I need some help please

Specialties Psychiatric

Published

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

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??????

Specializes in MS Home Health.

I think he needs a complete work up. I am sorry he is going through this. It sounds scarey and I would not want to be alone with him.

Good luck and let us know how he does? Did he start any new meds or something?

renerian

Specializes in Critical Care.

Good luck. I hope he gets the help he needs.

Noney

CardioTrans- No reliable practitioner will give you a diagnosis without seeing the patient, but what you're describing sounds like an unspecified psychotic disorder. If your brother-in law has insurance, he should find out which psychiatrists are on the panel and have him seen ASAP. If he has to go to the ER again, ask for the psychiatrist on call to evaluate. If the voices continue to tell him to "pull the trigger", ask if the voice is familiar. People are more likely to obey a familiar voice than that of "God" or "Satan". Also, does he have any violent history? Past violence is the best predictor of future violence (to others or self). If your city has a crisis hotline, call and get advise. If you believe he is in imminent danger to himself or others, call 911. It might not be a bad idea for you, your husband and his wife to sit down and come up with some sort of contingency plan for the times when he gets this way. Best of luck and keep us posted!!!

Hopefully a complete work-up will clear up the situation. Right now he is in a safe place and that's the best thing for him. I hope everything works out for him. Talk with your family members and try to see if there were odd things going on before this. You may find a longer history than you think.

luci

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

Thanks everyone for the replies, I have been talking to his wife and she said that it was like it came on all of a sudden. Started Sunday....... and at first he was having problems with his short term memory.......and slurring his words....... ok Im thinkin stroke or something like that....... kept progressing from there...... the security guards had to help get him in the hosp yesterday....... the only way we could get him to agree to CT was tell him we had to take his picture..... that he did....... took 2 injections of Ativan to get him to agree to blood being drawn..... it was awful. He can only be seen M-F from 6-730p...... and sat and sun 4-730p....... my husband is there now and is going to let me know when he gets home what all was done today test wise and how he did during the day today.........He has never had any violent behaviors before of any kind....... My hats off to all of you who work with patients like this on a daily basis..... If I cant see it, feel it or touch it, Im lost.......... guess I should have paid more attn in nursing school...... but psych didnt interest me........ as close as I get to psych dx is dementia.......and what he was exhibiting last night was far from anything I have ever experienced.

Again, thanks for all the replies, and I will keep you informed.

Please do keep us informed and maybe we can help with some information once a diagnosis has been made. Again, hoping for the best for you and your family.

luci

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

ok, we have a dx............ Bipolar disorder with psychotic features and HMP. He is taking Risperdal, Depakote, Ativan and Geodon...........Found out this afternoon that last night he was doing good, knew who he was and everyone around him, back to normal....... last night around midnight, had a episode where he thought he was someone else, became very agitated etc. I know that it will take time for the meds to level out in his system, but how long could he be in the hosp?? I know that it varies from person to person, but a guesstimate? Also, I have no clue what HMP is...... i can guess at what it stands for, maybe hallucinations with mult personalities??????? or am I way off base?

Specializes in MS Home Health.

Wow that is not my area of expertise but you are going to have your hands full. I am glad they found out what is wrong.

Hugs, renerian

HMP or HME? I think HME would be hypomanic episode although we don't use that acronym. As for length of stay, our patients with newly diagnosed bipolar disorder generally stay at least 10 days, 2+ weeks is more normal, because it usually takes some playing around with their meds (these are kids and adolescents) to get them stable. Patients with bipolar disorder are at a high risk for suicide so staying in the hospital until he's stable is probably a good idea (although as other people have posted, patients manage to commit suicide while hospitalized anyway).

good luck to you all

luci

Very interesting case!!!

That whole ordeal must of been very frightening!!!!

I'm gald to here they have found the problem and that he's getting back to normal.

Will Benson: thanks for the insight!! We have a few Psych. Patients where I work and your insight will help me to understand them more>

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

They let him come home last night, but not to be left alone, and he has to go back Monday for the classes. I talked to him last night and he still doesnt sound like "himself". He came home on the depakote 250mg tid and risperdal 2mg tid........a wk worth of med was $170. Amazing how much meds cost for any illness. My husband is on his way up there right now and Im looking for a med assistance program to help them pay for his meds. Unfortunately he is not on his wifes insurance at work and he doesnt have any. The social worker at the hosp said that if this begins to interfere with him being able to work that they may be able to get him on some type of disability, but they cant start the paperwork until something else happens to show he isnt able to work. So they are pretty much on their own with the costs. We are all pitching in helping them with bills and meds until then....... I'll keep ya posted. Thanks for everyones help, you dont know how much I appreciate being able to have some people to go to. Guess thats why Im addicted to this board!

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