Perhaps Saint Raphael would be a good option. Their website mentions they have a long-term care wing, though it’s limited to just 15 beds. I suspect other psychiatric facilities likely have similar specialized units with their own capacity limits—but honestly, everything feels a bit small when you consider how much actual need there is out there. If anyone happens to know more about what the admission process looks like for that kind of residential care, please feel free to share. I'm sure plenty of people would find that information incredibly helpful.
Personally, I think this book is absolutely stellar. I’m planning on picking up a copy to read through—and then sharing it with my family members so they have a clear idea of how to handle things if I ever hit a relapse. That said, I’m feeling quite optimistic about staying on track since I've been strictly following my prescribed treatment plan.
A brand new textbook titled "Emergency States in Psychiatry" has just been released by a major medical publisher—authored by Miroslav Herceg, Vlado Jukić, Zrnka Kovačić Petrović, and Aleksandar Savić from the Vrabac psychiatric clinic.
This manual is designed specifically for medical students and psychiatry residents—though it’s also an excellent resource for other specialists, family practitioners, and any healthcare providers who deal with patients facing acute psychiatric crises or simply want to master the fundamentals of emergency mental health care. The goal here is quite straightforward: to provide a concise, practical guide on how to manage patients exhibiting symptoms of acute psychiatric illness or those in crisis—situations where quick action is vital to prevent poor outcomes—whether that assessment happens in a psychiatric ER, a primary care office, or a general emergency department.
One could say that emergency psychiatry is a specialized niche—essentially the clinical application of psychiatry within high-stakes, urgent scenarios. The authors approach these complex issues from a standpoint of deep clinical expertise gained at the Vrabac psychiatric clinic, which serves as one of the largest psychiatric institutions in America. Because they handle such a massive volume of diverse emergencies every single day, the collective professional knowledge regarding emergency evaluation and treatment found in this book is truly immense. The textbook is organized into a general section, a specialized section, and several helpful appendices.
Since emergency psychiatry sits right at the intersection of psychiatry and emergency medicine, it really functions as a unique hybrid of the two fields. This book fills a bit of a gap in those specific areas—so we are optimistic that it will lead to better understanding and management of acute psychiatric patients, while also helping people recognize emergency psychiatry as a critical component of comprehensive patient care.
I once knew a girl—someone who was undergoing treatment at the same time I was—who actually ended up driving the wrong way down a highway. It was pure, unadulterated luck that nothing tragic happened. Since I don't drive, I obviously couldn't pull a stunt like that myself, but the reality is that when any of us are in an emergency state, we can be prone to paranoia and some pretty wild ideas. We could easily end up hurting ourselves or someone else—which is why I truly believe doctors and anyone working on the front lines should be better trained to handle psychiatric emergencies.
"Emergency psychiatry sits right at the intersection of psychiatry and emergency medicine; in that sense, you could view it as a specialized hybrid of those two fields. While this book covers certain aspects of those areas less extensively, our hope is that it will foster a deeper understanding of how to manage acute psychiatric patients, while also helping to promote the recognition of emergency psychiatry as a vital component of overall psychiatric care."
The idea that others might view us as the bad guys—well, it just didn't sit right with me—I’ve never really seen things from that angle before. Though, I did have one person—someone who joined my family through marriage—say something to me once that was so cutting, I won't even repeat it here. What’s most disappointing from a professional standpoint is the social worker involved. Honestly, you have to be incredibly narrow-minded to think that way, let alone actually say it—especially when you're supposed to be an expert on the situation. It just goes to show, you really can encounter anyone. 👋
It happened three times back when I was around 18 or 19—and it was always the exact same diagnosis. Honestly, if I had been a bit more level-headed, I probably would have stopped after the second episode. Some of us just can't function without medication!
It really hurts that some people view this as a character flaw—though, truthfully, I’m not sure which is worse: that judgment or the stigma that comes with being ill. 🙂
Hi there! After my second psychotic episode, I was diagnosed with paranoid schizophrenia. For a long time, my entire world revolved around one goal: getting better. After enjoying fifteen years of steady remission, I started thinking—not out of nowhere, mind you—that maybe I didn't actually need medication. I had been diving deep into the world of anti-psychiatry and critical psychiatry, and I decided to go all in. Well, guess what happened? Predictably, I hit a third episode. Thankfully, I’m recovering well now—and honestly, it wasn't thanks to any medication. But enough about my personal history.
