Expert: Libby Bonner - 7/22/2008

Question
My brother-in-law was hospitalized for what has been diagnosed as bipolar four days ago.  He went into the hospital talking very fast and very odd, but basically OK(ish).  He is now a total zombie. He is one of the only patients still there since his day 1.  He was combative in there and they had to restrain him.  Are they overmedicating him just to keep him quiet or are the tranquilizers helping his mind to stabilize.  We are extremely worried.  Shouldn't he be showing some signs of improvement.  He is completely non-functioning now which is a 180 from before.  This is our first time with all this and any help would be greatly appreciated.

Answer
This is a PS to my ealier answer, below:

I should not have been so quick to question the hospital.  It may be an excellent one.

"Combative" in full-blown mania mean very, VERY dangerous, so the restraints probably were needed, until meds could help.

As to the seeming over-sedation:  he may have been given meds called "atypical anti-psychotics," perhaps at higher than usual beginning doses, so that could control the mania with meds only and get him out of restraints as quickly as possible.  These meds, one or more of which he may have to continue with, have pronounced side-effects, including slowed responses, but esp in the earliest days...  Some effects moderate as the patient's body adjust to them....

However, they likely would prefer to begin his real treatment - treatment for bipolar, as opposed to just mania control -  w/ other, more usual 'first-line' meds......so they may back him down from this higher dose or even taper him off it/them, if I am correct about them using atypicals, as the more usual meds begin to work and his mania recedes.

Getting him on the right meds, at the right doses, is something that probably will take awhile, even ater he is released...and will require continual tinkering, later, anytime the patient's symptom control should change.

Be glad that he could get admitted before anything awful happened, to him or to others.

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It would take me too long to be complete.....  Pls contact your state office of NAMI to ask your questions and get immediate answers and suggestions on what to do next.

However, these comments.  You should be relieved that he is not out yet....most are, very unwell, by 72 hours.

I'm not sure why he is so out of it....he may not be in the best hospital....how did he get admitted?  Admitted self?  Wife did?  Police?  ...I am concerned that he was in restraints - the fed laws on that are extremely clear about using them rarely, and, if used, he must have been checked by a doc w/in an hour and, I think, regularly while in restraints.   He might still have needed the restraint of some meds for awhile but this seems a long time.

Other advice - talk to the hospital's patient ombudsman or pt rep about this care.    Maybe get an atty.  Maybe get him transferred.

Psych meds don't start working overnight, so don't know how soon to see improvement - not immediate, but within a week, maybe.  SOME improvement.  He will still be very odd at a week, but no longer manic....I think.

Your family needs to get up to speed on bipolar immediately...for when he is released....going to take awhile.  And, believe me, he was not "basically OK" when admitted.

For psych info, see nami.org or mentalhealth.com

Pls plan to start going to the best NAMI affiliate near you - again, nami.org.

Pls write again to update me.