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Can you briefly inform me the symptoms that made you think, he might be having bipolar disorder?Then if necessary I will ask few questions,if i want to clarify anything, so that i can give an well informed advice.
He has become very proud, self confident as well as aggressive Has grandiose plans and thinks his family is plotting against him
Has become very quite most of the time except when he wants things his way then will be very aggressive and loud
When angry shouting very loudly for two hours or more
Recently has even shouted on family members in front of drivers
ok.It must be a difficult situation to be in
Since last year occassionly has hallucinations and see s another person standing next to him and gets up very frightened from sleep
has been having this episodes but were much milder for last 20 years however they would happen once in 3-4 months and would be mild where he would cool down immediately and he would be very apolgetic and remorseful
However since last month episodes are very frequent once a week and much more agressive and now he does not show any remorse or apology after thah
instead thinks he is right
OK.Thanks.Very helpful. Does he have any other family members with similar problem? does he drink alcohol?If so is it often?
if any family rationalizes with him accusing them of being prejudiced against him
Father had similar issues but was never diagnosed as family was not aware also father had a heavy drinking problem , mother was epileptic , he is only a social drinker drinks a peg of whisky once a week
You have mentioned that he has grandiose plans? are they out of proportion to the real it (like his abilities or financial situation or was it mere ambitiousness)
he recently had a high fever couple of months ago in which he had febrile seizure and had a similar seizure five years ago with high fever
Ok. But you have mentioned grandiosity..I am trying to tease out the symptoms,so, don't feel bad if i sound insensitive.
ok.We do know that febrile seizure can occur if the temperature is high and i am not sure he has history of febrile seizures as a child because they are more commonly starts in childhood
we have recently have achieved much financial success and have real opportunities for more growth but he wants to do them fast and is taking high amounts of stress trying to over achieve
no he never had febrile seizures before only this two instances during high fever
ok.Thanks for the information.
first let me formulate a bit..
It looks like he is very ambitious in premorbid personality.The acute stress of taking on more and focussing (can be seen as preoccupying as well) with a view to grew at fast pace.we do know that stress can induce mood swings and some times transient psychotic symptoms if a person has vulnerability. The symptoms you have discussed do need further assessment. The assessment should consist of detailed history from him,collateral history from yourself and his parents(if possible to get childhood history,developmental history etc),Mental state examination and risk assessment. The biggest challenge as you have mention dint he question is making him see the problems and encoring him to acknowledge the symptoms in preparation to seek help. Some of the symptoms gives the impression of Bipolar type 2 illness which is a relatively less severe for of bipolar. Th epeople who experience this can be very successful,function well,creative but the bouts of energy can come in episodes with depressive symptoms in between.
I think your judgement is quite close to the issue How do we make him go to a psychiatrist and take medication because this time he seems to be shutting out the family more than ever and is not talking to anyone and we are afraid it could get worse
you told me that have already had discussions with him and he has been to the counsellor.I think first it is important for him to see a Psychiatrist to confirm the diagnosis and draft a management plan. Once it is done then the treatment can be either psychological therapy in the form of cognitive behavioural therapy or medication or combination. I am not really sure whether would be very keen to see a Psychiatrist given the information.But, he might find it useful to know that this is very treatable condition and the biggest obstacle is the person acknowledging it and seek help.so, you can start something by yourself to help the situation..
how should we behave with him should we try and rationalize when he becomes adamant on something or should we be submissive when is adamant
It is a stepwise process. First he needs to know that you guys are not judging him and not critical,all you want is for him to feel better.you can also tell him that stress can make a person feel unhappy(although successful which is alight paradox, because you might have seen people although rich they feel comfortable but might not be happy).
You can maintain mood diary on his behalf (which is slightly unorthodox way but given the circumstances pragmatic)..You document his mood daily between a scale of 0 to 10. 0 being his worse mood you can remember and 10 being his best(elated,high,over energetic etc). If you can do this for about 3 to 4 weeks then you might be able to see a pattern.That might help you to discuss with him with something to reflect on. You need to tell him that your would support him and stand by him,no matter what but wants what is best for him.And at least to reassure you ask him to see a professional who got expertise, may be the Doctor after seeing him say he is overambitious and nothing more. It is a possibility
Hi,have you got my messages
ok will this convince him to go to psychotherapist
however since the last few weeks he has started saying psychiatrists and doctors are messed up and they themselves need help
Well, we can only hope for the best. I hope he would be able to seek help because if he continues to have the symptoms and he he has bipolar(please note at the moment he hasn't been diagnosed formally yet) then the symptoms might deteriorate which would have knock on effect on his functioning,output,relationship with families tot he point he might burn bridges with some family members.so, you can urge him to seek help.as far a si am aware there is no legislative frame work that can be used in india.
Well, They are first doctors who have finished 51/2 years course of MBBS and then specialised in psychiatry which is at least further 3 years.
I guess the stigma is still very much there in India.
what are some of the warning signs that his symptoms start deteriorating
and if he still does not choose to seek help can we do something to reverse it maybe something at home
Ok. To start with worsening of the symptoms like, at the moment the behaviour if not persistent and pervasive.This might become more obvious.then symptom alike lack of sleep,saying that he got special poets or abilities to sort out the issues,developing some psychotic symptoms(which might become more obvious than now),developing inhibition both social and sexual,self neglect.these are the common early warning signs of relapse or signs of further deterioration.
The cognitive behaviour therapy is useful.This is to see and explore the link between his feelings,thoughts and actions in an attempt to modify them.again if he is not seeing the problem, it biomes tricky but worth a try.If you google there are numerous books on CBT and some free online course websites like MoodGym(you need to google this name)
he already claims he has special abilities says family should follow his lead and no one should disagree very obsessed with health and keeping fit and excersising regularly eating and sleeping well has become very active socially
ok.I hope he would acknowledge the issues and seek some help.
I wish you all the best.I am sure you have a tough job in your hands but with perseverance and following the suggestions i have mentioned you might be able to help him acknowledge the problem
are there any tests we can give him online or medical which can prove to him that he has bipolarity
There are no definitive biological tests that are available.however, there are few online sites that would help you to answer the questions and come up with score to suggest he has got bipolar or not.Again they are helpful for understanding and help to seek help than confirm the diagnosis
any online site you can recommend
One of the website that might be helpful is psychcentral.com/quizzes/bipolarquiz
ok thanks just wanted to attain clarity on this point should we be submissive or argumentative when he is adamant as it happens often and we dont know which way to react if we are submissive we feel we are encouraging his behaviour if we rationalize and argue it ends up with him being extremely angry and shouting
Neither.Just be assertive.Tell him that you don't agree with his views on particular matter, but try not to be critical as a whole person (for example rather than saying, i don't like your particular business plan or approach saying why to do always do such stupid and high risk things etc because this way he might see it as an attack on his personality than a problem which might fuel the argument or anger).
I hope you find the answer helpful.I wish you both all the best.if you find the answer helpful,please provide positive feedback. Thank you