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If someone beyond age thirty with a schizophrenic or bipolar illness has an episode of mania or psychosis, there is a significant possibility that they will not survive this. An episode of severe psychosis is a huge stress on the body. When someone is approaching or beyond forty years old, a psychotic episode could trigger a heart attack. When an older person is put in "four-point" restraints by hospital staff (usually because of being difficult to control) this can also trigger a cardiac episode.  

Relapses of mania or psychosis aren't always the result of noncompliance--they can happen to someone who continues to take prescribed medication. However, stopping medication against medical advice greatly increases the likelihood of a relapse, and it isn't a wise course of action.  

Severe psychosis can trigger a powerful "fight or flight" reaction because it takes over the mind with delusions--and some of these delusions can make a mentally ill person believe they are in imminent danger.  

The danger is real but does not usually come from the things the delusions are warning about. The actual danger is that of taking actions based on delusions. Consequently, it is the delusions themselves that are the threat. Delusions can make a mentally ill person believe that people are trying to kill him or her, or that there is some other kind of threat--this is a product of psychosis, and usually there isn't anything to worry about. 

Someone suffering from severe delusions may do dangerous things because their brain is lying to them and is producing a false, pseudo-reality. Imagine believing that you can fly, believing you are surrounded by extraterrestrials, or believing that all of your sources of water have deadly poison? A number of possible delusions can create a dangerous outcome.  

If an older man or woman initially survives a psychotic or manic episode, there is still an aftermath. When older, it takes longer for the brain to recover, if it does so at all. Recovery to a previous level of functioning following a full-blown psychotic episode takes not weeks, not months, but years--sometimes as much as ten years.  

(Following a severe episode of psychosis, all of the things most people take for granted are more difficult. It can be difficult to drive an automobile; it can be difficult to get basic tasks accomplished, such as cleanup of one's dwelling; it can be difficult to go out in public--especially to crowded places; it can be difficult to sit still; it can be difficult to focus on anything.)  

Someone with schizophrenia may believe the medication is the cause of problems. It might seem as though the medication is producing limits to consciousness, or making ordinary things in life very difficult. However, it is often the illness, not the medication, is causing these problems.  

One approach to medication is to prescribe the smallest dosage of antipsychotic medication that will work to keep the psychiatric consumer stabilized. However, this may not be the best way to go. A better option might be treating the illness more aggressively, with more medication, one option being the maximum the psychiatric consumer can tolerate without excessive suffering due to side effects. A higher level of meds than the absolute minimum is sometimes a good approach.  

If we go too low on medication, symptoms could begin to recur. That in turn can cause a loss of insight and judgment, the beginning of a possible relapse. At some point, an under-medicated person with schizophrenia will probably attribute his or her problems to the medication. The medication becomes the perceived enemy. That is the point at which we may become "noncompliant."  

When someone with a psychotic type illness meets with a psychiatrist for an outpatient visit, this psychiatrist, if they are any good, will probably ask a significant number of questions. They may ask if the psychiatric consumer has any unusual thoughts, may ask if the psychiatric consumer is eating and sleeping okay, and may ask if they have any discomfort from medication side effects. This is the perfect opportunity, if we feel that things are slipping, to report any symptoms we might notice.  

If the psychiatrist assesses that a higher or lower dosage of medication is needed, it is a good idea to heed this. If it appears to the psychiatrist that we are starting to have more symptoms, he or she may ask us to take more medication. If symptoms are under control but we are suffering a lot with medication side effects, it might be time for the doctor to lower the dosage.  

Preventative care is extremely important for someone with schizophrenic illness or bipolar illness. The work we do to get the illness under control, hopefully at a fairly young age, could determine the quality of life we have when we get older. If the illness doesn’t get controlled, we may end up with a future of being very ill. If the proper steps are taken to control the illness, it allows us to live under better conditions when we get to middle age and old age.  

Prevention at an early age could lead to better brain development and to becoming psychologically mature to match our chronological age. If we gain more development as a thinking, contemplating human being, it could lead to more development of insight, and this could prevent relapses when older--relapses that we could get too old to survive.