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Suggest Ways To Manage A Bipolar Patient

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Posted on Mon, 5 Jan 2015
Question: Hi Dr. Rynne, Im XXXX and I have a bipolar type 1, paranoid schizophrenic partner named XXXXXXX of 6 years. She broke up with me 3 weeks ago after going through one and a half years of being really sick with her cyclic vomiting, (and I believe Zoloft is making her pass out/faint); which included several emergency room visits and a couple of hospitalizations including me taking her to doctors whom don't find anything wrong (and finding out she stops her meds per a history of doing); of which the last time was after the start of October, 2014 and led to her (first week of November,2014) breaking down physically and mentally which resulted in me taking her to the hospital and she obtained a diagnosis of "altered mental status" over the course of 3 days being inpatient. Ive never seen her in such poor conditions unable to function. She had stopped medication after 2 months doing great when latuda was added to her medication regime. She became manic, went on a spending spree, and even signed a no trespassing form on me, etc. which she did undo. Just a mess all over the place, rapid cycling something awful,( that's when she crashed in which I took her to the hospital where she received the "altered mental status" diagnosis). I work with the medical team, again as her XXXXXXX and stuck beside her (through thick and thin over 6 years all the time) to get her the best help possible. After I brought her home from the hospital she totally devalued me and saw me with no emotion and unable to see my emotions. I knew she was being manic once in her comfort zone but this is the worse Ive ever seen her being so mean and I hurt deeply for us both. I went home and over the week she pushed me away as each day passed not wanting to be on the phone cause she don't feel well and was cyclic vomiting. She does have abandonment issues and is always afraid I will bail on her but Ive always told her its not about leaving her but about losing her, that I do not wana lose her. Once again this didn't help cause when I called her again she said its over, shes done, wont have any of my crying, wont take my calls or messages. I was flipping out crying and said why? and I was trying to make it ok for her but she said (robotically) cause shes tired of being sick, then she repeated that she wont take my calls or messages and then said she needed my help..and continued hurting me, and I said I loved her and cant do it without her, she said yes you can. Then she stated she call me from time to time to check and see how Im doing, which she has not done. Then hung up on me. Her memory is so bad that she forgets the previous days events, the date and the day and cannot handle her bills or her checking account without my help. She sees a psychiatrist and a therapist. Ive ran my tail off helping her and this is what I get - rejected. I know shes sick but its killing me emotionally. Im so worried about her mental and physical well being and Im so devestated about it all and I miss her so much! She has no support system at home. We live in different cities. Dr. Rynne, no one else is helping me on what to do and Ive learned so much on bipolar disorder over last 3 weeks and I look back at my mistakes, Im trying to comfort myself but all these online forums all say to use the no contact rule or run like mad. I don't run I just don't. I don't know what to do as the ball is in her court and I wish she would just miss and need me. Im afraid if I show up at her home for things of mine that it will backfire or if I call it will backfire. I know she loves me more than I will ever know according to her. Im so scared I will never hear from her ever again. I think of mailing articles off the web, a book, card, flowers. I just don't know what to do. I don't wana lose her. Dr. Rynne what can I do or what should I do? Thank you so much!
doctor
Answered by Dr. Seikhoo Bishnoi (50 minutes later)
Brief Answer:
BIPOLAR DISORDER

Detailed Answer:
Hello thanks for asking from HCM
I Dr. Seikhoo Bishnoi (Consultant Psychiatrist) will help you with your query.

I can understand you concern towards her and I can feel the pain. She has been diagnosed with Bipolar disorder and currently under episode. She has started behaving abnormally with you and broke every contact with you. She went into manic episode in Oct/Nov and was hospitalised and on coming back home she didn't value you and your efforts and bluntly broke every contact with you. I can understand how much you are suffering but you have to admit one thing that she is ill and is recovering from mania. This is common in manic patients to develop paranoid ideation and anger against close caregivers. In her case you were her caregiver and she is showing anger towards you. Normally manic episode last for about 1.5 to 3 months and patients start becoming better after that period. I am afraid but you will have to wait for at least this period, till she become normal. Once she would improve she will call you by herself. Currently she might have developed paranoid ideas against you and most probably this is the reason of sudden anger against you. The manic patients start blaming close caregiver for their failures and they develop paranoid ideas against them.

