Managing psychotic disorders: therapy options

I've had a close friend for years who struggles with what seem to be psychotic episodes, but he refuses any kind of medical treatment and has never actually received a formal diagnosis. In the early days, he dealt with hallucinations and paranoid delusions. His parents eventually reached out for psychiatric help and were given Haldol drops to administer "discreetly." His mother has been mixing about 19 drops into his morning coffee and then roughly 24 drops in the afternoon. Nowadays, he doesn't show any obvious signs of disorganized thinking and seems to function quite well. He generally prefers his own company and sticks to a very set routine. He’s reliable when you can trust him with something, though he lacks any real drive or initiative. He tends to avoid social circles or just stays quiet, but he does talk with family and even enjoys cracking jokes. That said, he rejects any professional medical intervention entirely; it’s simply not an option for him. The main issue we're seeing is that every ten days or so, he enters this state of complete withdrawal and absence where he's totally lost in his own world, moving slowly and becoming unresponsive when you try to talk to him. On those specific days, he smokes much more than usual and becomes restless, pacing around constantly and struggling with insomnia. By the next day, everything returns to normal, and he usually ends up needing a lot of sleep. It might also be worth noting that he occasionally slips a beer into his coffee, which is something he really enjoys whenever he gets the chance.
I'm reaching out to anyone who might have similar life experiences or professional insight to help this 35-year-old guy, his parents, and all of us friends who feel so helpless watching this unfold. Thank you all so much in advance for your kindness and help.

Hold on a second—this guy is 35 years old. And his parents are secretly slipping medication into his coffee??? Are they even his legal guardians? If not, they really shouldn't be doing that... I’d say it’s illegal, and he could seriously come after them once he finds out.
I know I would.

So, why on earth is a 35-year-old still living at home with their parents?
Is the whole thing just a result of some messed up dynamic between them?

With all due respect to everyone here, I feel like the direction of my thread is being shifted away from what I actually need. I’m looking for genuine help, not just commentary on my situation. I don't think anyone would go through this kind of struggle just for the sake of it; it comes from a place of real desperation, and I'm just trying to find the only solution left to me.

Hold on a second. You have to realize they aren't even allowed to do that to him. Just imagine being in his shoes!
Is this guy under their legal guardianship? If he isn't, is he even capable of working? If he’s not fully lucid, then his parents shouldn't be having any trouble becoming his guardians. But if he is sharp enough to function on his own, then they really need to sit down and talk to him about seeing a psychiatrist—which is pretty much the standard nowadays anyway—just to get things back on track. Though, the doctor definitely needs to know about any "off-the-books" meds...

Bottom line, seeing a psychiatrist is a must. He might be dealing with schizophrenia, or maybe there are just better medications out there for him.

One thing you can try right away, though, is physical activity. Get him out of the house and worn out with some sports or just spending time outdoors. It won't seem suspicious to him, and it should help settle that restlessness...

But again, I'm telling you—talk to a psychiatrist. The parents could even reach out for advice on their own first.

I really appreciate all the effort everyone is putting in here, but I can't help feeling that there might be a bit of a gap in understanding what it's actually like to deal with patients like this. It’s hard to convey just how much he refuses to engage with a doctor—he won't talk to them, and he certainly won't listen to anything they have to say. At this point, the parents are the ones handling all the communication with his psychiatrist, so the medical team is fully aware of the situation. We try everything we can to encourage him to seek help himself, but so far, nothing has worked. It isn't a matter of the parents acting as legal guardians because he is perfectly capable of functioning on his own; it's more that he's become incredibly unmotivated, perhaps even a little lazy. He isn't struggling financially, either, so this lack of drive has essentially just become a deeply ingrained lifestyle habit that we haven't been able to break despite our best efforts.

No matter how you look at it, I just don't get how any doctor would suggest giving an adult their medication behind their back. It's totally unthinkable... and illegal too.

hiddenowl9 said:I appreciate the effort, but I honestly feel like there isn't enough hands-on experience here with patients like this.

So true!
It’s actually pretty terrifying when people secretly administer medication based on some doctor's advice, especially when that doctor isn't even treating the patient!
It’s a slippery slope—someone could easily decide you're "unwell" based on their own weird standards and try to force meds on you too.

After reading through everything here, I’ve gotta say, it really sounds like these are textbook symptoms of schizophrenia.
And look, I’m definitely not saying it’s inhumane for his parents to be treating him on the down-low behind his back, but...

What on earth is going to happen to him once his parents eventually "move on" from this life?

Honestly, I feel like the time has come to sit him down and get him to face the reality of what’s going on, so he can actually learn how to himself handle it for the rest of his life.

bluemason44 said:Based on everything I've read here, it seems like these symptoms are textbook schizophrenia.
And look, I don't think it's inhumane for parents to treat him behind his back, but...

What happens to him once his parents are gone?

I really feel like it's time to sit him down and face this reality, so he can actually learn how to handle things on his own.

I wouldn't go as far as calling it schizophrenia. You're overreacting.

hiddenowl9 said:A friend of mine has been dealing with some psychotic disorders for years now, but he just refuses to seek treatment, and he’s never even had an official diagnosis. In the beginning, he was struggling with hallucinations and paranoid delusions. His parents reached out for psychiatric help and were actually given Haldol drops to administer to him "secretly." His mother would slip 19 drops into his black coffee in the morning, and then about 24 drops in the afternoon. Now, you can't even tell he has those "erratic" thoughts—he's functioning pretty well.

So, he doesn't want treatment, he’s never seen a psychiatrist, yet a doctor—based solely on talking to the parents—diagnoses the disorder and prescribes Haldol, an antipsychotic.

