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Dr John B
Dr John B, Psychologist
Category: Mental Health
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Experience:  PhD in Clinical Psychology, registered clinical psychologist.
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My wife had a major breakdown or something 6 years ago. Since

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My wife had a major breakdown or something 6 years ago. Since the she has been paranoid and thinks that every comment, car that goes by, license plate, song, everything must mean something or is a sign from God. Now she has an impending doom that she is dying from a heart attack or stroke or leukemia or some other awful cancer or or whatever. When asked she just knows that she is dying. Everything is exaggerated and dramatic. Previous to 6 years ago she was very very active hiking biking running etc.

Hi,

I'm sorry to hear of the situation. Can you provide some more detail around the major breakdown? What happened in terms of symptoms? Also, has she been assessed by a mental health specialist and if so what was their diagnosis? Had she experienced any major trauma? What do you think caused the breakdown?

Customer: replied 4 years ago.
She bought a $32k jeep and planned to divorce me and start a new life. She was very angry demanding and unreasonable to everyone, me her sister her mother our kids everyone saw her as going off the deep end. She went from liking me to hating me. Her mother had stage 4 colon cancer which was a trigger along with me working long hours at work. Her mother told her if your husband is not home by 8pm then he is cheating on you. She believed that lie for the last 6 years. Thyroid and HRT helped but she in not good T taking meds and misses doses often. She can't focus or understand a joke. She became hyper religious judging everyone. Withdrew from people and normally won't answer the phone because her head hurts and she is putting ice or heat on it.
Thanks Mark. Does she have a previous history of Psychiatric illness? Just to confirm; she hasn't had a Psychiatric assessment and is not receiving any Psychiatric treatment?
Customer: replied 4 years ago.
Mayo clinic said she was mildly depressed in 2006. In spring 2012 mayo said she had actually improved from 2006. In July she had another blow up and was in a behavior health facility for a week. They decided some of the naturopathic things the chiropractor was giving her were psychotropic and causing her the issue. Diagnosis was psychosis. They gave her a anti depressant and scheduled follow up with psychiatrist and therapist. She did not like them and stopped the anti depressant because it made her sick to her stomach and numb to everything. Feelings libido etc.

Ok, thanks for the extra information.

With a history of Depression I am wondering if she experienced a drug (naturopathic medication) induced manic episode. These usually occur as part of Bipolar Illness and often feature psychotic symptoms. Sudden spending sprees are a hallmark of mania and so the car purchase also makes me suspect mania.

Regardless, it certainly sounds as though she is continuing to experience some residual and ongoing delusional thinking. While medication is not the be all and end all of Psychiatric treatment it certainly is the cornerstone of treating acute psychotic symptoms (whether they occur as part of mania or a Psychotic illness). Are you able to double check whether she was given an antidepressant or an anti psychotic as treatment? I would be surprised if it was an antidepressant (as you have written) as antipsychotics are used to reduce delusional thinking and antidepressants can make mania much worse!

Many people struggle to maintain stable medication regimes as Psychiatric medications tend to be fairly unpleasant so she is not alone in this regard. In saying that, inconsistent adherence to medication can actually make a person worse and given that you describe ongoing delusional thinking it would seem that she is need of an urgent Psychiatric review. The longer Psychotic symptoms last the worse the prognosis so the key point at this time is that she be reviewed ASAP. When was she last reviewed?

Customer: replied 4 years ago.
Saw our GP today and he prescribed cymbalta to help reduce what seems to be hyper sensitivity to pain. He also prescribed Xanax for anxiety since she has chest pain and thinks her heart is ready for heart attack and fearful of a stroke. If you oppose her she does seem to work up into a manic sort of state where she hates me and everything about me, our church, etc. so the question is how to get a diagnosis... Mayo clinic failed me twice. 2006 and again in 2012 but they did not gather the whole story and primarily spent 5 hours having her take a test. Maybe cymbalta will make her worse?
Customer: replied 4 years ago.
They saw here in July in a behavioral health facility. I was I satisfied since they hung their hat on the natural stuff the chiropractor was giving her. When she used to do extreme sports she would often stay up all night before the big event. I can't do that. Yes they have always given anti depressants not anti psychotic meds.
Customer: replied 4 years ago.
I was not satisfied with the July episode... They seemed to just want to get her out of there. She has been delusional for 6 years now.

