Acute stress - "nervous breakdown" or "exhaustion" - ministroke?

[1sister]

Hello, Is there a contemporary version of what might in other times have been called a 'nervous breakdown'?

Could it prompt a ministroke?

I am concerned about a person in her early 60s, for whom the past six months have involved a number of extremely stressful events, against a background of ongoing (realistic) worries and years of both chronic and acute stress. Most of these worries and events are of the 'uncontrollable' type. (I hesitate to get into details, but I'm talking about a cluster of 6 or 7 unrelated events quantified as 40 and above on the Holmes and Rahe stress scale, including a separation.)

On three occasions she has gone into a state I've never witnessed: repeatedly screaming a handful of phrases, crying for hours, locking herself in her room. She also made a few passively suicidal comments ("I would be happy if I got sick, to release me from this life"). These have been in response to emotional interpersonal interactions. This is very atypical behaviour behaviour for her, and was shocking to witness.

Is there a name for this kind of episode?

I don't think it's PTSD necessarily, but this is definitely some kind of extreme stress response. I read about 'acute stress episode' but there were no delusions or hallucinations, that I'm aware of. Very dark & catastrophizing thoughts, yes. Some days after the second such event, which happened a few months ago, she complained of tingling in her left arm (again, unusual - ordinarily she dismisses physical pains or illness). A (reluctant) visit to the hospital yielded nothing other than 'normal', age-related brain degeneration, but when her GP reviewed EKG results (taken about a week prior to this, read initially as unremarkable), she found 'something of concern', which will be followed by a cardiologist in three week's time. I am concerned that a ministroke, or heart attack, or something like it, might have been missed.

Since then, I've been noticing an increase in forgetfulness, grasping for words, being a bit more sensitive and emotional. In addition, she just seems more 'out of it', more often. It's true that this person was always a bit absent-minded, always made little verbal slips, but I feel that these are happening more often. It might be that I'm just more attentive to her previous pattern, I'm not sure! The third event happened tonight, a few hours after a distressing conversation she had (not with me, btw).

I am worried that all of this is somehow linked, and may have medical consequences. Also - she has (treated) high blood pressure & high cholesterol.

Can anyone offer insight? Thank you in advance.

And - is there anything I should be looking out for, behaviour or symptom wise, that might need urgent medical attention?

 

[Retired]

Re: Acute stress - "nervous breakdown" or "exhaustion" - ministroke?

It sounds like this person would best be evaluated by, at minimum, a mental health professional, considering the cumulative stressors that seem to have taken their toll, the unusual patterns of behaviour, mood and possible physical issues.

In addition to the cardiological consultation, this person should request a referral for consulatation with a neurologis as well as a psychiatrist.

A person in their early sixties is not elderly by today's standards of longevity, so with proper care and follow up for the kinds of symptoms you have described, early detection might help restore this person's quality of life.

How much influence, if any, do you have, to help persuade this person to seek proper care?

 

[1sister]

Re: Acute stress - "nervous breakdown" or "exhaustion" - ministroke?

Thank you, Steve. I will try to make those suggestions to her. I suppose I might as well say, as might be guessed, that I am speaking of my mother. She resists medical care, full-stop, unless there's an undeniable or life-threatening problem, and hates being 'coddled' or nagged. She has strong views on the mental health care profession (even stronger than mine), but has recently said she might be open to help. She has acknowledged that she 'may' be depressed, at least.

I agree that 60 is far from old. My mom's had a difficult life, and has been a tough, resilient, and mostly cheerful cookie through it all. I honestly think she's just exhausted her resources to cope.

Will try to think of a way to approach her that she will not experience as patronizing, and hope I can make the timing work. Perhaps she will be more receptive to an argument that refers to her tiredness.

(I am not thinking dementia is happening... I'm more worried about a possible stroke or precursor to it... she's a lifelong smoker, and in the past five years has taken to having a couple of glasses of wine before bed 'to take the edge off'. Which she justifies with reference to European habits and the health benefits of revesterol. A tough cookie, I tell you!)

Thanks too for your careful editing; those line spaces are exactly where I thought I'd put them. (Have turned off my script blocker )

 

[Retired]

Re: Acute stress - "nervous breakdown" or "exhaustion" - ministroke?

The best you can hope for is to provide her with as much information, and opportunity for treatment as you can, but in the end, she has to make the choice to avail herself of the opportunity.

When people are prejudiced by stigma or some other reservation about mental health, you might be dealing with years or lifetime of cultural bias.

Hopefully she will recognize that her quality of life might be improved by seeking the right kind of help.

Does she continue to smoke?

This might be one of your priority projects with her, because of the serious potential consequences, especially at her age. Has her bone density ever been measured?

Will try to think of a way to approach her that she will not experience as patronizing

Are you and Mom on an adult to adult style relationship, or does she continue to interact with you as her child?

 

[1sister]

Re: Acute stress - "nervous breakdown" or "exhaustion" - ministroke?

It's true that it's up to her in the end. It is frustrating, though. One of my mom's gifts, which has carried her through difficult times, is singlemindedness (which unfortunately amounts to stubbornness, in another light). She's someone who's used to being in charge (in relation to work and community, at least). Cultural bias is indeed a factor here, as well.

I will keep at her, and have tried to enlist the help of her sister.

You're quite right to touch on bone health - she has osteoarthritis. She does smoke, but I am working on her around that, as well. (Another European indulgence that she's only now appreciating is, rightly, stigmatized. Embarrassment may be a stronger motivator than self-preservation, in her case.)

Our relationship is moving towards an adult-adult dynamic, not least because she has worked at being open to this.

Thank you, again, for your thoughtful questions and comments.