Can mental illness first appear in adulthood or old age?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To those who saw this in others, what were signs? The friend I am worried about is constantly angry and irritable about seemingly small things or things way way in the past, and she seems to have a lot of drama with employers, and has left several jobs. When I try to ask what happened, she evades or misleads.

I fear she is bipolar or maybe schizophrenic… she clearly needs psychiatric help but she won’t open up to discussing it

The anger and irritability could be the mixed mania that can come with bipolar disorder. That is what it sounds like to me, and I have bipolar disorder. I have rage quit a lot of jobs, unfortunately, due to raging unstable moods. The good news is that medications are effective. The bad news is that the side effects can be bad enough that choosing not to take them is a rational decision for some. The lying you mentioned doesn't really fit with mood disorder, though -- that points me more in the direction of substance abuse. There could of course be both bipolar disorder and substance abuse; the two go hand-in-hand most of the time (which I tend to forget because I don't even drink).

And ... gently -- please don't say "I fear she is bipolar." "I fear she has bipolar disorder" is more appropriate.

Ok, got it. Sorry about that.



What are meds that work and what are the side effects? Is it possible she’s not on any?

There are many medications given to treat bipolar disorder, the two big categories being antipsychotics (mostly second generation ones are prescribed now, 2GAs -- some of the most commonly prescribed ones being Abilify, Latuda, Seroquel, Vraylar, and Zyprexa, but there are more) and mood stabilizers (such as lithium and valproic acid and anticonvulsants like lamictal and trileptal). Side effects vary a lot but can be quite bad -- the big ones being weight gain (I gained over 80lbs within a few years of going on medication and tried many many different meds and they all had this effect on me -- I went from a bmi of about 20 when I first started the meds to an eventual bmi of 35 which is bad obesity), sedation (I am tired all the time and have been for years) and impaired cognition (I have multiple graduate degrees, including one in English and didn't read a book for several years thanks to risperdal). For some of us, this is no way to live. If someone's joy in life is, oh, studying the existentialists or something, taking away their ability to even read novels let alone study philosophy is to take away their life. The obesity leads to serious chronic health conditions such as diabetes, sleep apnea, and heart disease that cut our lifespans short. Tardive dyskinesia is a highly problematic side effect with the 2GAs as well. I take my medication, but I very much understand those who don't.

Nothing infuriates me quite like some ableist fool rolling their eyes about someone with mental illness not wanting to take the meds because "they don't want to gain weight." Like it is a question of 10 vanity pounds or something. These medications can be very destructive on both the body and mind.

At any rate, I can't really say what meds "work." Bipolar disorder is a constellation of signs and symptoms and is likely caused by different things in different people; hence the medication that works for one person does not necessarily work for another. There is a lot of trial and error in treating bipolar disorder. I would start with lithium -- it's cheap (you don't even want to know what the new 2GAs like Caplyta cost when still on patent) and effective. Doctors don't like to prescribe it though, because you have to monitor blood levels, and psychiatrists are not fans of having to do that. So it's underprescribed. It also has ... side effects (personally, it gave me hypothyroidism, diabetes insipidus which is a fancy term for peeing constantly, and acne in such awful places that I didn't know it was acne -- so I went off it right away). I think many psychiatrists start people out on lamictal. But it really just depends on whether or not the patient presents with mania, mixed mania, or depression when initially seeking treatment. With depression they will start you on something approved for bipolar depression (don't get me started on how the drug companies started structuring their trials to show effective treatment of bipolar depression so that they could market on patent 2GAs that cost over $1000 a month for bipolar depression). And the first stuff tried rarely works. A lot of trial and error. And bipolar disorder is episodic. So sometimes one is on trial medication number three or something, and the mood gets better, and they attribute it to the medication, but it was really just the end of the episode, and here the patient is, remaining on the medication, suffering side effects. I don't know -- it is very complicated and difficult.

[Anonymous]

Lots of data coming out by psychosis with marijuana use. The THC concentrations can be very high these days. So if trying to help a friend/ family member might want to look into this.

[Anonymous]

Anonymous wrote:Lots of data coming out by psychosis with marijuana use. The THC concentrations can be very high these days. So if trying to help a friend/ family member might want to look into this.

Big pharma is loving the marijuana legalization movement. It will yield Billions or even Trillions over the next few generations of pot heads.

[Anonymous]

I just had a really scary incident induced by stress. Part of it was it triggered really strong OCD ruminations. Like I wanted to stop and go to bed or whatever and felt pained trying to not keep thinking about things.

Some of it might have been a bad interaction between two medications, but I do think I had these tendencies latent in me and they emerged under extreme stress.

[Anonymous]

My mother was always a bit quirky, but overall was able to pass as normal. In the mid 30s she developed pretty bad hoarding and constant anxiety over economic instability. She was always worried that dad (who was also weird but functional) would lose his job and we would be destitute. Anyway she became a very bad hoarder and died in squalor and filth. I am still thinking maybe we should have ignored her rage and removed her from the filthy piles but she was competent enough so who knows. I am just glad it’s all over.

