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Ask Rafael-E-Therapist Your Own Question
Rafael-E-Therapist, Psychotherapist
Category: Mental Health
Satisfied Customers: 5971
Experience:  MHT-MHRS-MS-MA Integral Psychotherapist & Life Coach
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My daughter did a mental health assessment in her drs office

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My daughter did a mental health assessment in her drs office yesterday and was told she has bipolar and schizophrenia,
JA: The Psychologist can help. Just a couple quick questions before I transfer you. When did the bipolar disorder start? Has your daughter used any medication for this?
Customer: is it possible to have both at the same time?
JA: How has she been sleeping? Any insomnia or other issues?
Customer: Insomnia since she was born. She is 23 now
JA: Anything else in her medical history you think the psychologist should know?
Customer: She turned to substance use for a couple years and is clean now 4 months. She has always heard voices. She has had sexual trauma ptsd. She has depression, severe anxiety at times. Was diagnosed with borderline personality disorder traits at 15

Hello, I'm Rafael, an integrative psychotherapist. I'm here to support you. I'm carefully reviewing your post now and I am very sorry to know your daughter has been suffering from these tough conditions for so long.

Customer: replied 1 month ago.
She has been on different medications over the years. Dr wants to put her back on siroquel but she doesn’t like it.

Answering your question, bipolar disorder and schizophrenia can comorbidly occur in the same person. If your daughter suffered from psychotic symptoms meeting criteria for schizophrenia before her drug use, then that would be her first diagnosis.

Customer: replied 1 month ago.
That’s it. One question.

Unhappily psychotropic drugs can cause, worsen and trigger these and other mental disorders, even more, when the person presents a mood condition and a psychotic disorder. Extreme caution should be taken since the drugs prescribed to numb symptoms in one disorder could trigger the other condition.

Customer: replied 1 month ago.
What would be a treatment protocol recommended and what drugs would you recommend?

If sha hasn't already been working on her rehabilitation with regular individual, family and group psychotherapy, it is essential for her to seriously consider that otherwise the chances for further deterioration are very high.

Customer: replied 1 month ago.
Would schizoeffective disorder be a possibility

treatment for bipolar disorder and schizophrenia means individual, family and group therapy, behavioral and social interventions. If the person is violent, suicidal, homicidal, undergoing violent behavior, a crisis or severely psychotic, then the use of psychotropic drugs could be justified for short term to control and prevent those crisis.

Correct, schizoaffective disorder could be a possibility instead of schizophrenia, but only a competent and complete psychological evaluation by an excellent clinical psychologist could determine that.

Customer: replied 1 month ago.
Currently she is calm and actually started working but is terrifiedof getting depressed again. You don’t recommend any medication unless she turns violent etc?

Psychotropic drugs in my professional opinion could cause more harm than benefits as explained before, and should never be used without providing competent treatment. The exceptions for their use, in my opinion, are for cases of psychotic disorders and conditions like bipolar where the person becomes severely dysfunctional if psychotic, manic or depressed. Other than that, these drugs could backfire.

Customer: replied 1 month ago.
that includes siroquel?

Absolutely. Again, if a competent, ethical and experienced professional can objectively justify the use of this drug as more beneficial than detrimental to your daughter, base don their complete understanding of her medical and mental health history, development, current neds and stressors, after having provided necessary treatment to address those symptoms and the disorder/s, then no problem. Obviously this needs to be supported by the concrete evidence of your daughter's mental health, mood, and functioning improvements, and closely monitored by regular tests to assess organ damage and other problems caused by adverse effects.

Customer: replied 1 month ago.
The dr wanted to give her a dose of 250mg of siroquel? I strongly disagree and I’m taking that as you do too without a proper assessment and diagnosis?

Then that's my very point, and this is unhappily dominant practice in the mental health system, seriously risky, unethical and antitherapeutic, but it happens like that. These drugs create a unique reaction in each individual's brain, there is nobody who can tell you how your daughter's brain will react to any of these drugs, it is literally a process of trial and error, of experimentation. That tells you a lot of how it works.

Rafael-E-Therapist and other Mental Health Specialists are ready to help you
Customer: replied 1 month ago.
Thank you for your help

You’re very welcome. Please feel free to contact me if you have any further questions since I am here willing and ready to support you as much as possible.

You can contact me using this direct link to my profile, you could bookmark it for easy access, and just make sure you state “For Rafael only” in your request, for other experts to know you want me to reply, and I will respond in less than an hour most of the time.

Also, know that I provide confidential counseling/psychotherapeutic support via Premium Services, which is implemented via Skype or phone call, in case you feel comfortable with me and would like to discuss in more detail this or any other concern, and the best approach to work on it.

Thank you for your trust. Take gentle care.