I am very sorry to hear of the situation. Before I proceed could you please provide me with a little more information on her situation. Please take your time to answer each of these questions in as much detail as possible.
1) How long has she been diagnosed?
2) How long has she been seeing her current Psychiatrist?
3) How many Psychiatrists has she been supervised by over the years?
4) Has she ever experienced a period where she has been satisfied with the management of the illness (meaning has she been happy with her treatment not her situation).
5) Has her care involved any other kinds of professionals (Psychologists, etc) and if so what has their contribution been?
6) What has the course of the illness been like? What is she like at her worst and what is she like at her best?
Regarding her current situation:
1) Have you ever known her to attempt suicide or make preliminary plans to do so?
2) If a rating of 10 is no risk of self harm and a rating of 1 is a immediate and definite likelihood of self harm how would you rate her current level of risk?
1. since 2008 2.about 3 years 3. 3 4.I think so, from my own observation 5.No 6.At her worst, suicidal and talks of cutting her wrist and chopping her foot, At her best, XXXXX XXXXX cery well - she is a parttime actress 1.yes 2.5
Ok, thanks for the extra information.
If she has a previous history of serious risk (or attempts) and you believe she is currently at a quite high level of risk right now then she should be assessed immediately by a Psychiatrist. Does she have quick access to her Psychiatrist? If not, is it possible to take her to the nearest emergency ward?
It certainly sounds like she isn't receiving satisfactory care and my recommendation would be that she should also be consulting a Clinical Psychologist for Cognitive Behavioral Therapy in addition to seeing a Psychiatrist. I'm going to read between the lines hear and presume that her Psychiatrist really only focuses on her medication and this is why she has been unsatisfied. The role of a Clin Psych would be to help her to manage her illness and th e impact it has upon her life. When a person with Bipolar is well managed they shouldn't be experiencing Depressive episodes involving suicidality so I will also presume that her current Psychiatrist isn't managing her medication well.
So, first thing to do is have her immediately assessed for potential suicide risk. Secondly, I would recommend that she seek a referral to a more senior Psychiatrist nd also to a Clinical Psychologist.
You are right to try and encourage hope. Bipolar Illness can be managed well but it sounds like she is not receiving the proper care.
Unfortunately I am unable to make specific recommendations as I live in a different geographic region. However, I can advise you on how to go about seeking the right professionals.
The Malaysian Psychiatric Association has a Bipolar Illness Chapter and I would expect any senior BPD Psychiatrist located in KL to a member of this chapter. I suggest you contact the MPA and request a list of the members of this chapter. These individuals should be able to identify a KL based specialist easily. You can contact the MPA here http://www.psychiatry-malaysia.org/
To find a Clin Psych I would usually recommend you contact either the national registration body or a nearby by University based treatment (as these have excellent training an quality control. I cannot find an obvious point of contact for the national registration body in your area so I suggest you contact: Ms Serena Sinniah, Clinic Manager, Help University College (603) 2096 1212.
Alternatively you could ask your daughter's existing Psychiatrist to make these arrangements for her. It is standard practice for Psychiatrist to arrange referral to Clinical Psychologists and also to obtain review by more senior colleague. her current Psychiatrist should be happy to do this for her.
I hope this has been of some help. If you have further questions or would like me to clarify or expand upon anything I have written please don't hesitate to let me know.
Best of luck!