The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
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Requests for advice and / or encouragement. On basically any topic and for any scale of problem.
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Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.
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Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.
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Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).
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Notes -
First things first: "Secure the scene first," "at a cardiac arrest, the first procedure is to take your own pulse," "self-care bro."
However you frame it - this is going to be tough make sure you are getting support. Likely you did not do anything wrong. Try not to blame yourself. Try not to blame yourself for blaming yourself.
Caveats: I deliberately only skimmed so everything is general and pretend it's general if I didn't do a good job making it general (I am not your or her doctor and am not asking the questions required to provide specific or informed advice.
Second: These things are more common than you think and go in all kinds of directions. Be aware that catastrophic decline is on the table, but so is total remission and so is things like backbreaking medical causes. Try not to get locked into a particular hope or despair without more understanding, information, and crucially - time.
Third: You are going to get a lot of shitty medical and psychiatric advice. Your therapist may accidentally be right but already this doesn't seem like a true delusion (insufficiently fixed?) is inconsistent with borderline personality persistence and doesn't really exhibit evidence for bipolar. Could be prodrome however. Don't worry what any of that means that isn't your job. Could be you don't have the language to relay the behavior you are seeing (that's not your fault! You aren't a trained healthcare professional). Most of the geographic area of the country has poor access to psychiatric care (NPs/PAs have some uses in medicine but never in psychiatric care, I've never met a psychiatrist who was willing to privately say something good about an NP except those who were getting a significant financial benefit. With unusual patients they are significantly worse than useless), and while it's out there it is hard to find a FM/IM/ED doc who is sharp on psychiatry which is important because-
Four: In order to meet the criteria for a DSM diagnosis the symptoms have to not be better explained by a medical condition or substance use. Usually the work up for this is inadequate in most settings. The ED will usually get a head scan if the patient has a first episode of psychosis in atypical age range, but they don't always.... Other basic lab work like an RPR usually needs to be done, but they might not have done it. Someone who knows what autoimmune encephalitis is needs to think about it for three seconds. Realistically it isn't any of the rare stuff, but those things do happen. For drugs a UDS is grossly inadequate if she's doing anything weird, which she may be. Patient's get access to a benzo with the wrong metabolite, use some local herb, or buy some weird designer drug. Shit happens and in the case of something like caffeine nobody may ask the right question when it totally explains the psychosis.
With someone who is uncooperative it will be hard, but taking her to a competent PCP under the basis of "hey I'm worried about you its not your fault lets see if anything medical is happening" can sometimes gain traction.
This is difficult however because people who aren't truly mentally ill don't think they have anything wrong with them and are correct and people who are truly mentally ill often have refusal to acknowledge that they are as a symptom.
Medical/substance/environmental/lifestyle causes of psychosis and/or mood disturbance are not as common as simple causes but they aren't rare. If you wish get access to the medical records and google things and make sure the right crap has been done.
Five: Some facts about potentially relevant DSM conditions. -Women get schizophrenia later than men, especially a bump is seen around menopause. -The DSM has a diagnosis of "Brief Psychotic Disorder." Some people have true psychotic symptoms that remit spontaneously (and never come back). -Adequate care can get someone back to normal. It can also get someone normal enough. -The DSM has a diagnosis of "Delusional Disorder" which means someone is otherwise normal but has delusions about a specific thing. -If someone has schizophrenia you will see some combination of other things in addition to delusions. People act weird. Usually the family can pick up on this (but not always). Same is true for other conditions. Take stock of what you noted. Point it out to medical professionals. -Depression can manifest with psychotic features or other significantly concerning behaviors.
Six: Not every behavioral problem is a DSM disorder (they have a cheat option for "unspecified" or whatever but that's not really the same).
This moves out of medicine to the reality of people doing weird shit and having weird beliefs. I think social justice people are crazy! But they aren't DSM relevant. Some problematic behaviors respond well to therapy some don't but you will find people in the population who have something like midlife satisfaction issues, political freak outs and so on.
You can peck around the edges but if this is the case the medical and legal systems (including medication) will be of limited assistance.
This leaves some room for "maybe two years from now she'll be like....that was dumb" but the lack of options isn't really comforting right now.
You should be prepared for the possibility of this being a true medical/psychiatric issue and also for the possibility of it being a "she's changed." Both will be tough to deal with but in different ways.
I'm sorry.
I know what you mean.
Many of the possible organic causes are horrible.
The Elon Musk delusion has persisted since April / May.
Since July, she sometimes seems afraid of me. Has claimed at least at twice thqt I'm abusive but was unable to articulate any actual abuse.
I think I've already used all the let's go get you checked out attempts I'm going to get.
Many of them aren't though! And some if treated may remit.
With respect to timing .....not really brief, but things can get better spontaneously shockingly far out. The human brain gonna do what it do.
The increasing paranoia is concerning but not as unilaterally bad as you might expect, while getting worse is obviously not a good outcome, it can sometimes lead to treatment that makes things better in the long run!
Try and recruit as much support as you can. :/
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