"It's worse than being in a nightmare"

Peter Johansson has mostly blanks in his memory from the time period around his psychosis. What he does remember is that his brain was speeding frantically, but not working. Thanks to medication he now feels much better, but he has put on a lot of weight - 50 kg in three years.

Peter Johansson. Photo: Christian Andersson.

Text: Fredrik Hedlund, first published in Swedish in the magazine Medicinsk Vetenskap No 3, 2014.

Peter Johansson, 55, can clearly distinguish between before and after his schizophrenia diagnosis. He had experienced an episode of so-called borderline psychosis, something between mania and psychosis, during his time as a student at the University of Lund. It happened when he was doing the last stage of his economics degree. But that was something else entirely.

Several years later, a little impulsively, he went on a trip abroad and did not take the medicine he had been prescribed after the borderline psychosis. That's when it happened.

"When I woke up again, I was at the psychiatric clinic in Malmö. I had been abroad for five days, but I had no memory of the trip," he says.

Peter Johansson was committed to the psychiatric ward for almost six months. He remembers when he woke up in the hospital, but in other respects his memories are very foggy.

"My friends told me afterwards that I was completely out of things, there was no contact. The only thing I said was my address and which stereo I had. And I just repeated that all the time," he says.

He was prescribed new medication and sleeping pills at the hospital, eventually recovered and was discharged, but he was not in good shape. The sleeping pills made it difficult to remember things, and he put on weight - in a big way.

"Over three years I went up 50 kilos, from 85 to 135, and the doctors did nothing to try to stop it. There were no measures taken to control my weight, not even a discussion about it and the risks it could entail.

The doctors just looked on while Peter Johansson became heavier and heavier. After three years the sleeping pills were phased out and the anti-psychotic drug was changed to a different kind. It only took a week for him to get his memory back. Two years ago he changed medication once again. As well as quickly losing 15 kilograms, the new medicines also had a much better effect.

"I am much more sensitive now. I am much more present, but at the same time more vulnerable," he says.

Unfortunately, he put on those 15 kilos again.

Risk factors contributed

Peter Johansson was diagnosed when he was in his 40's, which is unusually late for schizophrenia. He is happy about that, though, because he had time to gain experience, to mature and he learned to stand on his own two feet. He has some classic risk factors in his baggage, including an older relative who had some sort of mental disorder, though it is a little unclear exactly what, and the fact that he was born seven weeks prematurely. All this, along with the stress of going abroad without the medicine for his psychosis, may have been the triggering combination in his case, so he believes.

Peter Johansson describes suffering from a psychosis like being in the middle of a nightmare, only worse, and awake.

"The big, big part of it is that you interpret the signals wrongly. There is chaos in your brain and it goes at full speed. You think and think and think and think. You can't relax, because it's speeding away the whole time," he says.

He often hears mumbling, too, and it is impossible to discern the voices, but then they suddenly become clear.

"I've sometimes been in bed trying to sleep when I hear my doctor clearly say, "Hello Peter". Then I know that things are serious, and it's time to take more medicine."

He is doing much better now, though. He has high blood pressure with the increase in weight, but the latest medicine made him flourish, as he says, and he took up contact with some old friends. He has accepted that he has to live by other rules, such as only working part-time.

Peter Johansson would really appreciate a solution to the problem of increased weight so that he could get rid of the 50 kilograms he put on when he started the treatment. And, of course, "some kind of cure" for schizophrenia.

"If they produced such a thing, I would take it immediately," he says.

Unclear why drugs increase patients' weight

The mechanisms behind weight gain due to the drugs are largely unknown.

Hormones affecting hunger and appetite may be involved, as well as the dopamine system itself, which acts rather like a reward system that encourages us to eat more.

The question becomes even more complicated since schizophrenia in itself is associated with obesity, perhaps due to a lack of mental and physical energy or a metabolism defect that is linked to the disease.

Source: Göran Engberg, Professor of Pharmacology.