It's been some time since I visited or posted. I've been consumed with my daughter's treatment and day to day management. It has been nearly 3 years now since our story began with her first psychotic episode. My daughter is now 21 and continues to battle psychosis, anxiety and depression without any definitive diagnosis. She has had 3 hospitalizations, the first 2 in the psych unit of our area hospital with about a 10 to 11 day stay each time. This last hospitalization commenced with her taking approximately 170 aspirin, spending 5days in ICU and then court ordered transfer to the "state" psychiatric hospital. She did well while there but quickly decompensated upon returning home. She has been on Risperdal steadily for the past 2 and a half years with trials of Invega, Latuda and Fanapt, all of which were ineffective. She was never entirely off the Rispderal with each of those trials. The state hospital initiated Abilify at 10mg daily and we quickly saw improvements. Her thinking cleared, she exhibited insight into her condition, she even began to make plans for the future. She was there for 3 weeks when they initiated discharge. The day of discharge I knew as soon as I walked onto the unit that she was deteriorating. I had concerns 2 days prior due to comments she made during a telephone conversation. I had relayed these to the social worker who called me regarding discharge plans but they were overlooked.
She saw her home psychiatrist within a week of discharge. Her psychiatrist increased the Abilify to 30mg daily but there has been little response. We never received a discharge diagnosis, all the diagnosis were on admission and considered rule out. They included schizophrenia, schizoaffective, bipolar, and episodic mood disorder. Her psychologist while home has firmly stated that he feels she is schizophrenic. Her psychiatrist does not. She has tossed around bipolar disorder but also borderline personality disorder. She has expressed the opinion that some of my daughter's symptoms are exaggerated. She stated to me, and I do agree with her, that she finds it hard to believe the state hospital would discharge her in this condition and on only 10mg of Abilify with this severity of psychosis. She had stated to me, prior to her hospitalization in the state hospital, that there was no way my daughter could have continued to experience psychosis while taking 8mg of Risperdal daily and not experience any serious side effects. If you don't consider an almost 100 pound weight gain a serious side effect. She insists that my daughter was not taking her medications. My husband and I give them to her daily and make sure she swallows them. We believe she was taking them, if she were not then she was very adept at hiding it. The condition she has been in mentally for the past several months make it very difficult to believe she could have managed that.
Her psychiatrist and psychologist are both with the same agency. The psychologist has become very upset with her psychiatrist because she does not seem to recognize the psychosis. He was also very upset when she mentioned the borderline personality disorder. He stated that that diagnosis should never have been mentioned and was essentially saying she was untreatable. I have read from several posts here and several other sources the symptoms and definition of borderline personality disorder. I honestly do not see how it fits my daughter. I see how she is when experiencing psychosis. It is not "faked". She is clearly disconnected, disorganized, hallucinating and extremely delusional. She also has periods that I describe as manic like. She goes for long periods, 24 to 48 hours without sleeping, she is more energetic, talks rapidly and is giddy like, giggling and laughing almost constantly. But, oddly enough, she can also become quite clear for short periods of time, carry on a conversation with us or others, be pretty much reality oriented and then shortly after fully psychotic again. It is enormously frustrating. So I can understand why her psychiatrist does not always understand why we feel her condition is so severe. She often presents clear headed in front of the doctor or at least semi clear. The psychiatrist has also stated that her affect does not match her words and for appearing as severely psychotic as she does, she engages, makes eye contact and does not exhibit any fearfulness. She stated to me that a patient this severely psychotic would be afraid. My daughter is at times very fearful and paranoid but then at other times she appears happy.
I realize this somewhat rambles but I am trying to present a picture of how my daughter is much of the time. She knows who we are and will respond to us appropriately but has also questioned me on 3 or 4 ocassions as to who I was or accused me of being someone else. She has left the house in the middle of the night resulting in us putting alarms on the doors. She does not have a driver's license and has taken the car and just left. We now have to keep the car keys hidden. We also of course keep all medications out of her reach. We have even hidden the knives. She admits to hearing voices "all of the time" but most of the time these voices are the voices of people she knows. Therefore she believes she is talking to them in her mind and that all of us can do the same. She becomes angry with my husband and I when we tell her no we can not talk to other people in our heads. She accuses of lying stating she knows everyone can do it. Many of her delusions focus on rape, that she is being raped or someone she knows is being raped. She has told me that she actually feels the sensation of being raped. I do believe she has had visual hallucinations as well but they are not as frequent. She can have grandiose delusions at times believing she is a writer, a rapper, or a producer. She has also told me at times of reality based thinking that she thought she was going to school and had a job the past few months. She does exhibit symptoms of personal care neglect. She has poor social skills at times but at others can be very sociable and function normally with others. I've read and reread medical literature from multiple sources regarding all of the above diagnosis. I honestly do not care what "it" is. I just want to know the best way to treat her. So, my questions center around this. 1. How does borderline personality disorder fit into this? I mean, I don't see it and I don't understand why her doctor does. 2. I can see her fitting more into a schizoaffective bipolar type diagnosis. Her doctor once told me as did some of my research, that antidepressants are not a good choice with bipolar disorder. She has been on Zoloft for approx 2 years now with increases. She is also now on Trazodone. I am concerned that if she does have bipolar tendencies that neither of these medications may be helping her. I am especially concerned now that she is using the Abilify and that the Abilify could be enhancing their effects. Her doctor did decreased the Zoloft back down to 100mg upon increasing the Abilify but she did increase the Trazodone. The Trazodone is for sleep so she ordered it by 50mg increments. She said to use it up to 300mg to help her sleep. If she sleeps through the night and wakes up without feeling groggy then that is the appropriate dose for her. But, the problem is, her sleep pattern right now is so disjointed I don't know if I should even give her the Trazodone. I would really appreciate some insight and thoughts.
