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Guest khuram

Schiz---marry ---Schiz

21 posts in this topic

Two schizophrenics want to get married.

And the risks are:

During Pregnancy-----RELAPSE?

TERATOGENICITY??(antipsychotics)

Post Pregnancy--------RELAPSE

CHILD WELFARE

What else?

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I guess we need to also consider risk of schizophrenia in the child and inform the couple!

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this is a tricky one/

there are other issues

re: consent/issues confidentality

induced psychotic disorder

is one presently psychotic and inducing in the other?

so i would assume you would need to figure out if both are your patients r not and proceed from there?

offspring have a 10-15% risk of having the disorder (off the top of my head)

so counselling would be required.

advice re: housing benefits compliance

any other ideas?

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Other than the risk around pregnancy & risk to the unborn child, another risk might be that if they want to start a family, they might face problems due to s/e of antipsychotics- sexual dysfunction, low fertility..

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offspring have a 10-15% risk of having the disorder (off the top of my head)

that's if one parent has schiz. closer to 50% if both have it.

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hey thanks j

u see i have soft neuro signs myself.. :o

and early dementa cant rem written materials from 4/52!

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The main issue in this pmp is of assessing the capacity of both the individual involved to take such an important desicion.The rest of the issues comes after this.

Please correct me if iam wrong.

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So, if they have not got the capacity , can we stop them to be married ? I think the only think we can do is advice & counselling if no florid psychotic symptoms

Consent , confedentiality issue, why ? Can some one explain more please

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i assume theres an issue of confidentiality of neither patient is married and you are discussing the treatment and prognosis and current status of either of them together?

or if you have to find out collateral info about them from other sources ie their present social circumstances?

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Hey!

Getting married does not mean just getting pregnant. Why is everyone obsessed with thoughts/doubt/fear of cyesis - This is OCD for the candidates. Let's have some cognitive restructure on this matter

First we need to assess capacity

Then review their illness eg how long well, previous relapse (marriage is a major life event can precipitate relapse Risk assessment in both etc. Are they both your pt or do we need to involve the other pt's team

There are contraceptive just like for everyone in the gen pop. This allows you time to plan pregnancy

Also think of social - eg where they will live, Benefit etc

If they decline contraceptives

Give them risks in offsprings upto 50%(46%) etc

With this insight, can we revisit the scenario

NB! PMP for you? How do I check my contribution on this site

Thanks

Rabadori

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DO NOT FOCUS ON CAPACITY!!!!!

start by offering support and discussing any issues they may have.

look at past history and recent psych. history, and evidence of prievious impulsive behaviour

enquire how long been together and relationship history

assess mental state. If floridly psychotic and unwell then capacity is an issue otherwise you cannot stop people from getting married

management

answer any questions about chance of children having schizophrenia( though be tactful)

discuss increasing support over stressful period

discuss medication and any sexual side effects

discuss family situation(ie social support) and any relevent help required ie with benefits and housing

any children then that needs to be discussed even with referral to social services

remember to offer support and even congratulate

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U have to assess capacity and rule out active mental illness otherwise marriage becomes null and void.

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what are the statistics for bpad

20% for first degree relatives is the closest i can get. don't know for risk for child of 2 bipolar parents. sorry.

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In Schizophrenia, rate of offspring having schizophrenia

one parent-10-13%

two parents-46%

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Capacity is very impt here. My team actually has 2 pxs with mild LD and schiz who want to get married, but they happen to be past the child bearing age.

Initial counselling needs to be done and assessment of mental states.

Good community support is essential once they do get married and are living tegether regarding psych issues such as medication compliance and relapse prevention; and social issues such as ADL skills and potential adult protection issues, as they might be vulnerable to expliotation by others.

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a few of our patients have actually married. Interestingly they all have mild to moderate LD. One of the marriages ended in a separation and the other is fairly recent. The staff supported them all from begining to finish. 8-)

The later couple are peculiar as the male has a hx of sexual offences towards minors and the team seem concerned about them having children of their own. :-?

It could be a dillema dealing with these matters. But general and specific support is needful + copious documentation.

A realistic approach is essential. The patients are told the truth at all times, infact refered for specialist input if need be.

A forensic assesment of risk was needed as part of risk management. It is interesting supporting patients in such kind of matters. Nearly every professional in the MDT had an input. We do not claim to be marriage experts, rather professionals offering to support them and provide any helpful info e.t.c (as per valuing people doc.

I guess acknowledging your limitations and how realistic pt's expectations are is crucial.

answering this in a PMP may not be that different from what you'd do in reality (albeit in a structured manner) :)

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U have to assess capacity and rule out active mental illness otherwise marriage becomes null and void.

Cautious to state this argument.

Active mental illness

NOT EQUAL to lack of understanding and decision making

NOT EQUAL to unfit to consent / make decision

NOT EQUAL to void any decisions made (including medical treatment and marriage)

You would consider effect of active mental illness on the decision making and understanding. And consider further discussion with MDT, patient and carer etc.

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hi,the main issue here is  to assess capacity,with regard to pregnancy ,we must first confirm that the two patients are man & woman,as they may be both men or both women .Who knows .

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