I need some help please

Specialties Psychiatric

Published

I have a question, or lots of questions actually. I have a family member that over the last few days has not been himself. Sunday he woke his wife up crying and telling her that he was sorry for everything that he had done wrong, yesterday he calls my husband (his brother) and is telling him that he wishes that their parents could get back together so they could be a family again (their parents have been divorced for over 30 yrs). Yesterday he walked off his job and doesnt remember doing it or how he got home. He has trouble remembering things that have happened in the last 24-48 hrs. Starts conversations and forgets what he is saying or tryin to say. He has never done drugs, drank alchohol, or even smoked a cigarette in his life. He is 43 yrs old. Today he thought he was a character on a soap opera, then he thought he was an attorney in the city he lives in, didnt want his wife talking on the phone to her sister, and kept saying all he needed to do was talk to my husband alone. They took him to the ER, CT was neg, labs and UA neg. He recognized me, my husband and his wife, but when asked who is mother was by name he said he didnt know. They admitted him tonight to lock down psych unit to run tests, as he was signing papers and answering questions, he would go back and forth knowing who he was and where he was to believing he was someone else. He told the nurse that he was having auditory and visual hallucinations. The auditory hallucinations were telling him to "pull the trigger" but when asked if they were telling him to hurt himself or someone else he said no. He kept saying that he was in this soap opera. The ER physician kept saying maybe bipolar/manic/depressive vs seizures.... said they were going to run EEG to check for seizures. He has never done things like this before and I am wondering if someone could shed a light for me of things that may have triggered this. I am a nurse but psych is not by any means my strong suit. He also told my husband and his wife when they first got to the ER that "we cant go through those doors, if we do we will die" I honestly dont have a clue...........can anyone give me any ideas or advice??????

CardioTrans -

Glad to hear he's back home. I hope he truly returns to his normal self before long. There are several things that are important to know now that he's home. Depakote and lithium are the first line drugs for treatment of bipolar disorder. Depakote levels should be drawn monthly, at least. He will also need a hepatic panel / liver enzymes drawn every 3-6 months. Risperdal and Geodon are good atypical antipsychotics but you should be aware of a couple things. At higher doses, Risperdal can cause the same side effects (EPS, stiff neck, thick tongue, etc) as Haldol and Thorazine. Goedon can cause EKG changes, especially Q-T widening, indicating slow cardiac conduction. Periodic EKGs might not be a bad idea. See if his psychaitrist will have a family conference with at least his wife, if not with all of you. She will need support and guidance in how to deal with this. Maybe the doctor would even consider family therapy. This whole situation was a big shock to all of you and I'm sure your big fear is that it will happen again and you won't know what to do. Finally, I have never heard the term HMP. The term "hypomania" refers to the symptoms of the patient when he is outside the hospital. Once he is hospitalized, he is, by DSM IV definition "manic" and no longer "hypomanic". However I'll continue to research this. Maybe I'll have an answer for you soon. Good luck and keep us posted!

CardioTrans-

I'm guessing that HMP may stand for hypomanic psychosis, but I may be way off base. Do his discharge instructions have an ICD-9 billing number? It's a 5-digit number with a decimal after the 3rd digit (example - xxx.xx). Sometimes that number will give the numeric code for the diagnosis. Keep me posted.

Specializes in ICU/CCU/MICU/SICU/CTICU.

No ICD 9 code........ I had told his wife that he would need to have labs drawn to keep up with the depakote level, and that it would be metabolized by the liver so that they would probably do LFTs on him every so often...... she wrote everything down so that she could be sure and ask about everything........ she wants me to go with her to the MD next week in case she forgets something......will thanks for all your help... and i will keep you posted.

Risperdal Patient Assistance and Reimbursement Support Program

PO Box 222098

Charlotte NC 2822-2098

(800) 652-6227

This is a program through Jaansen Pharm

Call and request an appl. A real person answers the call.The form may be fax'd back once filled out. Both the pt and the physician must fiil out required areas and sign.

It is not unusual for a man in his late 20's to have a sudden onset of this disorder.(I'm guessing here) The good news is recovery happens! Wait on disabilty, would be my recommendation. HMP? Maybe this would refer to an Axis II dx but I dont know which one.

Glad he is getting the attention he needs and meds. It sounds like he was having a manic episode [d/t the psychotic symptoms] rather than a hypomanic epidose. In any event, it will be important that he receives regular follow up and remains med compliant, which seems to be a problem after stabilization. They often dont think they need meds anymore b/c their symptoms have remitted. Have a number of a psychiatric emergency team available or if symptoms return, bring him to the nearest emergency room ASAP. Dont try and take this on alone. My best to you. Keep us informed.

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