Bipolar Disorder
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Dr. zafar iqbal Asks ...
One of my client diagnosed bipolar disorder by the Doctors. The Doctors suggested medications, respodrene, kempro, revotril and neurolithSR to control her aggressive behavior. She started above mentioned medication in 2004 but no response of medications appears. However when I started a therapy and got detailed history from her mother father and sisters and came to know that when she was one and half year old her mother went hospital for three months for her own treatment and client was alongwith her aunt it was the first accident that she (client) became insecure. When she took admission in school her teacher wrote comments on her copy that this little girl is suppressed/afraid. After this when she grow up some servant at her home try to sexual abuse with her which increased her insecurity/fear. Behavior of her father was also very strict with whole family and he beaten her many time in her child hood and beaten other sisters in front of client. All above mention situation increases her insecurity/fear gradually when she started class 10th in secondary school, her elder sister said few sentences “wear these cloth” on these sentences the client became aggressive suddenly and she lost her temperament. It was the first attack and after that when any person of the home said any thing to her she took it as order unconsciously and felt insult. And in this aggressive behaviour she beat her mother her father and her sister many time, so when situation became very bad and harmful for the family members and her aggressive behavior became uncontrolable at home, family took her in hospital by force with tied hands and legs which also increased her insecurity/fear and increased her hate with family. Doctors admitted her many time and during the admission the Doctors had done ECT in 2006 which effected her memory and now her memory is short in daily work. All the efforts made by Doctors cannot reduce her aggression from last seven years.
All the history shows that the client was suppressed from of her childhood and her insecurity/fear increases by the passage of time. When I started the therapy I dig out all the negative association with family, with school and with servants and brought all these negative association in her conscious from her unconscious which effect on her personality and now her aggressive behaviour is 90% disappeared/finished. Now problem is that after 90% reduced aggressive behaviour she became silent and don’t speak much with family and mostly unaware from her surroundings. This problem is creating some troubles in her daily life because when she became unaware from her surroundings she don’t know what she have done even she can’t remember what she have eaten in lunch or in dinner. Most of time she remain busy in her own thinking and she don’t know what is happening around her. Most of time during her own deep thinking, smiling is on her face.
I want to take some advised from the psychiatrist that which medicine came used for this situation. -
Dr. David Sack Says ...
This case is too complex to diagnose by email or make specific clinical recommendations by email. It sounds like her current behavior may be a type of catatonia. There are a number of cases of catatonia occurring in people previously diagnosed with Bipolar Disorder. Most often antipsychotic medications (typical or atypical) are tried but often with little success. ECT can be helpful and even life saving if the catatonia progresses to the point where the individual stops eating and drinking. While catatonia was once thought to be a type of schizophrenia, it is clear that it can occur in mood disorders as well.