This is sounding more and more like a mood disorder with a substance induced manic episode. People with a vulnerability to mood instability can often be triggered into mania by medications, even natural supplements.

If this is the case then she absolutely should not be taking any kind of Psychiatric medication unless under the supervision of a Psychiatrist (not a GP). Cymbalta is used for nerve pain but it is also used as an antidepressant to treat Depression and Generalized anxiety. As an antidepressant it carries a significant potential to induce or worsen mania and I would very much want the all clear from a Psychiatrist before commencing an antidepressant. Is anybody supervising her care from a Psychiatric point of view? Is the GP working in conjunction with this supervision?

Customer: replied 4 years ago.
The psychiatrists at the hospital and follow up we're giving her prosac. But she stopped it about 6 weeks ago. The GP diagnosis is GAD and thus treating it with Xanax and now cymbalta to reduce her sensitivity to pain. Her sister is studying to be a counselor and brought over a few chapters in a book about bipolar. I think there are a lot of similarities but she does not think it is her. She is convinced that the chiropractor adjustment in July mortally wounded her and she is going to die. Every night is goodby forever to me, our dog, our kids. 4 days ago she demanded we fly to San Diego for a vacation the following day to get away for a week. We made the reservation and packed. By morning she was not feeling well enough to go so we cancelled 1 hours before the flight. Later she said she did not want the kids to find her dead at home and was one of the reasons to leave town. Our kids are 25 24 and 21 and out of the house.

I think her sister is right in suspecting Bipolar, this is the mood disorder that mania usually occurs in. Again, I am concerned that she is displaying some Psychotic phenomena and this means she needs a review by a Psychiatrist ASAP.

Are you able to arrange a Psychiatric assessment for her?

Customer: replied 4 years ago.
I went to her first psychiatrist appointment the week after she got out of the hospital. I gave him a fair amount of info. He said it was my wife's decision if I came back with her. She decided not to have me come back. She decided not to go back to this psychiatrist or the counselor that the hospital assigned. She portrays me as a controlling domineering husband but I simply love her and have tried to get her help. I can't help her if she does not think she has a problem and won't go and or won't take the meds prescribed. Very very frustrating. She is unable and unwilling to receive help. What can I do?

Unfortunately it is very common for people who develop these kind of problems to lack insight into the situation and refuse help. It is one of the major complications in treating mental health problems. Is there anybody that she is likely to listen to? For example, her sister?

Psychotic symptoms are considered a medical emergency so could actually march her down to the nearest emergency ward or have mental health services come out and do an assessment. Obviously this is going to further distress her and strain your relationship so it's a last option.

You said she willingly attended an appointment with her GP and I'm wondering if this might be a pathway to an assessment. Do you have a goo d relationship with her GP? If so, could you discuss him arranging an assessment?

Customer: replied 4 years ago.
At the moment GAD assessment seems very real and appropriate but it does not address the psychotic aspects. Maybe more discussion with her GP is in order. Or I may try her sisters relationship to see if that... No likely though, although my wife will lister to what her sister has to say she does not believe her in the end. I will pursue the GP with our conversation and more history. Any other thoughts? Thank you.

Take a look at this book here http://www.amazon.com/Someone-Mental-Illness-Treatment-Anniversary/dp/0967718937/ref=sr_1_1?s=books&ie=UTF8&qid=1353407567&sr=1-1&keywords=xavier+amador

Xavier Amador has been writing in this area for many years and I find his work very helpful. I have referred many family members to this book and I always get good feedback regarding it being very helpful in a situation like yours.

If you have any further questions or would like me to clarify or expand upon anything I have written please let me know. If not....I wish you the best of luck with this very difficult situation.

Dr John B and other Mental Health Specialists are ready to help you
Hi Mark,

I ihope you've made some progress in getting your wife a new assessment.

If I can be of further help, or if you ever have other questions in the future, please don't hesitate to contact me directly. You can do this by simply putting "For Dr John B" at the start of any question you post.

Regards,

John

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