Bizarre behaviour and personality changes

  1. Suppose you have a friend or family member who you've known for years; female, a RN (BSN) who has been an RN for many years and is presently in a great supervisory job. Many stressors have been in your friends life over the past few years: a child with special needs and leukemia, another child with ADHD, divorce recently, financial troubles, graduate school (!)

    Over the last few months you have noticed some rather bizarre behaviour that makes you wonder (because of your own nursing background) if your friend or family member is experiencing signs of bipolar disorder, similar to some of the stories Patty Duke described in her book about her personal experiences with the disorder. Or substance abuse. Or some other mental illness. You may get a strange phone call in the middle of the night and your friend or family member is paranoid and irrational. You get emails with thoughts that just aren't connected. She spends several thousand dollars on "stuff" she really doesn't need with money she doesn't really have (credit cards).

    If a person has no insight into the fact that their behaviour is a little bizarre and they are not really rational, how does someone get evaluated for a disorder? Does something bad have to happen in order to get help?

    If any of you have had to deal with similar situations I'd love to find out how you handled it.
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  2. 10 Comments

  3. by   smallrice
    in fact,most of psychotic patients have no insight for thier sick. they don't recognise thier behaviour are bizarre such as crazy shopping, became hostile, high mood ... besides, they cannot understand why they must be treated by psycho..they would fight, refuse to take any drug...may be help them to see doctor
  4. by   bookwormom
    Ideally, you would share your concerns with this person, perhaps suggesting that her behaviors have concerned you, and that you are worried about her health. There is a possibility, too, of course, that her behavior may be related to some physical condition or medication reaction, and she may be receptive to seeking health care. Sometimes it's easier to seek help for a physical problem.

    If this is a friend, you can't do much else except be supportive to her and her family. If this is a family member, you can suggest (insist) that she see her health care provider, for whatever reason. (Talk to the provider in advance).

    In my experience, unless the behaviors are really dangerous, you can't force treatment. It is very hard to make someone voluntarily cooperate with treatment they don't want.

    If you think the person is truly dangerous or self destructive, in my state, there is a procedure for involuntary commitment, which would involve a visit to the county courthouse. (You could probably get this info from the state police). I have cared for many patients who were involuntarily committed. Usually the behaviors were outstandingly abnormal. You may fear the person will resent you committing them, but it's better than them hurting themselves or someone else, and once they receive treatment, they may understand where you were coming from.

    Good luck. I feel for you.
  5. by   suzyRN
    with all of those stressors in her life she may be experiencing some type of psychological issues- in fact she has to be. I would say that if it were me I would bring it up with the person and maybe suggest a therapist. as a biweekly therapist pt for 4 yrs I think that everyone could benefit by talking to a professional. I also think that if my children were ill I would need some extra help. As nurses I think that too many of us neglect ourselves and get trapped into only caring for our pt's and families. Do something nice for her- offer to babysit so she can get a pedicure or take a nap, bring her dinner, or maybe get a bunch of people to pitch in and get her a certificate for super suppers/dinners ready/etc. the little things count too-so just getting her a coffee could bring her spirits up. People under that muchstress can easily drown if someone doesn't toss them a life vest! I lost a brother after graduating high school and I nearly drowned in my grief and stress. Thank God for the angels on earth (friends)!
  6. by   jrussole
    I once had a friend who was bulemic. Most of our "group" of friends knew about it, yet never did anything about it. To this day, I sort of feel bad about 'ratting' her out to her family once she confided in me. She doesn't speak to me to this very day because of it. But she was vomiting blood. It was at a dangerous level and someone had to do something. She is alive and well today. She was forced to get treatment after I made that phone call to her mother. It may have cost me a friendship because of it. But there isn't a day that goes by that I don't feel that I saved her life because of making a difficult choice. Maybe oneday, she will realize how much I loved her. And then again, maybe not. I tried to tell her myself. But she was not hearing my concerns at the time. I was a friend to her. I loved her, still do. And atleast I know that I tried everything I could think of before calling her mother to help her. Someone had to do it. And I suppose it was me who had the courage and paid the price for it.
  7. by   Victoriakem
    Quote from jrussole
    I once had a friend who was bulemic. Most of our "group" of friends knew about it, yet never did anything about it. To this day, I sort of feel bad about 'ratting' her out to her family once she confided in me. She doesn't speak to me to this very day because of it. But she was vomiting blood. It was at a dangerous level and someone had to do something. She is alive and well today. She was forced to get treatment after I made that phone call to her mother. It may have cost me a friendship because of it. But there isn't a day that goes by that I don't feel that I saved her life because of making a difficult choice. Maybe oneday, she will realize how much I loved her. And then again, maybe not. I tried to tell her myself. But she was not hearing my concerns at the time. I was a friend to her. I loved her, still do. And atleast I know that I tried everything I could think of before calling her mother to help her. Someone had to do it. And I suppose it was me who had the courage and paid the price for it.
    That's what a true friend will do! Feel proud of yourself & maybe someday she will thank you. If not, you did the right thing. :Melody:
  8. by   jrussole
    Thanks Victoria. We were childhood friends. Grew up on the same street. It caused a rift between all of us. It has been 18 years since I had to make that difficult choice. And its around Christmastime that I think of her. She runs a health club now of all things. I can only wish that she too finds the courage to be a friend when a friend is in need. It is important to confront a friend when you may see something that you fear for them. Even at the risk of losing them, forever. She is alive today, maybe because I played a small part in helping her realize her disease and forcing the issue for treatment.
  9. by   Victoriakem
    I wonder if your friend is somehow thankful for what you did but just doesn't know how to say it.
  10. by   RedheadRN1958
    Update:
    I appreciate all the comments. I got a PM that suggested SSRI may enhance the bipolar disorder, and BINGO! She had recently started on Lexapro.
    Her children were removed from the home last week; the sheriff was at the house three times for domestic violence calls (Her trying to get the boyfriend to leave). Fortunately she went to the ER after I forced her to look at me and told her the Lexapro was bad. She went in for a bad headache but got an involuntary commitment. She's been upped a few more days but at least she's getting help (her working dx is bipolar disorder). Geez. I feel like a bad actor in a "B" movie.
    Again thanks for all your concern. It is nice to have someone to "type" to!
  11. by   lsyorke
    It is slowly coming out that ssri's in some people can cause "activation" of mania. This doesn't necessarily mean that they are "bipolar". It can be a direct side effect of the drug. This was a big topic of discussion at the latest FDA hearing on antidepressants.

    So the question to ask becomes, what was she put on Lexapro for? When did the behavior manifest itself in relation to starting the Lexapro? And probably the most important factor is cold turkey stopping of any ssri can exacerbate symptoms, prior to them being relieved.
  12. by   jetscreamer101
    Alot of times, with bipolar, a period of mild depression preceedes a manic episode. Get put on an antidepressant for the depression only hightens the manic episode.

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