Hello, my question is in regards XXXXX XXXXX Acid test and is probably best suited for a psychiatrist. My sister has been diagnosed with being bipolar and other mood disorders. She is supposed to be taking 300mg of Seroquel XR and 400mg of Depakote ER. The problem that my family is having with her is trying to keep her on her medication and keep her stable. Unfortunately she has her episodes where she refuses to take her meds and she wonders off with her so called friends that also have mental illnesses. Se will go months without taking her meds and she hallucinates and disappears for weeks at a time. She is not on any illegal drugs, she does not even drink. they have done drug test to verify this, they do it to make sure that she is not taking anything that would interfere with her medicine. Her battle,our battle is with her mental illness. Here is where my question begins. If she has not been taking her meds for over a month, will her psychiatrist be able to tell from any test? I am very worried about her because this is her 3rd psychiatrist. This is the only Dr. that she has really been comfortable sharing personal issues with. She has been having hallucinations since about 6 years ago and would never speak of this to anyone else but me and my mother. She has even opened up more to me and our mother by telling us things that she shared with her psychiatrist. We would not today understand the severity of her conditions if it was not for her bonding with this particular doctor. She has really made progress with her. She (her psychiatrist) called today and said if she did not get the blood count, liver function test, valproic acid test, and fasting blood sugar and lipid panel. also there were a couple that we were unable to make out. looks like, tu.ts.h, and bun. ceratin?? any way, if she does not get them done within a couple of days at the hospital lab then she is discharging her for non compliance. Me and my mother had a sit down (intervention) with her today. We informed her if she did not start taking her meds then she will not receive anymore help from us financially and she would have to figure out new living arrangements. We just want the best for her , she agreed to start taking them as prescribed. Regardless, we are still worried about her being discharged. This is her last chance the Dr. said. I understand how important these tests are to make sure that her meds are not negatively effecting her body and we are going to request that the Dr. order one every other month to keep her taking her meds. What can we do about this current test since she has not been taking her medicine in order to make her valproic acid levels remotely close to what they should be? Does the count go down the longer she has been taking them as an effect of her long term use of the meds (over 3 yrs), or should it show up as a high level since she has been taking them for so long? Although her dr. does know that she periodically stops taking her meds. If it shows up as lower levels than suppose to be we could tell the dooctor that she just started taking them a month ago. would that work? If she took a small piece of one of her meds hours before the test would that be workable to make sure her levels look right? If not then what would you suggest? I know that the Valproic acid test will show what levels of the Depakote and Seroquel is in her blood. will it show how long shes been taking it for? consider the amount she is supposed to be taking (listed above) and the fact that she has been on them for yrs. PLEASE HELP! OUR FAMILY IS IN DESPERATE NEED OF HELP! I hate to even ask such a question but if you were in our shoes you would understand. This is her last chance and we all know it. No more excuses! It is very hard dealing with a sister that has these conditions. She receives disability and has a hard time grasping reality but we are going to step up and try much harder on keeping her on the right path. I am just scared if she gets discharged then she wont be able to find another doctor that she trusts and opens up to. It took 3 doctors and about 4 years to get her to be honest about her problems. It is vital to my sister (which I love very much) to pass this test so that she can continue her treatment with her current psychiatrist. I feel that if she gets discharged then she will spiral down as she had always done with prior psychiatrist. Please help us with any and all information that you have and can acquire on this subject. thank you very much. you will be rewarded! Also, these are the test that she has to take, full blood count, liver function test, valproic acid test, and fasting blood sugar and lipid panel. also there were a couple that we were unable to make out. looks like, tu.ts.h, and bun. ceratin?? would any other test show anything to prove that she has not been taking her meds as directed?
Person's Gender: Female
Person's Age: 28
Hi, I am happy to try to help you with this question
I am a psychologist, not a psychiatrist, and if I see that this requires a psychiatrist I will opt out
Are you there?
You said that your sister was diagnosed with Bipolar d/o and other mood disorders. Which other mood disorders has she been diagnosed with
Has she been diagnosed with PTSD - posttraumatic stress d/o
or Borderline Personality disorder
her diagnosis stated on her disability papers just stated it as mental disorder. I thought that was strange as well
it could be to protect confidentiality
how old is she
she is 25 and schizophrenia does run in our family
okay. so, now trauma history? sexual or physical abuse?
yes she claims that she was sexually abused as a child by my mothers ex husband who is now deceased because someone killed him over a similar situation
before or by age 6
does she have a terrible memory?
no it was around 10
that's when it started or ended or both?
she may or she may just be not wanting to share the experience with others
how is her memory?
her symptoms kicked in around 22 yrs of age
does she have flashbacks?
yes she does
and she stares off into space sometimes?
more than the average person?
yes she does. do you feel that you can answer my question? I understand it may only be for a psychiatrist since they deel with meds and tests pertaining to meds
do you know if her hallucinations are bizarre - for example does she hear muffled voices from the wall or your mother's ex in hre head
yes, i do
in her head (last phase)
do her "hallucinations" relate to the trauma only?
very bizzarre. she does here voices, she claims are fallen angels that are trying to convince her that the God in the Bible is actually a bad God and that Lucifer is misunderstood and was cast out of heaven because he did not want to serve a tyrannical God
are the voices from within her head or outside of her head
does she get bad headaches?
