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Dr. Michael
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience:  Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
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My 31 year old brother has been sweet and gentle his entire

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My 31 year old brother has been sweet and gentle his entire life. After a traumatic relationship and subsequent divorce, he has become violently angry. He's assaulted family members, complete strangers, and even law enforcement. He has ruined what used to be perfect credit. He launches a slew of vile insults at anyone who provokes him even in the slightest. He has bouts of megalomania and delusions of grandeur. My family is at a complete loss on how to help him. I suspect borderline personality disorder or PTSD, but I'm no psychiatrist. Help us, please.
Submitted: 5 years ago.
Category: Mental Health
Expert:  Dr. Michael replied 5 years ago.
Hello. I believe I can be of help to you with this issue.

Well, the general physician doesn't have the training to even know what he or she is doing, based on your reports. Sorry to insult them but really---if the proper diagnosis is missed, prescribing an antidepressant by itself could very easily make his condition WORSE. That is, if your brother has bipolar I disorder, which is a reasonable speculation or hypothesis at this point (as is your speculation that he might have a borderline personality), antidepressants administered alone often make manic episodes worse. I wish to heck physicians would stop practicing outside of their area of expertise! He needs to be seen by a psychiatrist for a proper evaluation, diagnosis and medication trial. Another proper initial referral would be to a clinical psychologist who can administer standardized psychological testing and formal structured interview methods to find out what is going on. Sometimes arriving at a proper diagnosis takes several weeks and visits because the full symptoms of any particular disorder aren't always apparent at one point in time. They may show up now, or in a few weeks, or disappear for a short time, only to return. So a longer time line for full evaluation is very often needed.

The traumatic events you describe often trigger a serious mental disorder in persons seem quite normal but who carry a biological predisposition for the disorder. We see this in post partum psychosis triggering some cases of bipolar disorder, for example. Here is a key point----until he is under the care of a psychiatrist and agrees to go to psychotherapy with a clinical psychologist familiar with the proper types of therapy for severe mental disorder such as this, family members will really just be 'spinning their wheels' trying to be helpful. I believe you have provided a good summary of just how ineffective all family members and the approaches to 'helping' have been to this point.

Do not send him back to your general physician until you really know which disorder he actually has. A psychiatrist for example, might conclude he has bipolar disorder and he will be tried on a mood stabilizer, not an antidepressant. Logic and trying to placate or reason with him will simply result in frustrating interactions with him. It may take a serious emotional breakdown, a legal crisis (breaking the law and getting arrested, a DUI, etc.) to force him into proper treatment. Family members DO need to get together and plan a common strategy they can all stand behind, without wavering e.g., he can receive no help or support from family except based on his compliance with visits for a full evaluation, etc. Everyone needs to get on 'the same page' about how to support. But no one can really do much or 'fix' this because he really needs a treatment PROGRAM.

I'll pause here and solicit your reaction to this post.
Customer: replied 5 years ago.
Thank you for this information. I figured our general physician, god love him, was just throwing whatever he could at the situation.
He's already in some serious legal trouble. He assaulted four police officers while intoxicated, and recently violated probation twice by being arrested and put in jail (for much more minor offenses). Again, all of this behavior is out of the ordinary for him.
I'm not sure he can afford psychiatry, though I intend to research it on his behalf. I'm also not sure he would seek treatment voluntarily.
What are the chances I can convince his P.O. or judge that my brother needs state-mandated psychiatric care? That may be a question for a lawyer, but any answer I can gather will help.
Thanks again.
Expert:  Dr. Michael replied 5 years ago.
Check with your local/county court system and find out if they offer something called Mental Health Court. This would be ideal for him.

A less expensive route to getting him evaluated would be a licensed clinical psychologist. As the psychologist to evaluate him and provide specific recommendations for treatment. Based on this recommendation, you would then find a physician who is willing to put him on the right medication based on this evaluation, and follow him up periodically. Now, the mental health court has some financial subsidies to help with this. The evaluation would also be shared with the prosecutor, his P.O. and the judge, so your brother will have to ask for a copy of the report or you can, through a release of information signed by your brother (the psychologist will have such a release form) The eval. should suffice to demonstrate that serious mental health issues are in play here.

Let me know if I can be of further help. Please click on the green Accept button at the bottom of the screen. Thanks!
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