If a loved one with mental illness or suspected mental illness is arrested, the goal is to transition the person as quickly as possible from the legal system to the healthcare system. The Los Angeles NAMI Criminal Justice Committee has posted a very thorough seven-step guide to help families navigate the criminal justice system in Los Angeles County when a family member who suffers from a brain disorder (mental illness) is arrested. It’s called “Mental Illness Arrest: What do I do?”

This post changes the process a bit, removes details related to the Los Angeles jail, includes some additional notes and tips, and presents everything in more of a checklist format.

A study published last week entitled “Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis” (Cipriani et al The Lancet 17 Aug 2011) reviewed many previous trials of medications for mania. It looked at results for any of the following medications: Aripiprazole (Abilify) , asenapine (Saphris), carbamazepine (Tegretol) , valproate (Depakote) , gabapentin (Neurontin), haloperidol (Haldol), Lamotrigine (Lamictal), lithium, Olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal) , topiramate (Topamax), and Ziprasidone (Geodon).

In Wednesday’s post, “Childhood Trauma Linked to Psychosis: Maybe Not,” I introduced a few terms and concepts that many people seem to wrestle with. In this post, I try to clarify the terminology and explain some of the concepts related to psychosis, hallucinations, and delusions.

Psychosis

Psychosis is defined as an abnormality of thoughts (content) or thinking (process). Psychosis is not a diagnosis in itself but a type of psychiatric symptom that occurs in a variety of diagnoses, including schizophrenia and bipolar disorder.

Schizophrenia is primarily a disorder of thinking – psychotic symptoms are the main presenting symptoms. Depressive or manic episodes sometimes include psychotic symptoms, but not always. Certain drugs such as LSD, mushrooms, and other psychedelics can also cause psychotic symptoms.

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Without my battle with manic depression I would still be that fear-driven little boy, unable to truly give, or receive, love. Manic Depression was a gift….

Maura asks…

Hi Dr. Fink. My husband of 30 years has just been diagnosed “possible Lexapro-induced hypomania/possible true BPD” After a very difficult and abusive childhood with alcoholic parents, he has been seasonally depressed as long as I have known him. Usually starting around November, and not clearing until late spring.

Although fully functional, he was having somatic complaints and once, an episode of chest pain severe enough to take himself to the hospital for evaluation. Two years ago, he agreed to begin treatment with our family PMD for his depression and did EXTREMELY well mentally on Zoloft 150 mg. He stayed on Zoloft for a year but reluctantly changed to Lexapro 20 mg. qd, due to severe, unremitting heartburn with the Zoloft.

From Kate:

On a recent admission to hospital I felt more anger than mania. I felt angry over an involuntary admission. As I vented my feelings of anger, they were perceived as symptomatic of a manic episode. Where does that “fine line” exist? Please tell.

We expect that situations like these occur more often than most professionals would like to admit. Although therapists often point out that “Nobody can make you angry,” sometimes people have very good reason to feel angry, and an involuntary admission certainly qualifies as one of these reasons.

Unfortunately, any expression of that anger is likely to be perceived as a symptom of mania. It’s like being suspected of a violent crime you didn’t commit. The more vehemently you protest, the more your captors suspect you of being a violent person capable of committing such a crime.

PMK asks…

My daughter Baker Acted eight days ago. She is 25 with no indication of a problem until a few weeks ago. She has ADD and was taking Adderall. She started taking Phentermine to lose weight and was taking energy drinks – Rock Star etc. She’s had a very demanding sales job in which she needed to go to networking events at night in addition to her job. She lost it this weekend while involved in a very stressful job-related event. It appears she lost her sense of reality – made many charges for clothes, stayed up almost with no sleep three or four days, said and did things out of character, until someone called 911.

Is it possible this was caused by all of these stimulants?

Last week, Joe posted a piece entitled “Bipolar Dilemma: Insensitive Jerk or Irresponsible Oaf?” in an attempt to spark a discussion and collect insights on what to do when you sense that your loved one with bipolar is exhibiting symptoms of mania or hypomania. This week, Dr. Fink weighs in.

Dr. Fink Replies…

This dilemma lies at the heart of so much of the strife that families living with bipolar disorder face every day. I don’t have any magic answers – I suspect that people living with these challenges have creative solutions that will be more helpful to others than anything the doctor might have to offer.

Bipolar mania can really foul up the family dynamic. One minute, your family is cruising along on autopilot, and the next minute you’re in a tailspin. It can begin innocently enough with a barely perceptible increase in irritability and criticism, and then quickly escalate into knock-down, drag-out conflicts, all of which contribute to worsening the mania.

In Bipolar Disorder for Dummies, we talk a little about the differences in how bipolar mania is seen from the outside as opposed to how it is experienced from the inside. Inside, a person experiencing mania may feel…

• I am amazing!
• Everything is wonderful!
• I can do anything and everything!
• I have all the answers! My ideas will revolutionize the world!
• Sleep is only for people who have nothing better to do!
• Everybody loves me!

Outsiders may have a completely different perspective, saying or at least thinking…