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Q: Treatment Plan & Self-injures
Hello Dr. Phelps,
My question concerns my 80 year old mother who was diagnosed bipolar at UTMB
Galveston in 1968. She also had electric shock treatments. She has
been taking 600
mg. Lithium daily ever since. She is under the care of psychiatrist who has
prescribed Risperal .75 mg daily in addition to the Lithium for tremors and
obsessive thoughts.
Her Lithium level is .7 mg.
She also suffers from self-injury by scratching her head and face, making
herself
bleed a little for hours at a time. She has been doing this since 10 years
old. She
can stop herself when she becomes busy doing something like shopping or eating
out.
I never knew the magnitude of her problem until I started helping her out at
home
with medications, meals and bathing. She could always hide this problem when I
was
younger living at home.
Do you think she would benefit from Omega 3 supplementation or T3/T4? She
has all
the symptoms of hypothyroidism, however her TSH is .681 mg. I'm just hoping to
help
settle her down in her last years here so she has some peace of mind.
Thank you for your time! I have really learned a lot from your website.
God bless
you!
Dear Ms. M' --
You could ask the Galveston team to comment. Dr. Hirschfeld in that department
is quite famous re: bipolar disorder expertise. My thoughts: omega-3's have
significant antidepressant effects, so you'd have to watch out to make sure they
didn't seem to be making things worse (the target you describe is not really
depression, it sounds like; this kind of agitation/self-harm is very commonly
made worse by antidepressants). Similarly, adding thyroid could be considered
for "rapid cycling" or depressive symptoms, and it too could make the agitation
side of things worse. The treatment she's on so far is very logical, standard;
but I wonder what the team would do if you emphasized this self-harm? I think
they'd consider adding something or switching; there are numerous alternatives,
e.g. swapping lithium to Depakote (with a cautious cross-over phase of both,
probably); or swapping Risperidone to Zyprexa. Both Depakote and Zyprexa are
also very standard approaches, as you've learned, so this is not anything
radical -- just what might evolve with an emphasis on this new (additional)
target. Good luck with that.
Dr. Phelps
Published August, 2004
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