The psychiatrist Karl Menninger once said: "Attitudes matter more than facts."
Here is why: You could say this over and over again until the truth truly sinks in. No matter how hopeless a situation might seem, no single fact is as significant as the attitude you bring to it. What you believe about a circumstance can defeat you before you even take a single step toward addressing it. You might let a hard truth overwhelm you before you even begin to tackle the problem. On the flip side, maintaining a reliable, optimistic mindset can actually shift your reality and allow you to overcome those very facts. 🤔
Harold Anderson3 said:I’ve noticed quite a few of my "colleagues" and friends dealing with various forms of psychosis have had episodes rooted in religious experiences. While thinking you actually are Jesus Christ is a pretty extreme example, some psychiatrists tend to view any kind of belief in God—whether it's through prayer or seeking help and finding fulfillment—as nothing more than an escape from reality.
In a book I read once, 'The Road Less Traveled' by Morgan Scott Peck, it mentions
The path to holiness is paved with maturity. There are no easy shortcuts. If we try to take those "shortcuts," we are much more likely to end up facing schizophrenia rather than reaching true sanctity.
That is exactly how it's phrased in the book.
Some psychiatrists and psychotherapists are atheists, while others are believers—and they naturally react according to their own worldview and ideology. Consequently, they often hand out diagnoses based solely on how they perceive things. If schizophrenia typically manifests around age 23 or 26, depending on gender, it’s hardly a surprise that some psychoses are religious in nature—since this is the stage of life where people are searching for themselves as spiritual beings. Of course, not everyone goes down that route; some might mistakenly think they are Mary Magdalene, while others might think they are a Hollywood celebrity. If you possess true spiritual intelligence, you will remain a spiritual being regardless of the illness. The illness is merely a path, never the destination. We are shaped by our experiences—and that includes being shaped, in part, by our struggles. Through illness, we can actually grow and mature—sometimes even more deeply than those who haven't endured such intense and painful experiences.
bluejackal2 said:Hey there, my fellow Unknowns, I’ve got a question for you all, but please, take a second to really sit with it and give me an honest answer: Do any of the antipsychotics you're taking have any kind of impact on how you experience your religious or spiritual thoughts?
That breaking point is actually the breakthrough moment for a conscious, awakened being. Antipsychotics don't define who we are; they simply serve as a safeguard against relapses and the illness becoming chronic. After all, anyone can experience a mental breakdown or a psychotic episode if the outside world pushes them hard enough.
mistynomad12 said:Antipsychotics are basically known for tanking your dopamine—that’s their main job, right?—and because of that, your prolactin levels end up spiking. Since dopamine and serotonin kind of have this inverse relationship (like how you lose your libido on SSRIs), I guess the same thing is happening with antipsychotics. That’s probably why such a huge chunk of people dealing with schizophrenia smoke; they're just trying to ease those symptoms caused by the dopamine crash. I honestly don't know if there's even an antipsychotic out there that targets dopamine without absolutely killing your sex drive too. The only thing I can really think of is maybe asking if you can drop your dose a little. Obviously, don't go changing anything on your own, but I'm not sure what else you could even do.
Regarding the high prolactin thing... that can actually be what causes low libido or sexual dysfunction in guys, especially if there's a pituitary tumor involved. Usually, doctors prescribe dopamine agonists as a medical fix to shrink the tumor. But given what you're going through, that would probably be a total disaster since dopamine is also what's responsible for managing those positive symptoms.
You summarized that perfectly. It seems to me that roughly 70% of patients diagnosed with schizophrenia smoke—I’m actually a former smoker myself—but it really isn't a healthy way to cope, especially when dealing with negative symptoms. I believe the real solution lies in maintaining a healthy lifestyle: a balanced diet, and supplementing with Vitamin D3, Omega-3s, magnesium, and B-complex vitamins. Physical activity is always a plus, along with practicing kindness, empathy, and staying social. It's all about boosting those "happiness hormones" naturally.
