Q:  How Long does a Psychotic State Last Inpatient?

My daughter has been in the hospital now for 7 days in an apparent psychotic state of mind.  She has been diagnosed as bipolar a few times, cyclothymic, ADHD as well. She has been in and out of the hospital 5 times, as well as a residental treatment center for one year.  They are currently trying to get her out of this state she is in at the hospital.  Some stressors led to his admission.  They initially took her off Adderall she she had been on for about  a year, upped her lithium sbe just started 4 months ago, and are trying to put her on Seraquel now for an antipsychotic.  She is not being compliant with the Seraquel.  They keep giving her Haldol injectionsm, which she agrees to take, to keep her sedated, as she is pulling off the molding in all the rooms, lifting the tiles on the floor in the bathroom and pulling up the carpet attempting to find a key, for what she doesn't know.  She thinks the hosptial is not real and I am playing along with the game, joke, or whatever she thinks.  How long does it take to get out of this state.  I want more answers than the doctor can give.  Why. Why. What can I do?  She is 17 1/2 years old.   My heart is aching.  Is there any study, better care, something out there.  Someone can assess her positively.  Tell  me what to do.  I would change places with her in an instant.

Hurts

Dear M' -- 
Your daughter is going through an awful experience all right, but as the first ray of hope in this, I can tell you that after working on an inpatient psych unit for years, I saw many, many patients go through this -- and when it settles down, as it will, the focus can turn to better strategies for making the symptoms go away, and then, later, to keeping them away.  But in the short run, which I hope is settling down even by the time you read this, it can be absolutely awful.  

I know, not as a parent, but as the guy everybody was looking at to make it stop (usually our staff alone could settle things extremely well, but a few folks went through what's happening to your daughter and then everybody looks at the doc' to "do something").  In that position I too felt, sometimes, "there's got to be something better than this approach".  We would have to remind ourselves, the rest of the team and I, that we didn't invent this illness and that we weren't therefore necessarily responsible for having the perfect fix for it either, but rather for doing the best that we could with the tools we have.

But when she's your daughter, the absolute urgency of the situation, and the wish to make it stop, immediately; and the willingness to put yourself there if that would spare her -- all that is entirely understandable.  I wish we could translate that mother's love and commitment into a treatment more directly effective and more tolerable than some of the tools we have now, like the ones she's being offered or given. 

So, to answer your question, how long does it take to get out of this state?  Usually a few days.  I hope it's better already.  When people use things like methamphetamine or other street drugs, sometimes that makes it take longer; and sometimes it's just longer even without those.  Usually there's a phase of "better, but having lots of side effects"; and then, as above, the focus can shift toward staying better and lowering the side effect burden.  

There is more support for you via this site and others, including the national advocacy group NAMI (nami.org) where if all else fails you can put some of that maternal energy to work at least helping others if you are unable to directly help your daughter.   

Finally, though this may not be appropriate to your situation, I used to tell families:  "you've been through an awful lot, before your daughter/son/spouse got here.  Now is a good time to take a rest, and prepare yourself for more work soon.  We've got a good, well-trained staff and we do this all the time (which in my hospital is true).  Let us work hard now so that you can work hard later."  However, I know that letting go of responsibility when it's very hard to know whether everything that can be done is being done, is a hard thing to do.  Good luck with that difficult process. 

Dr. Phelps

Published October, 2004