Q:  Spouse is in Denial, Is There Hope? : Link Between BP/Schizophrenia & Toxoplasma? 

Even though my wife (23 years married) has been firmly diagnosed after presenting 11-13 of NIMH symptoms for BP Mania (current) and 11/11 for BP Depression (last winter). She is in full denial, presenting that this is the "new her" that the changes are the result of a religious "epiphany" (her Pastor disagrees - he has a BP son so he has some experience). She is destroying our marriage, affecting our pre-teen children  and generally driving me to distraction.

After a pretty bad psychotic/paranoia attack, we got her to accept treatment for 4 days at a private "Behavioral Health Facility", she is taking 2x500mg Depakote ER daily and attending out-patient group sessions - BUT still denies the diagnosis, still has the children in tears daily by being unreasonable, still has all sorts of grandiose plans, attacks me verbally 1-2x per week - The Depakote seems to have taken the edge off but she is still over-sexualized (I'm a healthy, red-blooded guy but there are limits to what I can take and I need at least SOME sleep to function)

Is there hope? I have heard stories about this taking years to stabilize (I go to a BP spouse/parent support group).

What about the suggested link between BP/Schizophrenia and Toxoplasma gondii infection?

She has spent almost all the money we had in reserve, still manages to buy unnecessary things - is totally self-focused.

Help!

Dear LJ --

First of all, yes, there is hope. You could present your experience to the other users of Bipolar World and ask for comment if you need some further support beyond your group (but congratulations for finding one, and going to it. That can be a great resource. Many people do not have access to one).

There is a book which might be of some use, although I found it to present less than I had hoped for: I'm not sick, I don't need help, by Xavier Amador. It is for people who are dealing with someone who does not have insight into their mental illness.

One part of the good news: I've seen people develop insight into their illness as their mania diminishes. Actually, I think this is quite common. It always amazes me what people think about their behavior when ill, when they have recovered. Some look back with dismay. Others press forward and seem to minimize what happened. Some never develop any insight at all. But many do. Those people are in a position to help craft a detailed strategy for how their significant others, like you, should deal with them if they become psychotic again with no insight. So, fingers crossed, put that on your list for when she gets well: create the plan for the next episode. Hopefully you'll not need it for a long time. (In some settings, one can create a legal document called an "Advance Directive" which spells out the plan and gives legal consent in advance for the treatment sought).

Hopefully between the pastor and the outpatient follow-up, others can take responsibility for trying to help move her toward greater insight -- or at least continued willingness to take medications for bipolar disorder. As you probably have learned, her one medication is often not sufficient, when she is on a relatively low dose of Depakote. It may take more to come out of a severe mania.

(Obviously this presumes that the diagnosis is correct. You emphasized that you think that this is so. I have no reason to doubt that in this setting, but of course recommending that someone take more medications relies heavily on that presumption).

As for toxoplasma: I know that this has been raised as a connection, but the data are still very slim, the connection largely a speculation (based for example on the fact that Depakote inhibits growth of this particular parasite (Dr. Fuller-Torrey and colleagues)).

Dr. Phelps