Some antipsychotics trigger prolactin issues more than others, while some barely touch it at all. Ultimately, a psychiatrist's primary focus is treating the mental illness, so it often comes down to their specific clinical perspective. For eighteen years, I was on monotherapy with Zyprexa—which is almost a gold standard for anyone with schizophrenia—but I could never quite feel right on it. My doctor kept insisting, "You're doing fine, this medication is working well for you." Now, I'm on a combination of two antipsychotics. I did experience a relapse, though thankfully it wasn't a full-blown one, but I actually find I have much more drive for physical activity now. I can see clearly that I feel better on this combination than I ever did on monotherapy. It makes this way of life much easier to accept; previously, my only thought was how to stop taking the meds altogether just to prove I didn't need them. So, everything has its pros and cons. I suspect that, over time, we will eventually be able to reduce the dosage—which is likely the best outcome we can hope for. 🙂 All in all, being a "schizo" isn't quite as bad as people make it out to be. 😁
Nicole Barrett76 said:Please, do not hesitate to speak up about this specific side effect, for how can one truly flourish when such a fundamental aspect of life is diminished? Over the long term, this lack of desire can severely impact your overall quality of life and lead to mounting frustration. Is it not his duty to listen intently to your concerns and work alongside you to find a solution? While the medication might mean your libido won't return to its former peak, suffering a total absence of desire is simply unacceptable.
Perhaps you feel a sense of embarrassment because he is a man, but should you really allow that hesitation to stand in the way of your well-being?
Thanks for the support, Nicole Barrett76. 👍 My biggest fear is that he’ll just tell me the benefits of the medication outweigh the downsides—and then I'll just end up feeling foolish for even asking. After all, I was only prescribed this because I hit a massive relapse after about ten years of being totally stable. It was essentially a "stop the bleeding" moment—like emergency responders rushing into a building to save people at the very last second—since I ended up checking myself into the hospital after complaining to my primary care doctor and the ER three separate times that things weren't right.
Prolactin is a hormone secreted by lactotroph cells in the anterior pituitary gland. Its synthesis and release are regulated by various peptides, steroids, and neurotransmitters. The primary inhibitory regulation comes from dopamine, which binds to D2 dopamine receptors on the membrane of lactotroph cells. Antipsychotic drugs block these receptors, thereby removing dopamine's inhibitory effect on prolactin secretion. While all antipsychotics block D2 receptors and can induce hyperprolactinemia, it appears that the faster an antipsychotic dissociates from the D2 receptor, the lower the rise in plasma prolactin levels. Another explanation for hyperprolactinemia involves the ability of the antipsychotic to cross the blood-brain barrier, along with the role of its metabolites. Consequently, antipsychotics can be categorized into those that elevate prolactin (conventional neuroleptics, amisulpride, risperidone) and those that are more prolactin-sparing (clozapine, aripiprazole, olanzapine). An American study indicated that 18% of men and 47% of women treated with antipsychotics for severe mental illnesses had prolactin levels above the normal range. Hyperprolactinemia is actually more common in women than in men. While sometimes asymptomatic, higher prolactin levels lead to more clinical manifestations in patients. Some symptoms result from hypogonadism caused by prolactin disrupting the hypothalamus-pituitary axis, while others stem from direct effects on target tissues. As a result, patients may suffer from sexual dysfunction, infertility, amenorrhea, gynecomastia, or galactorrhea. Data suggests these symptoms are frequent, yet patients rarely mention them spontaneously, and clinicians often underestimate their prevalence. Long-term, hypogonadism involves premature bone loss in both men and women. Klibanski and colleagues demonstrated that this loss is only significant in women with hyperprolactinemia associated with amenorrhea, suggesting prolactin itself may not be directly responsible for this specific feature. However, prolactin does seem to play a role in the development of breast cancer, though its connection to prostate cancer remains unclear.
I'll have to figure out my next move. I'm not even sure when my next check-up will be—given how much COVID is still flaring up lately—so I'll probably just wait for my doctor to taper my dose down himself. That will likely happen once I finish all 24 injections (I have 5 left). I might be rambling a bit—and I know I can be a little much sometimes—but I truly feel like we should be leaning on one another more. This space is such a gift because we can be totally anonymous while we talk about the things that are actually weighing us down. Maybe I just have this deep-seated need to vent, but honestly, there’s something so healing about being heard—especially when someone actually takes the time to respond. 🙂
Hello there, my dear fellow travelers! :-) I have a quick question for the group. About a year and a half ago, I started taking an antipsychotic, and since then, I’ve noticed a significant drop in my libido. I'm 46—not in menopause yet, and I don't currently have a partner—but regardless, I'd really love to move past this side effect. My doctor is a good man, truly, but he has such a strict, authoritative presence that I find it difficult to even bring up a complaint. Are any of you dealing with this too? Specifically, I'm wondering about women who might be experiencing this but aren't necessarily speaking up about it. From what I've been reading, this could be linked to hyperprolactinemia—which isn't something I can see outwardly, but they seem connected. And, theoretically, that can lead to an increased risk of breast cancer. Now, I actually feel quite good on the medication itself. It almost feels like when you're on antipsychotics, you just have to accept certain side effects and learn to live with them—since every single medication comes with its own set of baggage. You just decide which trade-offs are worth it. Still, it's been weighing on my mind.
