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Forum Name: Psychiatric Topics

Question: Psychotic wife


 Khan71 - Thu Jul 26, 2007 2:45 am

age :33
Sex : F
Schozzophrenia

Dear Doctor,

My wife was diagnosed being schizzophrenic. She never visited the doctor so i kept on discussing her case. The doc said it could be schizzophrenic. But I have doubts. She doesnt have delusions or hallucination. I only noticed once or twice her talking about it. But she can lose temper to a danger stage. She misunderstands most and then gets angry. Do not socialize then and keeps on screeming at home. If some one tries to explaing, she gets more angry of told to be wrong. She can even hit and slap the person or shout in public. When normal she is extremely good and caring. we have two kids. she is now taking good care of them but used to be very rude at times to the elder one who is 10 now. Last year she went out of control and slapped me badly plus hitting on the walls. i called the ambulance who came to collect her as I had already registered her case in psychy hospital. She then pleaded and agreed to see doc but preffered to go in car. The hosipital then admitted her and released after 5 days. They gave fluanxol 5mg. I was giving her this but later i noticed she is throwing it in the dustbin and showed to me as eating. I ignored and discussed with doc. He said not to show her that you know and now give risperdal liquid in water. I am doing this now for 4 months. I started with 0.5 mg and now on 0.75 mg. I told her its homeopathic for her body aches. then she takes it. I want to increase the dose gradually as if she notices side effects, she leaves the medicine. She does not even want to see the doctor again and curses the doctor. And me too for taking her to hospital like this. I take all the special care. she has everything but no change is seen even with medicines. The only difference now is that she has some control over her anger but still misunderstands others and want to stay away from them or talks to me about shouting at them.She cannot tolerate a reply in No. She wants others to agree with what she says. Any disagreement should not be direct. She is also very extravagant and then blames to have not enough money. Cannot take personal jokes on herself though she usually is humorous in gatherings. When she loses temper, she cares not about the relationship.
I feel sick then as they are my close family members and whenever she acts so, i get severe tension headache, dreams about their patchup and appetite loss. i am fedup as nothing seems to work. I took her on vacation to different part of the world but she is same on return.
please guide me
 Dr. K. Eisele - Sun Jul 29, 2007 3:02 pm

User avatar Dear Khan:

This is really a difficult situation. Before discussing anything else, though, I want to give you a few definitions that will help us communicate more effectively:

    Psychosis = the presence of hallucinations and/or delusions
    Delusion = a fixed, false belief from which the person cannot be swayed even in the face of contradictory evidence
    Illusion = misperception, such as a tree that looks like a giant; not necessarily a sign of illness, unless it is constant problem
    Hallucination = perception in the absence of stimuli, such as seeing another person in the room who does not exist.


While I cannot make a diagnosis over the internet, what you have described sounds a lot like Bipolar Disorder. Since she was previously diagnosed with Schizophrenia, though, it may be that what she really has is Schizoaffective Disorder, Bipolar Type. The latter is a type of illness in which the individual experiences psychosis, and at times, also has very marked mood swings.

You mentioned that she misunderstands people and becomes very angry. Is it possible that she is experiencing auditory hallucinations and/or illusions?

In Bipolar Disorder, the individual suffers from marked mood swings, primarily. During the peak of the mood swing, they can experience psychosis. In that case, we would say that she has Bipolar Disorder, with psychotic features.

As you can see, there is very little difference between Schizoaffective Disorder, Bipolar Type, and Bipolar Disorder, with psychotic features. Likewise, the treatment for these disorders is very similar.

Now, I need to give you my disclaimer about giving others medicines without their permission/ knowledge: I neither agree with nor condone this practice. Since her physician is already doing this, however, I will assume that he has a court order, or some other legal mechanism, to cause this to happen.

Risperidone liquid in water can be an effective treatment, but it sounds like she really needs either a higher dose or a mood stabilizer. Risperidone, to be truly effective for this severe a problem, is usually dosed at about 2 - 3 mg twice a day. If you were to suddenly increase to this dose, though, she would no doubt notice. I would think, though, that an increase of another 0.75 mg would not be terribly noticeable. If she did notice, you could simply attribute the effects to a virus, and tell her you have been feeling the same way. Then, simply go back to the 0.75 mg you were giving before, for a couple of days, then try a smaller increase, by only 0.25 mg, for example.

