Bipolar Disorder/schizoeffective sistet
QUESTION: Hello Dr Goldberg
My sister was diagnosed over 20 years ago as schizo effective. In the past,When she is not taking medication she believes she s been molested by family members, had abortions and affairs with priests. She has become very religious since her illness was diagnosed, with most of her life revolving around the catholic church. She has been unable to hold a job for any length of time. And has lived with my parents most.of the last 15 years. Over the years she has gone off her medications(haldol, ativan,lexapro, artane) and we are able to see the red flags, overly obsessed with church activities, delusions of molestation from family members. When she is put back on her meds she realizes these thoughts were not true. Sine last year after going off again,she convinced her Dr.the meds make her too tired and he lowered the dosage. She seems normal except she just filed a police report that my uncle (her guardian) and my aunt molested her and their daughter molested her son. Sherrif appears at their houses with an order to appear in court. Needless to say we as a family are devastated as she does not listen to any of us that her thinking is off and meds should be adjusted. She left her Dr of 20 yrs.as well for a new christian Dr.An attorney she has dealt with before was able to convince her to take back the charges.How do we get her to be evaluated by her new Dr to adjust the dosing. Her previous Dr.told my parents she was one of his most difficult patients as far as compliance with her meds. She is very head strong.We are very concerned she may accuse other innocent people of her delusional thoughts and follow thru with more charges against people. She becomes very righteous and once even after being told of a friends baby who was not gaining weight at a healthy,called social services on her . Its very scary! What can we do? Thank you in advance
ANSWER: Christine . . .
The situation you inquire about is a nearly impossible one. Unfortunately, many people with schizo-affective disease and other serious psychiatric illnesses refuse treatment as they feel the best when not taking adequate amounts of medication. When taking inadequate amounts of medication or no medication they may feel well, but act in ways that is very destructive towards themselves or the people around them. In some locations, such as New York, there is a form of outpatient commitment through which people outside of hospitals can be compelled to take their medication ( See: http://www.naminj.org/advocacy/Involuntary_Outpatient_Commitment.html
A strategy I have sometimes used with such patients is to treat them with long acting injectable antipsychotic medications. Such medications keep working for 2-weeks and injections are given prior to the preceding injection becoming ineffective.
best regards . . .
---------- FOLLOW-UP ----------
QUESTION: Thank you for the info. Do you know if Ohio has a form of the outpatient commitment. And how would I go about implementing it. Who could I contact here in Ohio? I have often suggested to family members that injections would be better for her since she comes off her medicine at her own digression. Would I be able to send a letter to her Dr. or Social worker to encourage them to look into this outpatient commitment or can I initiate it myself. She tells her Dr. and social worker she is doing just fine and they even did a competency test and she passed. This is so frustrating for all of us. Thank you!!
Christine . . .
You can find out what the law is in Ohio by contacting your local chapter of NAMI. See: http://www.namiohio.org/
The NAMI people can let you know if you can start the process of it it has to be initiated by a mental health professional. Situations such as the one you describe are among the most stressful with which a person can deal.
Best regards . . .