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Old 02-22-2004, 06:05 PM   #1
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erehgall HB User
"acute Psychotic Break"

I'm looking for advice, please. My 30 yr old sister has been in counseling for a few years for what I thought was depression and anxiety. About 2 weeks ago she had a complete break from reality but luckily had the presence to call 2 close friends to her apartment that morning. She was admitted to a locked psychiatric unit for 6 days. During the first 3 days she was afraid to come out of her room and kept repeating the same sentences over and over. This was a complete shock to my parents, my sister's friends, and I. We received little information regarding her diagnosis as the hospital and my sister's psychologist, who she has been seeing for a few years, kept citing the HIPA law(health information privacy act?). I work in healthcare and understand the reasons for the privacy act, but what good does it do a mentally ill pt to keep her problems between her and her psychologist or psychiatrist?
She is now going to outpatient therapy but we are left to deal with her labile emotional state and unbelievable financial responsibilities. (She had been unemployed for the past 7 months and hadn't been paying bills).
I had no idea my sister was struggling with her thoughts so much until I had access to her apartment and found it in such disarray, and found pages and pages of her writing about uncontrollable thoughts etc...
Her diagnosis at the hospital was an "acute psychotic break," but we have no further information. When I asked her caseworker at the hospital for more information regarding my sister's mental health, her response was something like, "we don't like to put labels on people. She's your sister...". That is true, but don't I need to know if my sister is Bipolar, or possibly schizophrenic?! We are very close and now in hindsight I realize I've been overlooking problems with her behavior for a few years now (financial irresponsibility, inability to follow through with committments etc....). At the hospital no one asked me for information on her background or behavior.
Has anyone else been through a similar situation? I need advice but I'm not ready to tell my close friends about this yet.
Thanks!

Last edited by erehgall; 03-19-2006 at 06:54 AM. Reason: Change title, please

 
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Old 02-22-2004, 10:39 PM   #2
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Re: My sister had an "Acute Psychotic Break"

Does your sister hear and/or see things that are not there? If her psychotic break down does include those types of symtoms she may have a form of schizophrenia. I have not experienced your situation personally but i do believe that you have every right to know if your sister is mentally ill and what type of illness it may be. Ive never heard of the Hipa contract but if your sister is willing to share her personal information with a loved one and she can sign on that, I do not see any reason why you should be left in the dark.

Therapy is absolutely a great start but ive never heard of anyone battling schizophrenia, psychosis or manic-depression without the use of medications and there are tons of effective ones for these disorders available. If she were to become stabalized on a proper medication while in the hospital, she should be able to come home and have a consistant medication regumine as well as seeing a therapist and all the better if you can attend the sessions with your sister.

good luck to you, i hope everything works out just fine

Atmont1977

 
Old 02-26-2004, 11:44 PM   #3
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Re: My sister had an "Acute Psychotic Break"

Does she have a health care proxy in place or set up? If not talk to her about one so you can be involved in her care. If she worked she may qualify for disability. I hope she is doing better.

 
Old 03-05-2004, 04:17 PM   #4
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Re: My sister had an "Acute Psychotic Break"