No psychiatrist in America would ever do that—it's just not how it works here—and if someone actually did prescribe medication without even examining the patient, that doctor should be reported to Medicare immediately for malpractice. 😕

I mean, I don't know... something about the logic in this whole story just doesn't sit right with me.

Look, if he actually saw a psychiatrist and they prescribed him Haldol, they didn't just pull that out of thin air... And they certainly wouldn't have handed over a diagnosis without good reason... Unfortunately...
But, if he was given medication based solely on what a psychiatrist heard from his parents, then we have a serious problem here...
His behavior, his age, and the simple fact that an antipsychotic is working—even though I secretly condemn giving meds behind someone's back—all say a lot...
He needs to get a full evaluation. He has to know what he's dealing with so he can treat it properly; he has to accept it before he can actually live his life...
You can't force him, but you also can't just secretly administer drugs without specialist supervision...

He first saw his doctor about ten years ago when he was originally prescribed the medication, back when he was dealing with those intense hallucinations and paranoid thoughts. These days, his parents just check in with his psychiatrist every once in a while to give them an update on how things are going. To be honest, those old symptoms have mostly faded away, leaving him mostly withdrawn and disinterested in things.

hiddenowl9 said:So, he saw a doctor at the very beginning ten years ago when the medication was first prescribed, which is when the persecutory thoughts and hallucinations were happening. Now, his parents just visit the psychiatrist occasionally to give updates on how things are going. It's true that all those earlier symptoms are gone; now, he just seems withdrawn and uninterested.

That withdrawal and lack of interest sound like the emotional blunting caused by taking Haldol, which you mentioned they might be giving him behind his back. Giving Haldol without consulting a doctor—and even worse, without the patient being part of that conversation—is incredibly dangerous. Seriously...

Psychotic episodes often relapse, and there is a high probability they will follow a cyclical pattern (like once a year, or every two years, etc.).

The patient needs regular check-ups and must attend all scheduled appointments with their physician.

When dealing with psychosis, personality disorders, or schizophrenia, the real struggle isn't necessarily finding the right long-term treatment; it’s the family battle to get them to actually see a psychiatrist.
They usually respond either with aggression or through manipulation. That is the hardest part.
I wouldn't recommend sneaking medication to anyone, especially not Haldol. That's meant for the initial two weeks following a psychotic episode, and even then, it should be paired with something like Akineton to offset the side effects.
For milder relapses, gentler antipsychotics are needed, with the dosage gradually tapered down.
I think your friend is being treated dangerously and incorrectly, primarily because the approach toward him is wrong from the start.

I've dealt with this personally with an extremely intelligent psychotic individual who spent eight years convincing everyone in the family of his delusions—delusions that were crafted so intelligently they seemed almost plausible.

Sometimes you just have to push through the conflict entirely, even if it means resorting to physical restraint or tying someone to a bed. It sounds awful, but sometimes you need the courage to be harsh...
People can be so easily manipulated, especially parents. Instead of taking charge, grabbing him, putting him in the car, and driving straight to the doctor, they take the path of least resistance and just sweep everything under the rug...

🙄

Look, this forum isn't some kind of amateur clinic where people can just prescribe pharmacotherapy left and right—if someone is struggling, they need to get themselves to a hospital for a real evaluation.

hiddenowl9
So, what you're saying is he actually saw a psychiatrist once, but it was... what, ten years ago? That's hardly a recent check-up.😲

If this person is truly your friend, as much as you claim, then stop playing doctor and actually help them.

crimsonhound80 said:🙄

This forum isn't the place for amateurs to prescribe medication; this guy needs to be taken to a hospital for a proper evaluation...

Just like I pointed out earlier...

Brenda Carter96 said:Sometimes you just have to commit fully to a confrontation and, in the end, resort to physical force, bed restraints, and all sorts of unpleasant, heavy-handed measures. You need to have the courage to be cruel sometimes. Yes.
.

I’m sorry, but what kind of "courage" are we talking about here? You can't just use force on anyone; neither the police nor emergency services will step in unless there is an immediate danger to that individual or a threat they pose to others. Period.

It is especially problematic when someone is currently in that withdrawn, lethargic phase. What exactly would you do? Tie them up while they're in that state and haul them off to St. John? It doesn't make sense.😁

Perhaps it would be more effective to guide them toward voluntary consent by explaining that their medication needs adjustment—which is clearly necessary—provided it comes from someone they actually trust. They could talk about adjusting a dosage or something similar, rather than just forcing chemicals into them until they become a complete zombie.

There should be no violence, and this idea of working "behind the scenes" collaborating with the psychiatrist, well, I have to wonder if that psychiatrist is treating the parents or the patient, considering they haven't even seen the patient in years!?!?

Good grief...

Sarah Wilson95 said:I’m sorry, but what kind of "bravery" are we talking about here? You can't force anyone to do anything, and neither the police nor an ambulance will step in unless there's an immediate danger to that person or someone else. Okay?

especially when someone is currently in a state of being "numb and withdrawn." What would you even do? Tie them up and drag them to St. John? It doesn't make sense...😁

Learn how to read.

Brenda Carter96 said:Maybe try reading more carefully next time.

Fair enough.😉

You were actually referring to a different example earlier on. I apologize if my previous point seemed rushed, but the core of what I was saying—in a general sense—remains valid.

Given that your friend hasn't seen a doctor in quite some time and a formal diagnosis hasn't even been established—especially since those initial symptoms have long since vanished while he continues to be heavily medicated... Have you considered the possibility that he might actually be fine, and is simply experiencing a mental fog caused by the medication itself?
I am not suggesting this is definitely the case, but it remains a distinct possibility...