Bad headaches, yes. I assume the voices are outside of her head since she has confessed of actually seeing these entities
that doesn't mean anything
two last questions:
1. does she sometimes seem like a diffferent person - different dress, different speech, sometimes talking like a child?
and 2. how old was she when your mother started dating that man
She definitely has PTSD as you noted and with tha diagnosis you can have hallucinations but they are usually trauma based - hearing the voice of the abuser and seeing him when he's not there or hearing the voice of a little girl crying. It sounds like you sister also suffers from dissociation if she's staring off into space a lot and then "comes to."
People often mistake these disorders for schizophrenia
why was she diagnosed with bipolar and not schizophrenia?
She has been diagnosed with PTSD but that was from a car wreck that almost killed her. I have read on chronic pain and ptsd and how traumatic events that have no explanation for chronic pain can be caused by the traumatic event and ptsd. she is constantly crying and complaining of pain but we dont know where to take her for her pain. I even read an artical that the VA prescribe strong opiates for ptsd
was she 22 wen she was in the accident?
she was diagnosed with bipolar at around 15
I believe she was 22 when she was in the wreck
did she start having hallucinations then or before? (I think you mentiond that)
I assume she showed all the signs. some days she would be compulsive, other days she would be down in the dumps
I think they begin before but she never admitted anything til she was seen for her ptsd
This is a compicated case and I would recommend that you have her seen with a psychiatrist specializing in traum and dissociatioi
what state are you in
sorry, sticky keys...trauma and dissociation
let me get you a couple of referrals. can you hold on one sec?
thats completely fine
how far away are you from cincinnati
just about an hour and half
Here's one of the top 3 people in the trauma field - he's a psychiatrist. I'll attach his contact info in a second. If he is unavailable for an assessment ask him (via phone or email or both) whom he would recommend. Tell him that you are not sure if your sister is dissociative and has trauma-based hallucinations or is schizophrenic. You can also mention that you spoke with a psychologist who did her postdoc at Sheppard Pratt's Trauma Disorders Program under Dr. Richard Lowenstein (one of the other top 3 people in the trauma field).
Thank you so much for that info.would you know of any doctors that could help her with her pain that would understand the relationship between chronic pain and ptsd. The only place that I googled that treat pain for ptsd is "pill mills" and we dont want to take that route
If for some reason you can't get a hold of him call Sheppard Pratt at XXX-XXX-XXXX and tell them to connect you to Dr. Lowenstein or Dr. Susan Wait or to Dr. Diane Adelstein. They will help you sort out what is going on.
They will point you in the right direction. You don't need a whole bunch of clincians, just one good one
actually hold on one sec i'll get you a source for that
apparetly he was on Oprah - he has cds and books: mediation for chronic pain
he's in MA I think
I've read and heard his stuff: it's great
If you are satisfied with my response please click "Accept" (green button) and please leave feedback. Good luck to your sister and to you...you obviously love her very much.
If you have questions today, feel free to send them on this thread (free of charge).
If you have questions in the future and want me to answer them, you can address them to me personally.
Thanks I will check out his work. We were hoping that theie would be some illegitimate pain doctor in ohio. she definitely needs low doses of pain meds. as stated above, the VA are prescribing strong opiates to soldiers with not injury at all, just for treating PTSD because ptsd can cause severe chronic pain as listed on the va site and the national pain foundation site but she does not need strong opiated, just mild pain pills for her cronic pain
I would go with these first (Putnam, Kabat-Zinn) and you can also contact her primary care doc
I have to run t a meeting. I will send you a referral for pain docs in Ohio later this afternoon if you'd like. What large city are you close to?
Okay, I'll send that out around 8-9 pm est.
Please remember to click Accept. Good luck!
you did not answer any of my questions
my question is in regards XX XXXXXXXX Acid test
Okay...here are my thoughts - your sister is not taking the Seroquel and Deakote because they are sedating and lead to pakinson-like symptoms.
It is unclear at this point if she is bipolar, schizophrenic, or has a significant dissocaitive disorder
that is why i recommended Dr. Putnam
if her psychosis is trauma based then the meds will not help much
but my question was if she has not taken her meds then will it show up on the test since her levels will be low, if she took a small peice before the test would that help?
I don't know...but if she's getting meds she does't need then she doesn't need them
Her doctor is one of the highest rated in the state
If you want I can opt out and you can repost and request tha only psychiatrists answer
many wonderful doctors don't know a thing about trauma and dissociation
although it sounds like she might have both dissociation and prodromal schizophrenia
OK I am very sorry for wasting your time but I need to know these answers. it took her yrs to open up to a dr
you are by NO means wasting my time
I just dont feel like you read my full question
give me five minutes to delay the meeting and I can help you for a few more min. how does that sound?
you did give me very helpful information and i appreciate that
why don't I opt out..you can have a psychiatrist anwer the medical questions.. how does that sound?