Paranoid schizophrenia is actually the most common type—and generally much more manageable than other clinical forms—yet people still get it wrong. It isn’t hereditary, and for heaven's sake, it certainly isn't the same thing as autism. I’d highly recommend doing a bit more reading—ideally diving into literature from a wide variety of sources.
Anthony Green9 said:I guess I actually envy you. You seem pretty high-functioning despite the schizophrenia. There might be some gender differences too, since being a woman can make this affect you differently than men. Plus, meds work for some and not for others. I definitely get it, though. I can't seem to find the drive to do anything; the lack of motivation is brutal. It's a daily struggle, I suppose.
Hi there! When you use the term "high-functioning," it almost sounds like my own experience was somehow milder or easier to manage—though I’m not entirely sure that’s actually the case. I am aware of the gender disparities in how we handle this, and I personally feel that men often struggle more with the diagnosis. And, as you noted, medication efficacy varies wildly from person to person. The reality is that while some people might face only one or two hospitalizations in their entire lives, others could face thirty—so the intensity of this illness is certainly not a uniform experience. However, if someone is functioning "well"—and I use the quotes intentionally—it is usually the result of immense effort, sheer willpower, and, frankly, a fair amount of favorable circumstances. Those circumstances can shift in an instant, though; life has a way of throwing you off balance when you least expect it. Another massive factor is having a solid psychiatrist. I was lucky enough to have the same doctor from my first episode at age 26 through the next fifteen years. Because of her, I only had one other hospitalization—mostly because I stopped taking my meds after that first scare. If it weren't for her, I doubt I would have ever finished college or held onto the vision I had for my future. I was convinced I was stronger than the illness itself—and if anyone ever suspected otherwise or pointed something out, I simply refused to be pushed around. After all, everyone has bad days or moments of distraction, so why should anyone single you out just because you forgot something or seemed lost in thought? I would just push back against those comments, and honestly, I felt I had that right—given how hard I worked to stay on track, I often outperformed everyone else. I'm 46 now, and I'm currently not working. To be perfectly blunt, life hasn't turned out quite the way I envisioned—there are many reasons for that, which I won't list here—but believe me, the illness isn't the primary culprit. Still, I think it made everything so much harder; even though I resisted admitting it for a long time, it would be fair to say that I should still qualify for disability benefits as I continue this difficult journey. That said, I don't think we all need to be tossed into the social welfare system—that wouldn't be fair to many of us. Just remember one thing: prejudice can't touch you if you don't let it! ☕
Anthony Green9 said:I haven't told anyone at work about my diagnosis. It’s pretty obvious from how I act, though. People are always asking me, "to be or not to be," or if I just didn't get enough sleep. My issue isn't hallucinations or voices; it's just that my cognitive issues are pretty bad. I guess soon I won't even know what 2+2 is. I thought I could manage something easy, but even the simplest tasks feel like trying to master nuclear physics.
On the surface, I look perfectly fine—but trust me, it is so much harder for me than it is for the average healthy person. I push myself so hard during my shift to make sure nobody notices anything is wrong, but by the time I clock out, I'm absolutely spent. While other people go home to cook dinner, run errands at Target, hang out with their kids, spouses, or friends, and maintain a regular social life every single day—I'm a different story. If I give it my all at work, there is nothing left in the tank; I just collapse and sleep.
Anthony Green9 said:Anyone here dealing with schizophrenia? Just wondering what your experiences have been like. I feel like people at my job look at me like an alien or something, and honestly, I've become a bit of a laughingstock. I guess it makes me wonder if it’s even possible to hold down a job while dealing with this.