Quote:
Originally Posted by erehgall
I'm looking for advice, please. My 33 yr old sister has been in counseling for a few years for what I thought was depression and anxiety. About 2 weeks ago she had a complete break from reality but luckily had the presence to call 2 close friends to her apartment that morning. She was admitted to a locked psychiatric unit for 6 days, 3 of which she was afraid to come out of her room and kept repeating the same sentences over and over. This was a complete shock to my parents, my sister's friends, and I. We received little information regarding her diagnosis as the Hospital and my sister's psychologist, who she has been seeing for a few years, kept citing the HIPA laws. I'm a nurse and understand the reasons for the privacy act, but what good does it do a mentally ill pt to keep her problems between her and her psychologist?
She is now going to outpatient therapy but we are left to deal with her labile emotional state and unbelievable financial responsibilities. (She had been unemployed for the past 7 months and hadn't been paying bills).
I had no idea my sister was struggling with her thoughts so much until I had access to her apartment and found it in such disarray, and found pages and pages of her writing about uncontrollable thoughts etc...
Her diagnosis at the hospital was an "acute psychotic break," but we have no further information. When I asked her caseworker at the hospital for more information regarding my sister's mental health, her response was something like, "we don't like to put labels on people. She's your sister...". That is true, but don't I need to know if my sister is Bipolar, or possibly schizophrenic?! We are very close and now in hindsight I realize I've been overlooking problems with her behavior for a few years now (financial irresponsibility, inability to follow through with committments etc....). At the hospital no one asked me for information on her background or behavior.
Has anyone else been through a similar situation? I need advice but I'm not ready to tell my close friends about this yet.
Thanks!
Well who will they come to to pay her bills? Especially her hospital bills. Also what happens if she winds up being dependent on her family during this? Family who have to be relied upon at discharge will have to be included in the after care plans, and the treatment plans, if they are to be of any help. and then you will absolutely need to know what is going on labels or not. What if she decides she doesn't want to take meds, (which a lot of mentally ill people don't like their meds) doesn't want to follow Dr's orders. There can be a whole spectrum of issues that will need to be dealt with, and the family need to be informed. I can't imagine they would not be forthcoming with you even with privacy laws.
You should also attempt to see about ( or get her to) SSI disability for her because if she cannot pay her bills or work she should qualify for mental reasons. It might be hard to get started, but once she is on it they will pay her medical, and a monthly check. You contact social security for that. Plus if she qualifies they will give her back pay from the time she files to the start date, (that is important becaue it takes time to get it started) and that would help with bills.
My son was in that predicament when he was grown because our insurance did not cover him after he grew up and moved out. So he got on SSI, which paid for his medical and a monthly check since he couldn't work. He finally got a label--bipolar. Later he got another label--schizophrenia. He has struggled with this all his life, he is now 30. There is no "cure" for either disorder. A grown person is harder to deal with than a child, because while they have their rights, we also have responsibilities to them. Of course you cannot force a person to get treatment, but a court can. We never had to go that route with my son. There are a couple of movies about schizophrenia, one stars Diana Ross another is about Margot Kidder (from superman movie) don';t know the names but you can look them up online.Also there is one about bipolar with Richard Gere--I think (Mr.Jones) Try to rent and see if that seems like your sister. These are very compelling movies. They let you see what it is like to live with mental illness.The best thing you can do is be there for her even if she seems like she doesn't want you to. Schizophrenics usually have trust issues. This is not your fault, it is just a part of the illness. I would check out the credentials etc of the mental health people she is dealing with, because if she had that bad of a break, a few days in the hospital and outpatient therapy doesn't seem to be a major response. Who is going to make sure she doesn't have that happen again? What are the plans for if it does?
Good luck

 
Old 05-12-2005, 11:57 AM   #5
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erehgall HB User
Re: Recovery from a Psychotic break

Thank you to everyone who responded to my original post--your comments & suggestions were very helpful. My sister is doing much better but there are still many concerns. So far we don't know if her doctor has diagnosed her with a mental illness other than depression, but it seems that there must be a more serious diagnosis as she is still taking 5mg of Zyprexa at bedtime, & Ativan if needed. Does anyone have any thoughts on the use of Zyprexa for over a year? What does that mean from a mental health standpoint? She has started exercising regularly and socializes with our friends, but she is very cautious about sharing more than polite conversation. She seems to need to think everything through before sharing, even in a casual setting. Her feelings about the "psychotic break" are that it was related to stress caused by her unemployment(she works in IT). She had been having trouble sleeping that week and believes that is why she became so irrational/psychotic that morning. She was brought kicking & screaming into a Chicago ER though & required leather restraints & Haldol to calm her down. That doesn't happen from sleep deprivation alone. She has been working for 11 months but I still worry. She hasn't signed any consents to have any family members or friends involved in her outpt therapy. I find it extremely concerning that her doctor doesn't insist on meeting someone(family or friend) who is part of my sister's support system.
On one good note, the government does have a program that helps people when they are having a mental health crisis. 5 of her 6 hospital days were paid for under a mental health act.
I would appreciate any feedback you may have.

Thanks!

Last edited by erehgall; 05-12-2005 at 12:25 PM.

