
Suggest Ways To Manage A Bipolar Patient

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


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

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