Try to understand that she is ill and don't feel emotionally bad. The bad phase will pass in some time. One thing I would advise you, though its very difficult for you, don't call her or contact with her for few days. With natural course her symptoms will improve and she will start feeling the support you provided to her.

She is on LATUDA which is an antipsychotic drug with good actions in bipolar disorder. I will also advise you that she should also be prescribed some other mood stabiliser drug like Valproic Acid or Lithium Carbonate. These mood stabilisers will help to improve her mood early. Avoid ZOLOFT for now because the drug has risk to cause manic switch in bipolar patients. Consult a psychiatrist for prescription of drugs.

Thanks, hope this helps you. Ask again for more doutbs
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Seikhoo Bishnoi (24 hours later)
Dr. Bishnoi, thank you so much for your help. You are absolutely correct with everything you have told me. Yes she was very angry with me and has been paranoid concerning me and does not feel emotionally bad. I know she blames me for her failures as shes always felt inferior next to me and not good enough for me even though I would assure her otherwise. Before she went into the hospital I managed by the skin of my teeth to see her psychiatrist with her in an appointment. I was very detailed about issues occuring with XXXXXXX and her home surroundings. XXXXXXX was incredibly mad during the visit but had to contain herself but stated she that its my fault that I had thrown out her meds.(she froze them and threw them in the dumpster after putting cat feces in the bag with the meds). I got upset at that particular time, and said why did you freeze your meds. She replied that the doctor (her psychiatrist) and her decided she didnt need them any more). The doctor was shocked and very surprised at everything I was telling her. She stated "I believe XXXXXXX (thats me) is trying to help". I agreed with doctor and doctor proceeded asking me specific questions about whats happening with XXXXXXX XXXXXXX was not herself during the visit due to mania, paranoia and confusion and doctor and nurse clearly saw that and knew something wasnt right. XXXXXXX never opens up about issues as per her telling me months ago because of "self preservation". So in the office visit I spilled the beans so to speak in order for them to help her further as well as for when she continues seeing her therapist. After arriving home, she flew into a rage wanting me out of the house as her mania was sky high and i knew this and I was very upset. // It has been 3 weeks and 3 days with no contact as of today Dec 10. I will say that at 2 weeks of no contact I left her a voicemail and a few texts. No replies. // The following week after her leaving the hospital, I called her bank and she had removed my name from her checking account. I was only on it to help her with her checking (Elaine knew this) to pay bills which XXXXXXX and I did every month at the kitchen table. Being upset I thought this was the end of us being together. But now see it as paranoia and anger. I have 2 house keys she lended me years ago and Im surprised she hasnt called and asked me for them. I know she isnt about to change 3 door knobs and a dead bolt lock. At least i hope not. Im still very worried about her physical and mental health. Yes I understand what you said about ZOLOFT and that she should stop it altogether. The meds she takes are: SEROQUEL, ZOLOFT, LAMICTAL, LATUDA AND COGENTIN. She has told me that long ago she took LITHIUM and that it made her very stiff and unable to walk right so she stopped the medicine. Is VALPROIC ACID the same as LITHIUM? Also, Im unable to get through to her psychiatrist and therapist per HIIPA guidelines and XXXXXXX absolutely will not sign me on the form. However, in my hopes we speak again, I will mention these medicines to her but she probably will not take the LITHIUM so this is why I want to know if VALPROIC ACID is the same as LITHIUM, and is VALPROIC ACID the same as DEPAKOTE? // Dr. Bishnoi, Im so scared I wont hear from her. Though 6 years is alot of time together Im really hoping she will call me after she becomes back to normal. SHOULD I NOT CONTACT HER AT ALL EVEN IF SHE DOESNT CONTACT ME IN DECEMBER? Christmas is coming up so is a Christmas card ok? Should I say call me some time and write my number in the card? Will it backfire? Should I not send a card, a note or even cookies? Will it make me look desperate and backfire? IM SO AFRAID SHE WILL FORGET ME AND NOT CONTACT ME. I KNOW SHE HAS NO ONE ELSE TO HELP HER OUT WITH BILLS, SHOPPING AND HER CAR IS IN POOR CONDITION. SO SHE HAS NEEDED ME. Shes always felt bad about not being able to do back for me, and has said I havent had time for my life and my pets. She said in a voicemail and stated that she dont wana lose me, that she loves me, that shes sorry shes such a b*tch and apologized for her behavior where Im concerned.( this was before she broke off contact). So her up and down behavior has had me confused. I dont want her to forget me. I miss her as she is a good person. So basically Im stressed and worried about everything with her and myself. Dr. Bishnoi if her and I are in contact again what book would be good for her to read on Bipolar Disorder so she can learn more on how to help herself? ALSO, If I need to ask questions here again will I be able to get ahold of you here in reference to this? Thank You So Very Much! XXXX
doctor
Answered by Dr. Seikhoo Bishnoi (2 hours later)
Brief Answer:
Her behaviour due to anger is because of Manic Episode and she will improve

Detailed Answer:
Thanks for writing to HEALTH CARE MAGIC again.