 
Old 05-13-2005, 12:18 PM   #6
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bbybyrd HB User
Re: Recovery from a Psychotic break

Quote:
Originally Posted by erehgall
Thank you to everyone who responded to my original post--your comments & suggestions were very helpful. My sister is doing much better but there are still many concerns. So far we don't know if her doctor has diagnosed her with a mental illness other than depression, but it seems that there must be a more serious diagnosis as she is still taking 5mg of Zyprexa at bedtime, & Ativan if needed. Does anyone have any thoughts on the use of Zyprexa for over a year? What does that mean from a mental health standpoint?
I've been diagnosed with major depression with psychotic features (along with many other things) so just because she had a psychotic episode doesn't mean that she's schizophrenic. Zyprexa is an antipsychotic. I was on it when I first had my breakdown and it did nothing for me. A lot of people said that it made them gain weight but it actually had the opposite effect for me. Long-term use of Zyprexa can cause diabetes so you may want to encourage her to get regular physicals as well.

Quote:
She hasn't signed any consents to have any family members or friends involved in her outpt therapy. I find it extremely concerning that her doctor doesn't insist on meeting someone(family or friend) who is part of my sister's support system.
Is she seeing a regular family doctor, psychiatrist, or therapist? If she's seeing a therapist then, and I can only state from personal experience, they usually ask the patient if they'd like to have a family session. I know I've had two...one when I first got depressed and was in the hospital and another one when I started individual therapy outside of the hospital. I'm not sure if there's a certain number of sessions a therapist wants to have with a patient before they go down that road or not. You may want to talk to your sister about that. You also might just want to sit down and talk to your sister about the consent forms also. I know, only my sister can get my psychiatric information from my therapist and pdoc. I did that for security reasons because I totally trust her, we live together, and I know she wouldn't let anything happen to me that I wouldn't want (like being sent to a particular hospital that I refuse to go back to, or ECT and things like that).

 
Old 05-15-2005, 08:32 AM   #7
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Re: My sister had an "Acute Psychotic Break"

The Health Insurance Portability and Accountability Act of 1996. (HIPAA) is the legal reason that her doctors CANNOT speak to you about her condition without her consent.

Yes, I agree that there are major differences between mental and physical disorders (people used to be in hospitals that are now roaming parks & living in homeless shelters) but we don't want the mentally ill treated differently in other areas (i.e. insurance ) and so here we are....

She should be encouraged by her parents or you to have someone added to people who can get information - suggest that she may prefer you having input rather than just the psych ward if she is ever admitted again.

But the truth is that as it stands, if she is of legal age then her medical information is hers and hers alone to share...

 
Old 05-16-2005, 02:16 PM   #8
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Re: My sister had an "Acute Psychotic Break"

Hi Im a mental health nurse working in scotland so some of the legislation involved in your sisters case confuses me. I work in an acute admission ward and your sisters admission would appear to have been valid I dont know the full details and would be reluctant to make a diagnosis purely because i have never met her but the details do suggest a schizo_affective disorder with negative symptoms. olanzapine at 5mg which is an atypical antipsychotic would appear to be a reasonable maintainance dosage for long term maintanance of such a disorder one of the things about olanzapine is that it is indicative of weight increase therefore your sisters interest in excercise may be at the advise of her consultant. The best thing that anybody can recieve in your sisters position is social support including the reminder of the need for compliance with her medication. My own particular specialism is psychopharmacology and I would be happy to give any futher advice in this field
also as a scot I would obviously require huge amounts of money for any futher wisdom required (just in case you dont know about the scottish race this a joke)
I really hope I can be of futher assistance
yours colin

 
Old 10-10-2005, 08:33 PM   #9
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"Acute Psychotic Break"

Update----September 2005.
I need advice again. My sister has had another "episode," not as intense as the last one, but she became paranoid at work, & thought that someof her coworkers were talking about her and trying to stress her out so she would quit??? She ended up requesting a medical leave through HR before she had another breakdown, thank God. I haven't been involved in this recent crisis(unfortunately my parents have been taking her to outpt therapy--they shouldn't be worrying about these things at their ages), but I have been there along the way watching it emerge. She was on zyprexa and apparently weaned herself off a few weeks before this recent incident occurred. She has also been on a benzo at night which she has been trying to wean off because she doesn't want to be on any medicine, even though she NEEDS medication in order to function! The weekend before she had this recent breakdown, she started crying suddenly when we were at a festival because she couldn't count the coins in her hand for the bus fare(couldn't concentrate). I went to her apartment (which I hadn't been in for over a year) & it looked like she was either moving in or moving out. Still no pictures on the walls, unmade bed, messy bathroom, papers everywhere.....I just don't know what to do. She won't let me talk to her counselor/psychologist so I don't know if this is bipolar or a form of schizophrenia. It is so frustrating because as her sister, I have to deal with her unpredicatable moods, financial instability, etc.....but I don't have the right to really know what's going on. I'm sure her psychologist has a whole file on me(the nagging sister who has caused all of her problems). At this point I don't really trust her medical care. She has been seeing the same counselor/psychologist for about 6years and I really don't see that things are better.
Please offer your thoughts & advice on this situation. Doesn't it sound inappropriate to instruct a pt. to use Zyprexa AS NEEDED when she can't sleep or has problems with her thought. I'm at the point where I feel like I should just move away & get on with MY life, because mental health care & follow-up is so stressful & unsupportive of the family & friends who actually deal with the patients outside the psychologist's office. The doctor & psychologist are indifferent to our concerns and haven't taken ANY time out to explain the situation & what we can do to help. We live in Chicago & you'd think the care would be better here since we're such an "academic city." I hate to think what it's like in small towns in America......