She saw her home psychiatrist within a week of discharge. Her psychiatrist increased the Abilify to 30mg daily but there has been little response. We never received a discharge diagnosis, all the diagnosis were on admission and considered rule out. They included schizophrenia, schizoaffective, bipolar, and episodic mood disorder. Her psychologist while home has firmly stated that he feels she is schizophrenic. Her psychiatrist does not. She has tossed around bipolar disorder but also borderline personality disorder. She has expressed the opinion that some of my daughter's symptoms are exaggerated. She stated to me, and I do agree with her, that she finds it hard to believe the state hospital would discharge her in this condition and on only 10mg of Abilify with this severity of psychosis. She had stated to me, prior to her hospitalization in the state hospital, that there was no way my daughter could have continued to experience psychosis while taking 8mg of Risperdal daily and not experience any serious side effects. If you don't consider an almost 100 pound weight gain a serious side effect. She insists that my daughter was not taking her medications. My husband and I give them to her daily and make sure she swallows them. We believe she was taking them, if she were not then she was very adept at hiding it. The condition she has been in mentally for the past several months make it very difficult to believe she could have managed that.
Her psychiatrist and psychologist are both with the same agency. The psychologist has become very upset with her psychiatrist because she does not seem to recognize the psychosis. He was also very upset when she mentioned the borderline personality disorder. He stated that that diagnosis should never have been mentioned and was essentially saying she was untreatable. I have read from several posts here and several other sources the symptoms and definition of borderline personality disorder. I honestly do not see how it fits my daughter. I see how she is when experiencing psychosis. It is not "faked". She is clearly disconnected, disorganized, hallucinating and extremely delusional. She also has periods that I describe as manic like. She goes for long periods, 24 to 48 hours without sleeping, she is more energetic, talks rapidly and is giddy like, giggling and laughing almost constantly. But, oddly enough, she can also become quite clear for short periods of time, carry on a conversation with us or others, be pretty much reality oriented and then shortly after fully psychotic again. It is enormously frustrating. So I can understand why her psychiatrist does not always understand why we feel her condition is so severe. She often presents clear headed in front of the doctor or at least semi clear. The psychiatrist has also stated that her affect does not match her words and for appearing as severely psychotic as she does, she engages, makes eye contact and does not exhibit any fearfulness. She stated to me that a patient this severely psychotic would be afraid. My daughter is at times very fearful and paranoid but then at other times she appears happy.
I realize this somewhat rambles but I am trying to present a picture of how my daughter is much of the time. She knows who we are and will respond to us appropriately but has also questioned me on 3 or 4 ocassions as to who I was or accused me of being someone else. She has left the house in the middle of the night resulting in us putting alarms on the doors. She does not have a driver's license and has taken the car and just left. We now have to keep the car keys hidden. We also of course keep all medications out of her reach. We have even hidden the knives. She admits to hearing voices "all of the time" but most of the time these voices are the voices of people she knows. Therefore she believes she is talking to them in her mind and that all of us can do the same. She becomes angry with my husband and I when we tell her no we can not talk to other people in our heads. She accuses of lying stating she knows everyone can do it. Many of her delusions focus on rape, that she is being raped or someone she knows is being raped. She has told me that she actually feels the sensation of being raped. I do believe she has had visual hallucinations as well but they are not as frequent. She can have grandiose delusions at times believing she is a writer, a rapper, or a producer. She has also told me at times of reality based thinking that she thought she was going to school and had a job the past few months. She does exhibit symptoms of personal care neglect. She has poor social skills at times but at others can be very sociable and function normally with others. I've read and reread medical literature from multiple sources regarding all of the above diagnosis. I honestly do not care what "it" is. I just want to know the best way to treat her. So, my questions center around this. 1. How does borderline personality disorder fit into this? I mean, I don't see it and I don't understand why her doctor does. 2. I can see her fitting more into a schizoaffective bipolar type diagnosis. Her doctor once told me as did some of my research, that antidepressants are not a good choice with bipolar disorder. She has been on Zoloft for approx 2 years now with increases. She is also now on Trazodone. I am concerned that if she does have bipolar tendencies that neither of these medications may be helping her. I am especially concerned now that she is using the Abilify and that the Abilify could be enhancing their effects. Her doctor did decreased the Zoloft back down to 100mg upon increasing the Abilify but she did increase the Trazodone. The Trazodone is for sleep so she ordered it by 50mg increments. She said to use it up to 300mg to help her sleep. If she sleeps through the night and wakes up without feeling groggy then that is the appropriate dose for her. But, the problem is, her sleep pattern right now is so disjointed I don't know if I should even give her the Trazodone. I would really appreciate some insight and thoughts.