I used to hide my diagnosis like it was a state secret—honestly, I probably deserved an Oscar for my performance because I didn't have any issues for a long time. But now, I've hit a wall. I've exhausted all my options and have to apply for disability. If the medical board decides I'm unfit for work and sends me back to the agency, I'm honestly lost on who would even hire me with this diagnosis—though I truly believe I could hold down a job if it were low-stress and wasn't physically demanding. The problem is, who's going to offer me that, especially out here in a small town? Could you tell me a bit more about what you've been through? 🤔
Adam Morris4 said:I’ve been saying this for ages: those "doctors" with degrees from backwater rural clinics out in the Midwest don't have a clue what they're doing when they practice here in the States... They don't understand the actual effects or the side effects of the meds they hand out like candy. For them, it’s all about looking the part—playing the big-shot doctor in society while you hand over $200-$$100 just to get through the door. Their goal is to get you out as fast as possible, ideally making sure some big pharmaceutical company gets a little "kickback" for the prescriptions they write. It’s all just fuel to lease a flashy new truck, add an extra floor to the house, pay for the kids' college tuition, or maybe even fund a little secret lifestyle on the side... I'm talking specifically about the psychiatrists I've encountered out in California...
The worst of the heatwave has finally passed, so I finally managed to get a bath yesterday around 5:30 PM—though honestly, you could probably head to the beach even earlier without needing much sun protection at all. I'm hoping to catch a little tan. About three years ago, my psychiatrist in Washington, D.C. actually warned me that if I saw any doctors in the nearest California cities, they wouldn't truly understand my situation and that I should steer clear. It isn't exactly news that healthcare quality varies wildly depending on where you are. Even in Washington, D.C., you really have to know which door to knock on—and frankly, you need a fair bit of luck regarding who ends up treating you. After twenty years of navigating treatment, you start becoming a bit of an expert yourself. Still, we have to trust the science—so why aren't we handing out red cards to the people posting nonsense online claiming that schizophrenia isn't a disease, but some sort of spiritual enlightenment?
Adam Morris4 said:All this psychotropic stuff really messes with how your body regulates temperature...
For a long time, I was on Zyprexa monotherapy—it made working under the sun impossible, but I could still hit the beach around 4 or 5 in the afternoon, swim out to the buoys, dry off, soak up the rays until 6, and head home. It wasn't ideal, but it worked. Now? It’s a disaster; I can barely leave the house. Being on both Zyprexa and Xeplion together has completely shattered any illusions I had about Xeplion being some kind of miracle cure once summer rolled around. My psychiatrist is playing dumb, and honestly, I don't even know what to hope for anymore. I certainly didn't expect my entire summer to be ruined like this. At least the weather was free—even for someone living in a tiny rural town without any of the medical privileges or lifestyle options you get in a major metropolis. I only make the trip to the big city every few months, and it makes me wonder if people there don't receive much better care. These local psychiatrists really lack expertise; everyone hands out different diagnoses and suggests different treatments, which ultimately just drives a person crazy and leaves them feeling lost—which is exactly what happened to me. If things had gone differently, I would likely still be on monotherapy right now. For now, I have no choice but to stoically endure this current state. And judging by how much I'm rambling here, you can see how well I'm managing. I’m hoping to wake up earlier tomorrow and finally shake off this fatigue. If I manage to pull it off, I'll write another post—this time about the wonderful life in California.
Does anyone have any substantial experience with Xeplion? I started receiving injections back in October of last year, and honestly, I’ve been very happy with them. When I was strictly on Zyprexa, getting any kind of physical activity going was an uphill battle—it wasn't that I lacked the willpower, it was just that my body wouldn't cooperate. It felt out of my control. With Xeplion, things shifted significantly, and the difference has been quite night and day. However, now that summer has arrived, I was really looking forward to getting some sun and spending time in the water—especially since I'm not working right now and I live right near the coast. By June, even before the peak heat hit, pharmacies were already running sales on sunscreen. I prepared myself by picking up some Avene 50+ because I'd heard great things about SPF 50, but as soon as the heat actually kicked in, I found I couldn't handle even five minutes in the sun. This never happened when I was on Zyprexa; back then, I didn't even bother going outside, whereas now I feel forced to stay inside with the AC blasting—I haven't even managed a quick evening stroll in the last four days. The only real fix would be to get up quite early, take a walk, go for a swim, and be back home by 9:00 AM. But I am definitely not a morning person—especially since these medications tend to make me sleep in longer. I did come across some information online suggesting that Xeplion can interfere with the body's ability to regulate temperature, and I even read somewhere that those twelve fatal cases in Japan were specifically due to heatstroke caused by this issue. Perhaps I'm just overthinking this or complaining too much, but it would be a huge help to hear from someone else who has dealt with this. Any advice, comments, or insights would be most welcome...