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DrRussMD
DrRussMD, Board Certified MD
Category: Medical
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Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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26 yr old Son has bipolar 1. Currently Manic and finaly admited

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26 yr old Son has bipolar 1. Currently
Manic and finaly admited to psychiatric unit after 6 weeks of trying to get help for him. He is deluded and frustrated being very intimidating and grandiouse. He is not responding to meds ( antipsychtics pluss benzodiazipines) This is second episode, last time late 2010. Followrd by prolonged period of deep depression. Worried that his prolonged manic state will negatively impact on long term prognosis. Is it time to consider ECT?
Hello from JA

I would need more information to appraise this.
First what is his psychiatrist saying?

Second has he ever been on lithium.
Customer: replied 4 years ago.

seeing him in the morning and want to go informed. he conducted review earlier today and increased olanzipine from 10 to 15 mg because symptoms deteriorating since admission last wednesday. commenced benzodiazepines but has been taking diazepam 4mg tds for a month whilst we tried to avoid admission. deeply concerned this has been going on sice med discharge from navy in 2010 following psychotic episode. took riaccutaine foe 3 months prior too for acne and think this triggered initial episode.

OK
So in fact he has not had a course of lithium
Customer: replied 4 years ago.

no he has been scared of taking it

OK
I see no indication for ECT here, which helps mainly in bipolar when depression and suicidal ideation predominant.

I do see that he is not compliant and that his medication trials have been very limited.

Does he have any substance abuse problems as well?
Customer: replied 4 years ago.

when manic uses cannabis

OK
What is actually indicated here is hospitalization until his mood is stabilized.
Not ECT.

There are very many drug choices.

His attitude about treatment is typical in quite a few bipolar patients, and will not change until effective medication is used.

The effects of lithium can be monitored, as can any of the other drug choices. He is probably going to ultimately object to any medication until he is lucid.

Does this make sense, and what have his doctors told you?

Let me know if you have more details.

Please let me know if you have further questions.
Please don’t forget a positive rating.
Customer: replied 4 years ago.

ok thanks. its just so heart breaking am on compasionate leave from my nhs snr management job. family in bits. just worried that has been ongoing for so long. back to wrk monday whilst he is safe in hospital but he has spent himself in to serious dept and his friends n family cant cope with him. husband on antideppressants...devastated... he is a retired DS n we have had police n OOH involved on numerous occassions. cant contemplate son home untill he complys with trestment. guess it happens all the time but just cant believe its gappening to us. thanks for advice

I understand this situation.
But do not give up hope here.
Insist they keep him until he is stable, that he also gets therapy....both together are for more effective than drugs alone.

Please let me know if you have further questions.
Please don’t forget a positive rating.
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