I can understand your situation. What she is doing is because of her illness only. She is showing the behaviour because of "reaction formation" and "projection". During episodes manic patients project their close ones for their failure like I have mentioned earlier. This is the reason for her anger towards you. Normal natural course of mania is about 1.5-3 months and with time she will show improvement in her symptoms and should feel better about you. She has asked you to move out, stopped back access because of the intense anger. I am telling you again that there is no need to take this thing personal, she is in her episode and such behaviour can be explained by her illness.

Yes, I have observed in many patients that Zoloft or Sertraline can cause manic switch. The other drugs she is taking like Qutiapine, Lamotrigine, Latuda and Cognetin are fine and appropriate for her. Lithium caused her stiffness and she will not accept to take it. In such case Valproic Acid can be kept in option. The drug is also a mood stabiliser and is safe to use.

Depakote is Divalproate Sodium and is almost similar to Valproic Acid. It has same effects as lithium carbonate. Also, valproic acid is not same as lithium, they are different drugs.

As per my opinion even if this is festival season I am afraid that contacting her in her episode will make situation worse. Yes, you can send her a card and can mention your number on it. Sending a card should not make her backfire.

She will not forget you, as she in in her episode and she is not aware of her actions. With improvement of her symptoms she will start acknowledging you and your contribution again. From the history you have mentioned it appears she also loves you, but have to wait for some time.

" Manic- A memoir", " Less than Crazy" etc are some fiction books that depict life of a bipolar patients. Personally I haven't read these books but after recommendation from colleagues I have mentioned these books here. "Take charge of bipolar disorder" is a self help book.

Hope this helps you, If you have more doubts about her situation ask again. You can ask me a query directly any time in future at this link.

http://doctor.healthcaremagic.com/doctors/dr-seikhoo-bishnoi/65151

I would be glad to help you.

Thanks



Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Shanthi.E
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Answered by
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Dr. Seikhoo Bishnoi

Psychiatrist

Practicing since :2007

Answered : 5192 Questions

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Suggest Ways To Manage A Bipolar Patient

Brief Answer: BIPOLAR DISORDER Detailed Answer: Hello thanks for asking from HCM I Dr. Seikhoo Bishnoi (Consultant Psychiatrist) will help you with your query. I can understand you concern towards her and I can feel the pain. She has been diagnosed with Bipolar disorder and currently under episode. She has started behaving abnormally with you and broke every contact with you. She went into manic episode in Oct/Nov and was hospitalised and on coming back home she didn't value you and your efforts and bluntly broke every contact with you. I can understand how much you are suffering but you have to admit one thing that she is ill and is recovering from mania. This is common in manic patients to develop paranoid ideation and anger against close caregivers. In her case you were her caregiver and she is showing anger towards you. Normally manic episode last for about 1.5 to 3 months and patients start becoming better after that period. I am afraid but you will have to wait for at least this period, till she become normal. Once she would improve she will call you by herself. Currently she might have developed paranoid ideas against you and most probably this is the reason of sudden anger against you. The manic patients start blaming close caregiver for their failures and they develop paranoid ideas against them. Try to understand that she is ill and don't feel emotionally bad. The bad phase will pass in some time. One thing I would advise you, though its very difficult for you, don't call her or contact with her for few days. With natural course her symptoms will improve and she will start feeling the support you provided to her. She is on LATUDA which is an antipsychotic drug with good actions in bipolar disorder. I will also advise you that she should also be prescribed some other mood stabiliser drug like Valproic Acid or Lithium Carbonate. These mood stabilisers will help to improve her mood early. Avoid ZOLOFT for now because the drug has risk to cause manic switch in bipolar patients. Consult a psychiatrist for prescription of drugs. Thanks, hope this helps you. Ask again for more doutbs