Bipolar Disorder and Schizophrenia

[chell]

The man l am seeing has a daughter and the whole family is affected by his daughter who is diagnosed as having Bi Polar and Schizophrenia. The problem here is the daughter denies having anything wrong with her and refuses any medication.

From the laws here in Quebec, she cannot be forced to take any medication unless she harms herself or others or is a threat. She constantly is giving out parts from the bible and says that the bible talks to her and also the TV telling her that she is the "chosen one".

She calls her relatives during the night, (middle of the night) and appears on the doorstep of the relatives which scares the 74 yr. old grandmother half out of her wits because she is alone and does not know what to do with her or how to get rid of her, so most times this girl is left to go for herself.

At one time in her teens and early twenties, she was normal and fine and had a job and good life and then tried crack cocaine and meth and then snapped and the Bi Polar came out as well as the Schizophrenia.

With all jokes aside, everyone is afraid for their life when she comes around because she is so unpredictable with her moods. l just cannot believe they cannot force her to go for treatment. Any advice l can give?

 

[Retired]

You may want to have a look at the Schizophrenia Handbook for Families, available in English and French, online.

Schizophrenia: A Handbook For Families
La schizophrenie - guide a l'intention des familes

Published by Health Canada in Co-operation with the Schizophrenia Society of Canada

Available online in HTML format, this handbook for families can be read online at the Public Health Agency Of Canada website.

In order to pursuade this girl to consider medical attention, the family would need to identify specific difficulties she may be having such as trouble to sleep, and suggest she see the doctor for her sleep.

Quoted from NIMH:Schizophrenia last reviewed: April 02, 2009

The role of the patient?s support system?
Support for those with mental disorders can come from families, professional residential or day program caregivers, shelter operators, friends or roommates, professional case managers, or others in their communities or places of worship who are concerned about their welfare. There are many situations in which people with schizophrenia will need help from other people.

Getting Treatment. People with schizophrenia often resist treatment, believing that their delusions or hallucinations are real and psychiatric help is not required. If a crisis occurs, family and friends may need to take action to keep their loved one safe.

The issue of civil rights enters into any attempt to provide treatment. Laws protecting patients from involuntary commitment have become very strict, and trying to get help for someone who is mentally ill can be frustrating. These laws vary from state to state, but, generally, when people are dangerous to themselves or others because of mental illness and refuse to seek treatment, family members or friends may have to call the police to transport them to the hospital. In the emergency room, a mental health professional will assess the patient and determine whether a voluntary or involuntary admission is needed.

A person with mental illness who does not want treatment may hide strange behavior or ideas from a professional; therefore, family members and friends should ask to speak privately with the person conducting the patient's examination and explain what has been happening at home. The professional will then be able to question the patient and hear the patient's distorted thinking for themselves. Professionals must personally witness bizarre behavior and hear delusional thoughts before they can legally recommend commitment, and family and friends can give them the information they need to do so.

Caregiving. Ensuring that people with schizophrenia continue to get treatment and take their medication after they leave the hospital is also important. If patients stop taking their medication or stop going for follow-up appointments, their psychotic symptoms will return. If these symptoms become severe, they may become unable to care for their own basic needs for food, clothing, and shelter; they may neglect personal hygiene; and they may end up on the street or in jail, where they rarely receive the kind of help they need.

Family and friends can also help patients set realistic goals and regain their ability to function in the world. Each step toward these goals should be small enough to be attainable, and the patient should pursue them in an atmosphere of support. People with a mental illness who are pressured and criticized usually regress and their symptoms worsen. Telling them what they are doing right is the best way to help them move forward.

How should you respond when someone with schizophrenia makes statements that are strange or clearly false? Because these bizarre beliefs or hallucinations are real to the patient, it will not be useful to say they are wrong or imaginary. Going along with the delusions will not be helpful, either. It is best to calmly say that you see things differently than the patient does but that you acknowledge that everyone has the right to see things in his or her own way. Being respectful, supportive, and kind without tolerating dangerous or inappropriate behavior is the most helpful way to approach people with this disorder.

You may also wish to read the Mayo Clinic overview of schizophrenia for additional insights.

Is it possible for a family member to communicate with the girl's psychiatrist or family physician to get some suggestions as to how to get her to treatment?

 

[Budoaiki]

Chell,

The diagnosis you gave is similar to the one given for my mother, she had paranoid delusions along with it. I had to do a lot of research to really understand her, in combination with many many conversations which put me through a lot of stress to put that knowledge into context.

In the end I forced my family to come to a consensus that we needed to come together in order to help her to see that she needed help.

Despite my warnings my family elected to confront her bluntly about her delusions which given her paranoia wasn't exactly the wisest thing to do and in fact proved to be counter productive.

I didn't take part in this because I knew her paranoia would cause her to see it as us conspiring against her which unfortunately triggered further delusions.

