Brief Answer:
surely, she can be helped greatly with medicines
Detailed Answer:
Hello XXXXXXX
welcome to HCM!
I have read your question carefully and appreciate your concern about your family. From the details you have provided in the question-- patient has always been sensitive by nature, easily provoked to anger and irritability, and is somewhat suspicious.: all these reflect that she is depressed and anxious, with suspiciousness towards others , mainly family and close ones.
The points that she has
rheumatoid arthritis like symptoms which have disfigured her hands and she keeps them covered: lead to increase in
depression and low self esteem, reduced public interaction--> increasing suspicious nature of the patients.
intense concern about her pimples is also related to her anxious nature and (sometimes aggravated by suspiciousness-
psychosis).
It is very common that such people do not seek out help, even when under lot of stress. As you have said that complaints increased after she turned 50 years, also can be related to
menopause hormonal problems, which aggravate already lying psychiatric disorder in patients.
I think that she has a personality disorder- may be paranoid type with depression and some anxiety.
It is seen that such people respond nicely to treatment, but the response to their basic nature-- sensitivetiy and suspiciousness is upto a certain limit only. The aggression responds easily and patients is more calmer within few days of treatment. Treatment is usually for long time in such people and may continue for life ( at the lowest possible effective dosage) --- but certainly helps.
I have seen and treated personality disorders, and am very hopeful for this patient too. She will also feel the decrease in her irritation and get mental peace with medicines.( this is reported by patients themselves after about a month of treatment).
Before giving drugs, it is good to get her vitals and basic tests done- routine
blood test, thyroid profile.
It is nowhere mentioned that patient is hypertensive or diabetic, so, I think she can be given any medicine for her problems, appropriate for her age.
One has to meet the
psychiatrist and get tests and at least once interview the patient in person. Psychiatric drugs are better started with proper prescription , especially when treatment is expected to be long standing. If she does not want to go, the doctor can be called home in one of her rages and the drugs can be stared.( initially may be given in food- hidden) and later with improvement, it is seen that patient usually accepts medicines willfully.
I have found from my clinical experience that drugs like --resperidone or
quetiapine or amisulperide show good results and are safe for her age.
Hope the reply is useful and you can help your family with it
feel free to ask more related questions
Dr. Manisha Gopal