I hear you loud and clear. The doors and windows are locked, just as they always are at night. I know that the world is not always a safe place, so I take sensible precautions to keep our family safe.
Choose your words carefully, avoiding anything that could sound judgmental. Think before you respond. In their confused state, they will not notice any slight hesitations.
If the paranoia persists for months, you may want to make certain accommodations to make your teen feel more comfortable. For example, if they think people are out to kill them, they may not want the garage door open until they are safely inside the car. This is not the same as saying that you agree with the false belief. It is simply a courtesy to make life less stressful for them.
During auditory hallucinations,remember the following:
- Your own voice will be a source of reassurance. When the voices are at their worst, your loving tone may cut through the nonsense.
- During a lucid moment, ask your teen to list all the things the voices have said. It may comfort them to realize that the voices always lie.
- Getting your teen to talk can refocus their attention and make the voices stop. Some people find that singing makes the voices disappear. If they say they will feel silly, sing along with them.
- Hide anything that could be used as a weapon, including knives in the kitchen or tools in the garage.
Don’t wait until things become out of control. If you feel you are in danger, get out of there and call 911. Explain that your teen is in the midst of a psychotic episode and that you need an ambulance. The police will come too, but they will not arrest your daughter if they are clear on what is happening. Inform them if there is a weapon so that they are not taken by surprise.
If your teen is taken to the hospital, do not despair. Let the professionals take over. Afterward, avoid talking about the things your teen said at their worst. If they did something that now has consequences, such as over-spending, offending someone, or getting into trouble with the law, reassure them that there will be time and opportunity to fix it. For now, it is time to focus on getting well. After your teen is well, it is a good idea to work together on an emergency plan.
Recommended Books:
The First Episode of Psychosis, by Michael T. Compton, M.D., M.P.H. and Beth Broussard, M.P.H., C.H.E.S.
When Someone You Love Has a Mental Illness, by Rebecca Woolis M.E.E.C.
“You may feel as though your teen could still benefit from being in therapy longer, yet they may need a break.”