In the end this turned out to be a blessing in disguise because I was able to help her understand that they had confronted her like that out of desperation because they were so concerned.

After disclosing the level of my own concerns, she agreed to seek help and requested that I go too out of concern for my own stress level. Unfortunately the psychiatric head at the local hospital was either over worked or extremely calloused. The first thing he asked her was point blank, why she thought she was hearing voices and she literally ran out of the hospital.

After that, thankfully and luckily she still acknowledged my concerns that had helped bring her to the point of wanting to seek help but she was still reluctant to do so.

So I took the time to show her how her stress was connected to her delusions through unresolved issues with the people involved in the delusions through the context of those delusions.

she finally approached her family doctor and sought out some professional care.

The reason I give such specific and personal examples here is to illustrate that it isn't easy or a task for a person to do on their own.

As the old adage goes, "United we stand and divided we fall." and for good reason.

By the sounds of it your family is already united on the status of her mental health.

I strongly recommend coming to a consensus on how to approach her about the issue with the subjective insights on her mindset from your family and consultation with a psychiatrist or psychologist which would help minmize stress all around.

 

[David Baxter PhD]

I don't think you can be diagnosed with bipolar disorder and schizophrenia at the same time.

 

[Budoaiki]

Dr.Baxter,

In my mother's case, she was formally diagnosed with Paranoid Schizophrenia and it was stated that she also displayed symptoms of Bipolar Disorder. I am not sure if that means she was formally diagnosed with bipolar or if the doctor was using it to describe some her symptoms.

I also did a bit of research on this of course after her diagnosis which leads me to believe that schizophrenia can cause people to display a variety of symptoms. On their own they could but described as bi-polar or paranoia but in combination with other symptoms they fall under the classification of schizophrenia or at least that is my understanding.

I did find the following article after reading your post on schizophrenia.com.

Links between Bipolar, Schizophrenia
Read more... Schizophrenia Biology

Despite the fact that schizophrenia and bipolar disorder have different diagnostic credentials in the bible of American psychiatric medicine (the DSM-IV), the two disorders show a significant overlap of symptoms, as well as some similar treatment strategies. Now, scientists are discovering some of the key biological similarities that may link these diseases even more strongly.

For example, Dr. Amy Arnsten at Yale University Medical School has found what she calls a "molecular trigger" for both bipolar disorder and schizophrenia. This trigger appears to be stress, which can over-activate a brain protein called protein kinase C (PKC) in the prefrontal cortex. Dr. Arnsten points out that increased PKC activity (noted in the brains of people with schizophrenia and bipolar disorder) can lead to some of the common symptoms of the two disorders, such as distractibility, impulsivity, poor judgment, and hallucinations. Moreover, medications for schizophrenian and bipolar disorder often decrease PKC activity.

More evidence is coming in from the field of genetics. Dr. James Potash of Johns Hopkins University Medical School says that "schizophrenia and bipolar disorder [appear to] share at least a few genetic roots." He gives the example of research that traces genes suspected as important to both disorders to the same region of chromosome 13.

In other fields, researchers like Dr. E. Fuller Torrey are examining the role that infections play in the development of both diseases. Torrey notes that antibody response to some infectious agents are elevated in people with schizophrenia, and also people with bipolar disorder.

The ramifications of such findings are many. One consequence may be a restructuring of diagnostic categories; for example, some medical experts are discussing whether people who experience psychosis along with the symptoms of bipolar disorder should be diagnosed under schizophrenia spectrum disorders rather than with mood disorders. Similarities in underlying biological pathology may also lead to new treatments that will be effective for both disorders. Finally, further understanding of these links provides even more evidence that psychiatric illnesses are diseases of the brain, just like diabetes is a disease of the pancreas and hepatitis is a disease of the liver.

Read more about research that shows schizophrenia and bipolar disorder are diseases of the brain:

1. Schizophrenia is a disease of the brain
2. Bipolar Disorder is a disease of the brain

Read about the link between stress and schizophrenia risk

For the original news story, see: "Stress May Link Bipolar Disorder and Schizophrenia" (Jan 16 2005). Available online at South Florida Sun-Sentinel.com

 

[David Baxter PhD]

Whether bipolar disorder and schizophrenia have some genetic or etiological features in common isn't the issue, though.

If the person shows evidence of both schizophrenia and a mood disorder, the appropriate diagnosis should be schizoaffective disorder, not schizophrenia plus bipolar disorder.

It just sounds like sloppy diagnosis to me.

 

[forgetmenot]

Thanks for a very interesting read as with my daughter who displays both bipolar and schizophrenia her psychiatrist did eventually diagnose her with schizoaffective disorder along with a number of other diagnosis. The treatment remained mostly the same with addition of one medication resperidone.

 

[texasgirl]

That is also what happened with me.

TG