Last edited by erehgall; 10-10-2005 at 09:03 PM.

 
Old 10-10-2005, 08:47 PM   #10
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Re: My sister had an "Acute Psychotic Break"

erehgall-First let me say how sorry I am for your sister, you and your family for what you're going thru. I don't know about the medication aspect of it, but I think your sister can get a power of attorney for health care, so you (or whoever she designates) could make decisions for her when she is incapacitated. Maybe you can talk to her about it. Let her know you will only act in her best interest, so it may give her some security for her. Also tell her you need access to her records to be able to help her. The one thing I think you should re-think is paying her bills. She is responsible for them, and maybe you could help her make some arrangements for consolidation or something. They are not your responsibility, and if her credit is bad anyway, at this point it doesn't matter (not sure if it is). I'm not being selfish when I say this, but I wouldn't pay anything that isn't in your name, and I also wouldn't put any bills of hers in your name. If you bail her out, you will continue to do so forever. I'm sorry if I sound harsh, I want you to look out for yourself!

 
Old 10-11-2005, 08:34 AM   #11
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Re: My sister had an "Acute Psychotic Break"

It does not really matter whether they label your sister's illness as bipolar or schizophrenia because from what you said the aspect that is disrupting her life is the psychosis, which is always a symptoms of schiz. and sometimes of bipolar. Did she gain weight on the Zyprexa? Was she sleepy all the time? Maybe that was why she wanted to stop taking it. 5 mg is a low dose, but if she was doing well on 5 mg maybe she could take a lower dose and still avoid her symptoms with less side effects. I have noticed with my son that the Zyprexa could be lowered to 2.5 mg and still keep his symptoms under control once they were under control and maybe even less would have worked. I have never heard of prescribing Zyprexa as needed for sleep or uncontrolable thoughts, but I think it would work pretty well that way for some people, if the person would take it at the first sign of trouble. Zyprexa has a long half life (20 hours) and some people may not really need to take it every day. Each person is different.

One really great thing about Zyprexa is that it works quickly for the people that it works for. The first time my son took it it took 3 days to get rid of the voices at 10 mg a day. Then he switched meds because of the weight gain, but at a later time I had to give it again because he had stopped taking his Abilify and was hearing voices and the situation was frightening, we were afraid he might become violent so I gave him 20mg right off the bat and then he was able to get to sleep and in the morning he was calm and no longer hearing the voices and over a period of 5 days I was able to lower the dose down to 2.5 mg without a return of symptoms and that way he did not have the increased appetite side effect.

I hope this information about Zyprexa is helpful to you in some way. It is much better if a person with a problem like this is living with people who can help to evaluate their symptoms because often they are not able to make an accurate evaluation themselves. Our son is only 18 and lives with us, so that makes it easier because we know how he is doing every day.

Last edited by Kime; 10-11-2005 at 08:43 AM. Reason: adding detail

 
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Old 10-11-2005, 09:19 PM   #12
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Re: My sister had an "Acute Psychotic Break"

You have to be careful with psychosis. I have major depression with psychotic features and if I come off my psych meds (which I have) I can have another psychotic episode and from what my previous therapist told me the longer I'm off the medication the worse it's going to get. I was taking seroquel and risperdal because I have extreme paranoia, hallucinate, hear voices, agitation (which is usually my biggest sign that I'm becoming psychotic). I took zyprexa before and it didn't do anything for me but make me lose weight and put me to sleep. If she doesn't seem to be getting any better then it's probably time to change pdocs/therapists. I hope she gets the help she needs.

 
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