I just dont have the money to post another question. It is vital for my sisters health that i get all the answers. Her meds to help her tremendously.
not a problem...take care.
did they charge me for this? how do i decline?
no, they didn't. they don't charge you anything until you accept.
I may have accidentally hit accept instead of reply beacuse my balance went from $25 to $3
no, you have not accepted. they did not bill you. i requested that a psychiarist contact you and sent JA an email indicating such. they should reopen your question in a bit
ok thank you very much and i will most definitely suggest that I get you to answer any other questions that fit your expertise. you were very friendly. God bless! oh, how can i tell if it is reopen or can i also just post the same question
Hi, I’m a moderator for this topic. Your Professional has opted out and I wonder whether you’re still waiting for an answer. If you are, please let me know and I will do my best to find another Professional to assist you right away. If not, feel free to let me know and I will cancel this question for you. Thank you!
Greetings, and thank you for your questions. I'm sorry you and your family are going through this! I'd like to help and answer your questions:(1) Yes, a Valproic acid level, or Depakote level, can determine if a person has been compliant with their medications. It takes about 4-5 days to reach a steady-state in the blood, so if a person takes their medication dose like they should, a level 5 days from then should be reflective of their true blood levels. A non-detectable level usually means non-compliance (in rare cases it can mean the dose is so low it does not even register).(2) Standard tests to monitor include liver function tests (LFT's), a complete metabolic panel (CMP or Chem -7), complete blood count (CBC), and of course a depakote level (VPA). The TSH is looking at thyroid, which is always important to check when a person has the symptoms you describe. The BUN (blood urea nitrogen) is a marker for hydration among other things, and the creatinine is a marker of kidney function/health.(3) Given that it takes a while for the blood level to reflect the actual dose taken, short of "loading" her on a high dose (which should not be done outside of physician supervision), her VPA level will be low. The number of years a person has been on VPA does not change the levels - if a person takes it for years and then stops, the levels in the blood will fall to zero in a short time.I know you have other questions, but wish to make sure this is what you are looking for first! Please let me know as soon as you are back online.Regards,Dr. Anderson
Hello, I am very sorry for the confusion but I originally posted this question and had an expert on board to try and help. She was a psychologist and did not know anything pertaining to Valproic Acid tests. She apologized and said she would opt out so someone else could help. this being my first time using this site, I thought that I had to make a new question and I did. It was answered and accepted and I apologize for not making sure that this question was not closed. After reading the information that you wrote, I wish I would have had you respond quicker. Although the expert that I accepted the answer for was some what informative, he did not fully answer my question. He said to take the meds as directed the day of the test and it will show high levels, which would make the Dr. order another test. He said that this would buy her time and all she would need to do is take the meds as directed for 3 days and then get the test done. He said this would make the levels correct. The problem that I have is since she has not been taking her meds then that means she has not been getting them filled. We have found a few of her Depakote pills but thats all she has. I wish I could have you help me on this but I just dont have the money to spend another $22. is there anyway we can lower this? Her doctor had to go out of town for personal reasons so she has a a few more days till she has to see him.
Greetings!No need to apologize! I myself am still learning the in's and out's of the site. I'm not sure how to get the amount lowered - please allow me to copy and paste our chat to a moderator and see if they can help with that.In the mean time, to add extra info, if she takes the meds as directed the day if the test, it will not lead to an elevated level. The only two ways the level will be elevated are:(1) If she takes more than the dose (1000 mg instead of 400 mg, for example), or(2) She gets the lab done a couple hours after taking the dose, which would be a peak blood level (the test seeks a trough level, when the blood level is at its lowest).Since her doctor is out of town for a few days, it is possible to get her therapeutic if she had enough pills, but that in itself can also be a valid reason for not having a blood level in the therapeutic range - lack of medicine! Her doctor should know, more than anyone else, that individuals with chronic mental illness have a devil of a time remembering to take their meds, let alone get refills for them.Hope this helps! Let me now see if I can get the moderator to help - it might take a day for a response, which is why I wanted to give you guidance to go on, just in case.Regards,Dr. Anderson
Thanks so much! see if they can do half of the listed price. I swear I'm not trying to be cheap. It's just the whole college mom thing and every penny counts right now but you definitely deserve it. you are very helpful and nice. I really appreciate that. Thank you!
they went ahead and accepted the answer for me but i had a couple more questions i needed to ask. I will be leaving momentarily for the night so maybe i can catch you on here tomorrow or sunday if possible. thanks again!
Yes, please ask away! This dialogue will stay open, so please feel free to ask your questions. I will see them again when I am online.Regards,Dr. Anderson