Bipolar Father in law

[vaggabonda]

Hello,

My husband's father is a 70 year old man that has been diagnosed with bipolar disease 5 years ago.  My husband and I live in Canada, but his family are all in Italy.  His father is taking 450mg of lithium carbonate daily, and is a very large (overweight) man.  He has recently been in a manic period of extreme energy, productivity (he tries), and has been extremely abusive verbally to his wife and daughters at home.  He is constantly angry and has been recounting to anyone who will listen to him how unhapppy he is with his life, including his wife and all he has done in the past.  He is nagging about people who are dead and what they did to bother him.  He is also keeping a journal writing his life story.  He has told a close family friend that he "doesn't have much time left".  He is out all day so we are not sure that he takes his medicine in th pm.  He will not go to see doctor, and we think he may be suicidal....what to do?

[Rendy]

I'll bet the Lithium is low, but only a blood test will tell for sure.  That alone may help with the aggression.  It's possible that an anti-psychotic might be in order to calm the situation down.  There are many out there with varying degrees of side effects.  In general, they sedate and calm and work pretty much immediately.  It would be important that he not drive - if he does, at least until he got a good feel of how he reacts to them.  For years I took both Lithium and an anti-psychotic as on just Lithium alone, my mood was too unstable.  

What is the mental health hospital system like in Italy?  Is it something the family would feel comfortable with?  

I have been hospitalized, once in the state hospital - and trust me, that was a terrifying experience, and another time in a private hospital, which was very beneficial.  

So, to me, it depends a lot on the situation, both with him and with the care over there.  

A good hospital can be a great thing.  Lots of caring people with therapy and getting the medications straightened out in a safe place.  

When manic....it's hard to see in yourself.  You blame everyone around you.  It's you, and you, and YOU!  NOT me!  Depression, you know when you're there.  So, if he's wildly manic and fighting everything and everyone, and they are able to get him stabilized, then he may be calmer and more willing to take his meds as prescribed.  

I agree, an ambulance with someone injecting him and hauling him away would be a last resort, but if the situation is truly bad...as in life threatening, then sometimes there is no choice.  I hope for your family's sake that it doesn't come to that.  

I just reread what you posted about seeing his son as the enemy who put him on meds in the first place...that might be some paranoia, which can go with mania.  Another reason why an anti-psychotic might be a good idea.  

It's all about finding a balance.  What I hate about it all is that doctors sometimes overmedicate, leaving the patient an obedient, shuffeling, drooling zombie.  You're still supposed to feel - that is normal.  The whole point is to make someone functionable.  So watch for that.  It's the saddest thing to see someone medicated to that point.  

Wishing you all the best.
Rendy

[vaggabonda]

Thank-you so much for your reply.  It is nice to hear advice through someone else's experience.  He is diabetic, and overweight.  He feels like we are all against him, and no one  can convince him to go back to the doctors.  His wife and daughters went to see his mental health specialist who thinks his lithium needs to be increased, 450mg a day sounds awfully low from what I have read.  They are actually debating on giving it to him without him knowing.  Is there another drug that you know of that could calm the agression in him more immediately?  I know that his blood is checked regularily and the lithium has not been toxic.  

We can call the ambulance and have him injected and carried away for a medical evaluation in a hospital, but we are all feeling very guilty and want that to be a last resort.  My husband is on stanby and leaving for Italy to try and get his father to accompany him to see the doctor again, he sees his son as the enemy who put him on the meds in the first place.  

My compassion runs high, for the family who suffers from his behaviour, and the ill who can't help it.  Thanks again.

[Rendy]

What you describe may be more of a mixed episode.  He has the manic energy and the depressive thinking rolled into one.  I have always described it like this when it comes to mania....you can have a "White High" which is mostly euphoric...all that manic energy, but it feels mostly good - even that, if left long enough, will turn bad though.  You can't go like that forever.  And then there is a "Black High", being unable to sleep or sit still, may have pressured speech but also has a lot of anger, agitation and depressive thinking.  Mixed States are particularly dangerous because manic impulsivity can be present with those dark thoughts.  

You said that he's in Italy.  I have no idea how things are handled over there.  Is there some family member who could contact his doctor?  He might need a med adjustment, or to have his Lithium levels checked to see if they are in theraputic range.  If those levels are below that theraputic window, it's not doing any good at all.  Sometimes in a particularly bad mood state, another medication can be added to help calm all that agitation.  If things are to the point where you feel he may need to be hospitalized for his own protection, try to find out what the laws in Italy are for such things.

We had a friend here once (in Texas) who got into a very bad state...suicidally depressed, hallucinating....and we called the police.  They came and were very knowledgeable, and very gentle with him.  They sat him down, kept him calm, and called in the county mental health crisis team.  They talked to him for several hours, finally convincing him that he should go to the hospital.  He was convinced that he had cancer and that he was dying.  He was 23.  He insisted on going to the regular hospital first, to check out the cancer...and they did that for him, of course, he did not have cancer...so then he agreed to go on to the mental hospital.  When he came out, he was a different person.

He is 70 years old, does he have any other illnesses?  How is his physical health?

With his age, it makes me wonder if he feels something.  I've known people who are ill and have a sense that it is the end, they speak about it.  It wasn't long after that they did pass away.  

I would say that he should be completely checked out, both physically and mentally.  

I wish you the best of luck in getting treatment for him.
Please keep us posted.
Rendy