Expert: Ivan Goldberg, M.D. - 5/17/2008

Question
QUESTION: our son is 39 and was diagnoed bi-polar 4 years ago. his first psychotic episode was treated. 7 months later he stopped his meds. he has been constantly hospitalized as a result and getting worse. we realize the resistence to meds is part of the psycosis. how long can this go on?

ANSWER: Hi Cathy . . .

I am not sure what you are asking. It is not unusual for people with the psychotic forms of bipolar disorder to refuse treatment. In some situations it is possible to get a court order to allow hospitalized patients to be treated without their consent. You may want to talk to one of the senior doctors at the hospital about this possibility.

Best regards . . .

Ivan
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---------- FOLLOW-UP ----------

QUESTION: thank you dr. for responding.  since our son only takes the medication when he is in the psych. ward , then discontinues the meds when he gets  home (he is ususally admitted for 2 to 3 weeks because of being paranoid, delusional and suisidal) this happens 7 or 8 times a year. It is his belief that he is not really mentally sick.  We have approached the lead psychiatrist but he just states that one day he may get a window of insight.  Has there been any progress of certain treatments to help them get outof this resistance psycosis he seems to be stuck in.  there are no long term facillities here for him and our son must agree for a community treatment order.  we have even had this issue in court, and as always he refuses this.  we have gone through training on helping and understanding mental health issues through the NAMI course.Maybe we are the problem.  We cant seem to make any headway in getting him long term treatment.  they now call him a "revolving door mental patient"  At our age we seem to be stuck in his misery as well as he blames us for his delusions.   We have read all the usual books and internetinfo.  is there any tricks to negetioating with a bi-polar to take their meds??  what is the lastest research on this problem?   thank you for helping us.

Answer
Hi again . . .

While out-patient commitment and long term hospitalization are available in some place I am not sure that either is a practical solution. I certainly think out-patient should be tried but often it just turns into another form of the revolving-door. Long term treatment is available via two means: a)commitment to a state hospital and b) private hospitalization. The first is usually only available while the individual is psychotic, and the second requires well over $1,000 a day plus the cooperation of the patient.

Something I have occasionally done with so-called revolving-door patients is discharge them from the hospital immediately following the injection of a long-acting antipsychotic medication. The patient is then visited at home by a visiting nurse who gives another injection of the injectable antipsychotic medication before the previous injection has worn off. While difficult to maintain, by means of such a schedule an occasional patient can be kept out of the hospital by such treatment.

I have no idea what, if anything, you may have contributed to your son's illness. It is something you should discuss with his psychiatrist (NOT with the social workers or psychologists at the hospital).

Best regards . . .

Ivan
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