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Question:

My nephew was diagnosed as psychotic at the age of 15 yrs old. He is now 22 yrs. old. He used to volunteer but has stopped. He is completely socially isolated. The family believes he has schizophrenia. How can we help him since he states he is fine and only has a social anxiety problem?

Answered by: Cheryl Corcoran

If your nephew acknowledges that he has social anxiety and identifies it as a problem, then I would start with that.

Social anxiety can be treated with cognitive behavioral therapy, which involves looking at assumptions (cognitive) and trying out new things (behavioral). Would he be amenable to talking to a friendly therapist just to find out more to see if this is something he might be interested in? There are also medications that can help with social anxiety, which even his family doctor can prescribe, if your nephew is at all open to taking medications.

The key to engaging someone in treatment is to understand what that person's goals are. Did your nephew enjoy volunteering? Would he like to work on getting back to that? Maybe he didn't like it much - then the question is whether he would like to have friends and acquaintances whom he can do things with. If he is adamant about not seeing any clinicians at all or if he denies having any goals, his family can simply try to coax him out of the house, but it can be very challenging.

This kind of "negative" symptom - his complete social isolation - can be hard to treat and is also frustrating to families. The National Alliance for the Mentally Ill (NAMI) is a family organization that can provide support and offer strategies to families struggling with these same questions.

A clinician who evaluates him for social anxiety will certainly ask about psychotic symptoms as well. If he still has psychotic symptoms, he may not acknowledge them or want treatment for them. And as he is an adult, there is not much his family can do about that short of gentle and patient persuasion, unless of course he presents a danger to himself or others, and then treatment can be mandated.

The key is to be patient, like how the Little Prince tamed a fox - sitting a little closer to the fox each day until the fox finally tolerated having the Little Prince sit next to him.

As for whether your nephew has schizophrenia, he might. But that label may not be useful for him right now. Social anxiety (and resulting lack of social drive - a negative symptom) is common in schizophrenia, and causes marked functional impairment. In people with schizophrenia, the treatment of social anxiety can improve other symptoms as well (suspiciousness, unusual thought content) - it certainly doesn't worsen them. The goal now is to try to find a therapist he would consider talking to.