Have Mental Health Questions? Ask a Psychiatrist Online
Hello, I am Rafael. Thanks for asking your question - I'm here to support you. (Information posted here is not private or confidential but public).
I am truly sorry to know about your friend's situation. It seems truly overwhelming for you as a close friend, apparently more shocking because of how suddenly these changes happened.
Could you please tell me about what happened for me to better understand her situation?
Yes, I was hoping to be able to given the situation
I wish there was some way to attach an image of a letter that she had written when asked to write down what was on her mind a few days ago
Let me see it.
she has gone the last 4 days without sleeping according to her husband, she has almost a routine where she is very agressinve and upset, then once she is threatened with something like having the cops called she usually will appear to know that she did something wrong and remorse over it while talking to their two dogs, then she will get up and kiss her husband and say everything will be alright and that she loves him. Only to begin rambling to herself or about something.
You said she started presenting similar behavior but not that severe for the past 3-4 weeks, and it got to the point where she was just to unstable and was hospitalized, right?
Yes she was ommitted earlier this week when her husband called the cops. When he was on the phone with dispatch she began violently screamin g that he was raping and abusing her. Her husband video recorded hours of these instances and showed them to the officer when he arrived and he took her to a psych ward close by. She has been to one before and has a habit of masking everything around people other than her husband and they released her the next day.
It's truly sad and concerning, since her thought process seems to show poor insight about reality, a lot of confusion, fear, delusions and other symptoms present durnig psychotic episodes.
I made the trip down to their place this past weekend for support and when I got there she was at home and I could tell she was off but was trying to hide it from me.
She was also prescribed adderall for a little while and stopped taking it, only to then begin to smoke marijuana on a regular basis. Her husband also informed me that she had an eating disorder a little while back where she was throwing everything up, and that when she started to smoke marijuanna that all stopped
Cannabis is a powerful drug, it is addictive and can cause or trigger anxiety, depressive and psychotic symptoms and disorders. She mentions religious concerns and speculations around her faith, reading and identification with such religious concepts - symbols, which she takes in very literal ways, with poor insight. It's a priority for mental health professionals to identify the origin of this psychotic episode, the triggers and its nature, since there are multiple possible roots for it, from medical conditions, to drugs or psychological trauma. Treatment must be based on the nature of her disorder and an accurate diagnosis.
Her husband has hours of video and voice recording of her, one in particular that I was shown of her sitting in front of a computer typing and talking with a almost dead stare, but what blew me away was that the screen was black and the computer was turned off
He has not shown the videos or letters to anyone until showing them to me this weekend. I told him that he needed to share them with a doctor or someone that is evaluating her because like I said she tries to mask it all when she is outside of what I call her "safe zone"
Then she could be experiencing hallucinations too, which are core symptoms of psychotic disorders. If she was already suffering of an eating disorder, then I could imagine that she already had depressive and anxiety related problems, which got worse by the use of drugs and possibly by not having necessary psychological support to cope with these overwhelming experiences-symptoms, and the disorders she already had.
I was also just informed by her husband that she has just been handcuffed at the hospital for what he says "beating the shit out of him and her dad" and has been ommitted once again to the psych ward.
her husband also informed me last weekend that she has a medication to help bring her down off of these type of instances or help her go to sleep and she consumed one and a half pills and never slowed down or fell asleep.
That could show she is suffering or paranoia too, since willingly trying to manipulate people's awareness of her situation. She is obviously feeling terrified, that's the core feeling she expresses in her letter, thus it seems obvious she is suffering of a psychotic episode. Only after complete evaluations, professionals should be able to get an accurate diagnosis.
He said that he took a half of one of those pills and was out for 12 hours
I am terrified for her and love her as much as I do family, and her husband is beside himself not knowing what to do ... No one has really said anything as to what might be wrong with her and if she will eventually come out of it like she has in the past
Also, her husband said that she was diagnossed with bipolar disease a little while ago and refuses to take her medication for that, which sadly I didnt not find hard to believe considering another good friend of mine years ago also would refuse to take his medication for the bipolar disease
What about psychological treatment? it seems she has been suffering of different serious disorders. People with an eating disorder, most times suffer of depression and anxiety, many times of personality disorders too and other addictions, in her case we know about the cannabis, then it seems she was already having a tough time in her life facing all these disorders, which overwhelmed her to the point of presenting this psychotic episode. Numbing a person does not help, unless adequate intensive psychological treatment is provided.