A mood stabilizer, such as valproic acid (brand names Depakene and Depakote), would be something to ask your doctor about. Divalproex comes in a liquid, but it is red and patients says it is truly awful. There is another form, though, called Depakote Sprinkles, which is a capsule full of very small, coated "beads" of medicine. The "beads" are multi-colored (at least in the US), and can be mixed with ice cream, or applesauce, or pudding, etc.

Depakote Sprinkles are usually very well tolerated, particularly when mixed with food. The most common side effect is drowsiness. Most patients are instructed to take it before going to bed, making the side effects much less noticeable. Some people also experience dizziness. The problem you would have with giving her this medicine without her knowing it is that this medicine must be monitored by blood tests. It can cause liver failure and pancreatitis, both of which can be fatal. The likelihood of that happening is very, very small.

Talk to her doctor about the continuing symptoms, and that the symptoms (particularly the overspending) seem to be intermittent, or cyclic, in nature. That will help him make a diagnostic decision and prescribe more effective treatment.

Please come back and let us know how things work out for you and your wife.
 Khan71 - Fri Aug 03, 2007 2:55 am

Dear Dr. Eisele,

I thankyou so much for a detailed reply. I will definitely discuss with the doctor about mood stabilizers. But you see the main issue are the side effects which make her not continue with the medicines. And the worst is she doesnt want any followup with a psychiatrist as she in no way believes herself being sick. She just keeps on blaming others for her mood.
I don't think it is bipolar either as she does not have mood swings. I don't even notice delusions or hallucinations cauing her to misunderstand others. Its just that one has to be very much explanatory and detailed when someone is saying something to her. Otherwise she would take it negatively. HEr temperament goes bad when she feels someone said something to her, or ignored her or abused her and replied in No. Elsewise she is ok. She has been teaching in school but then there she used to have problems with the colleagues. Again she joined an institute for some courses but there she had problems with teachers.

Most of the poeple tell me its no sickness and she has personality problem which cannot be cured.
What do you think can that be so.

I think I may have only once or twice noticed her talking about delusions or haalucinations. Very very rare. But she does keeps on telling me that she gets to know about any bad events like someones death or severe sickness before time. When i inform her about any such thing, she replies, I am not shocked as I had this feelitngs few days back that this was going to happen. This she would say always.

I cannot even sedate her more as she is taking care of the younger son who is 1years and two months and she has to wake up for bottle feeding during night.

I am very slowly increasing her risperdal dose as the moment she would get a hint that it is making her sedative or gets anyother prominent side effects, she would leave it. And then I would be all helpless as myabe little dose is giving her atleast some benifit.

The idea of giving her drops is mine and got the consent of her doctor as he says if life is being tolerable with this little dose, its no harm in giving her the medicine like this for good. Here in my country, the rules for this are not as strict as in US or else.

She is also gaining some weight because of risperdal. She is quite sensitive about weight and that brings her mood quitet down when someone tells her she has put on weight.
She is also possessive about me cannot take if I be frank with any lady. She even related me to my niece and someone elder when I was being frank with them.
She gets very abusive too when shouting or in the bad mood. Once when I was driving she got so angry that she grabbed on the neck and then slapped me. She asked me take her to the person she got irritated with and would hit her then. It was really difficult to control her. When her such anger repeated again, it was then I got her admitted.

I know its all so tough on me.but feel afraid of getting effects of this on myself and getting sick.


Please advice further.

Thankyou so much

Khan
 Dr. K. Eisele - Sat Aug 11, 2007 3:59 pm

User avatar Dear Khan71:

I think her "misunderstandings" and possessiveness, in light of everything else could be a sign of psychosis--paranoid delusions, for example. I once had a patient who had a problem similar to that of your wife.

I think the mood stabilizer might be a good roiute to take not only becuase of the portential for her to have Bipolar Disorder, but also because mood stabilizers tend to damp down anger and rage.

Good luck!
 Khan71 - Wed Aug 29, 2007 3:43 am

Dear Doctor,

Thankyou so much for your valuable suggestions. I will discuss the contents with her doctor here.

Thanks and Regards

Khan

p.s. You would surely be rewarded byt God for your free of charge services

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