My Brother Thinks He Is Being Stalked

My older brother, who is 53 and extremely intelligent, has had a history of sleep disorders, a multitude of non-descript physical ailments (Or so he says. It used to be Epstein-Barr; now he says he has fibromyalsia (fibromyalgia)), and beliefs of impending catastrophic earthquakes and stock market crashes based upon psychic readings and astrology.  His sleep disturbances began when he was about 18, and he dropped out of Berkeley in his third year, used psychedelic drugs and entered into a life of isolation (in order to secure quiet surroundings for his sleep disturbances), inability to work and support himself, and constantly moving from place to place.

He is convinced that for the last 18 months he has been stalked by a maintenance man from the motel where he stayed in the Los Angeles area.  He believes the man followed him as he moved to about 6 locations in Southern CA, Australia and now in New Zealand.  He complains that the individual knows precisely his sleeping habits and knocks on the door or taps on the window as he sleeps 3 to 5 times each night.  What condition does this sound like and what effective treatments are there, if any?

[HFHS MD - RG]

Your brother may be suffering from paranoid schizophrenia. This is associated with early onset in life usually in thelate teens or early twenties. This is also associated with the symptoms you had described called as delusions and sleep disturbance.

Other features includes a disturbance that lasts for at least 6 months and includes at least a month of active-phase symptoms, that is, 2 or more of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms like affective flattening (flat emotions), avolition (no motivation), alogia (no speech).

Chlorpromazine and Haloperidol are some of the medications that were used until recently. Currently, there are newer anti
psychotics that are available in the market with lesser side effects such as Risperdal, Zyprexa, Clozaril, Seroqual etc. Along
with medications, treatment should include behavioral therapy, family oriented therapy and supportive therapy which are
beneficial for the prognosis.

For more information of schizophrenia, you can refer to The American Psychiatric Press home Page ( http:// www.appi. org/
schizo.html ) OR national Alliance for Research on Schizophrenia and Depression ( http:// www/ mhsource.com/narsad.
html).

Your brother would benefit from a psychiatric evaluation and management.