She her husband is an athletic personal trainer, and according to him he said that she only began to have an eating disorder when he got a management job running a gym as she was constantly worried that her body was inadequate for that of a personal trainer, so my friend gave up his career in personal training to try and diminish her eating disorder.
I see, then this is a very complex case, you see, bipolar disorder is a chronic mental illness, sh has also an eating disorder, plus drug addiction, inconsistent medication support and apparently no sound and effective regular psychotherapeutic treatment, then it makes sense why she has got to the present point. Most people with bipolar disorder do require medication to avoid hospitalization, controlling new intense manic -depressive episodes and worsening leading to psychotic symptoms. But medication does not cure nor solve core issues with this disorder, for that only regular psychoptherapy could help, and taking not account she has been suffering of these other chronic mental illnesses-conditions, its not uncommon to behold such level of deterioration in the present.
I guess I am trying to figure out from a professional such as yourself, if providing the doctors evaluating her with the written, verbal, and video documentation of her episodes would help expenentially given her tendency to mask everything?
This person has a long history of multiple and serious mental health disorders, all chronic conditions, which have been reinforcing and worsening each other to the present point. For adequate and accurate diagnosis and treatment, current professionals should have all previous clinical history from clinical records, all the information husband could provide about the beginning and evolution of each one of these conditions and symptoms, and provide every piece of data that could help professionals to support her. For sure writings, and any multimedia recording would be very valuable next to the other core information.
Based on your words I would say that this could be a case of a person suffering of multiple mental health disorders, whose bipolar got to develop psychotic symptoms due to lack of adequate psychiatric and psychotherapeutic treatment, pushed by eating disorder and drug abuse-addiction.
She needs to be treated for each one of these disorders, understanding that these are chronic diseases, there is no cure, but rehabilitation is possible as long as she receives all necessary and effective support from psychiatrist, psychotherapist and other mental health professionals, support that should include intense inpatient individual, group and family therapy once she gets more stable, followed by aftercare program, and intensive outpatient support, including regular medication, individual psychotherapy and at least a support group.
Does it make sense?
Also within her family I know that her brother was a severe substance abuse case and highly addicted to drugs, I am unaware what drugs he was addicted to but it is in the family
I guess I just do not understand how for the entire 6 years I have known her that I have never seen any of this, from the eating disorder, mental break downs, aggresiveness, I feel as though maybe I missed something and being able to reach out to her and Kris
Makes sense, most times, people suffering of a mental disorder or disease, do have relatives presenting mental health issues too, and many times there are serious past experiences related to neglect, abuse or dysfunction n families leading to the development of these disorders.
All of what you have said makes sense to me, and I would agree to support groups, taking the right medications regularly, and so on and so forth, but how do you get someone that refuses to take stuff to see that it is hurting not only her but the people around her that love and adore her more than she could ever imagine?
Mental disorders-diseases do not happen in isolation, it is the person's very support system which require intervention, since these conditions could get triggered by any stressful life event, or develop from concrete and long term painful life experiences, but they would evolve depending on how healthy or dysfunctional her support system happen to be. Denial, avoidance, repression, secrecy, manipulation and codependency -a core addiction here- are main symptoms of most of these disorders, and it is her loved ones, who need to work on becoming much more assertive supporting and promoting her rehabilitation, otherwise it would be hopeless. They need to learn to set health and solid limits and boundaries, eradicate any form of codependency and enabling, hoping she would commit to her rehabilitation process once she finds that there is no other way but to to take responsibility for her actions and rehabilitation.
This is why treatment must take into account not only the patient but the whole system, including spouse, children, and close adults - friends present in her life.
I am very sorry but I must leave now, we have been close to an hour and I have a client schedule for a session in two minutes. If you have any further questions about it, please feel free to post them, and I will reply as soon as I return from this other session in around two hours. Thank you for your understanding and trust.
I think that I got everything I was looking to get, and I appreciate your words. Thank you so much
You're very welcome. I hope your friend and her family get the support they need and deserve to get back their lives. Thanks.