[Anonymous]

You are concerned about an inherited disorder? It sounds like your friend would be smart enough and educated enough to follow the instructions on an at-home genetics test bought on the internet. That is what I would encourage if you are concerned something genetic is showing up. For testing, the company will most likely send the sample to Fulgent, which is the testing company currently used by Inova genetics department (in NOVA). You can research different companies and ask what testing lab they use so that the information is reputable. That would be a start for identifying an age-related neurological disorder that can initially appear psychiatric in nature.

[Anonymous]

Anonymous wrote:You are concerned about an inherited disorder? It sounds like your friend would be smart enough and educated enough to follow the instructions on an at-home genetics test bought on the internet. That is what I would encourage if you are concerned something genetic is showing up. For testing, the company will most likely send the sample to Fulgent, which is the testing company currently used by Inova genetics department (in NOVA). You can research different companies and ask what testing lab they use so that the information is reputable. That would be a start for identifying an age-related neurological disorder that can initially appear psychiatric in nature.

This is bizarre advice. Who would think to order a genetic test on the internet to diagnose a mental health issue? Weird. Go to a doctor.

Fwiw I have myself taken the genetic tests that doctors pushed for awhile to determine the best mental health meds to use. Nice to assume it could work, but I found it useless. The drugs recommended were not the ones that worked for me in real life.

[Anonymous]

There is no genetic testing for mental health disorders. There is a genetic test that can say how a patient might metabolize certain drugs more slowly or quickly.

However, anyone who is experiencing depression, anxiety or other mental health symptoms should get screened for physical causes - thyroid labs to rule out hyper or hypothyroid, calcium/pth/vitamin D to rule out hyperparathyroidism, liver panel, and possibly sleep apnea. These are some unlikely causes of mental health symptoms.

It can be very difficult to approach a person with mental illness and get them to see a psychiatrist and consider medications. I love the book, "I'm not Sick, I don't need help" by Xavier Amador for its explanation of anosognosia and the LEAP method - listen, empathize, agree, partner.

[Anonymous]

Anonymous wrote:I just had a really scary incident induced by stress. Part of it was it triggered really strong OCD ruminations. Like I wanted to stop and go to bed or whatever and felt pained trying to not keep thinking about things.

Some of it might have been a bad interaction between two medications, but I do think I had these tendencies latent in me and they emerged under extreme stress.

Don't underestimate the chances of this.

[Anonymous]

Anonymous wrote:My mother was always a bit quirky, but overall was able to pass as normal. In the mid 30s she developed pretty bad hoarding and constant anxiety over economic instability. She was always worried that dad (who was also weird but functional) would lose his job and we would be destitute. Anyway she became a very bad hoarder and died in squalor and filth. I am still thinking maybe we should have ignored her rage and removed her from the filthy piles but she was competent enough so who knows. I am just glad it’s all over.

Some friends and I tried to help a woman from our church with this when she was going to get evicted. We were really confused when the minister wasn't super positive about us doing so -- he didn't say "Don't do that," but he didn't encourage it either, and isn't that what church members do? Support one another? Well, he knew more than we did -- others had already been through this with her. After days of work from several of us (while she sat and played on her computer until she would decide to get up and get upset over one of us doing something like throwing away an expired Bed Bath and Beyond mailer that had a coupon because "They usually take them even if expired") and another day with a professional organizer that another church member paid hundreds for, the apartment was passable enough for her to not get evicted. Less than a year later -- similar crisis and different people from our church who hadn't been in the go 'round I'd been in were helping her, and it was even WORSE. Mere months later after three of us working multiple days to get it passable -- it was worse. So although you could have "removed her from the filthy piles," chances are good she would have remade those piles in far less time than you would imagine possible. It's so unfortunate, but that is generally the way it is for people who hoard. I'm glad it's over for you.

[Anonymous]

Anonymous wrote:

Anonymous wrote:You are concerned about an inherited disorder? It sounds like your friend would be smart enough and educated enough to follow the instructions on an at-home genetics test bought on the internet. That is what I would encourage if you are concerned something genetic is showing up. For testing, the company will most likely send the sample to Fulgent, which is the testing company currently used by Inova genetics department (in NOVA). You can research different companies and ask what testing lab they use so that the information is reputable. That would be a start for identifying an age-related neurological disorder that can initially appear psychiatric in nature.

This is bizarre advice. Who would think to order a genetic test on the internet to diagnose a mental health issue? Weird. Go to a doctor.

Fwiw I have myself taken the genetic tests that doctors pushed for awhile to determine the best mental health meds to use. Nice to assume it could work, but I found it useless. The drugs recommended were not the ones that worked for me in real life.

Same. I think GeneSight is barely above the level of scam.

[Anonymous]

Anonymous wrote:You are concerned about an inherited disorder? It sounds like your friend would be smart enough and educated enough to follow the instructions on an at-home genetics test bought on the internet. That is what I would encourage if you are concerned something genetic is showing up. For testing, the company will most likely send the sample to Fulgent, which is the testing company currently used by Inova genetics department (in NOVA). You can research different companies and ask what testing lab they use so that the information is reputable. That would be a start for identifying an age-related neurological disorder that can initially appear psychiatric in nature.

Huh? What in god's name are you talking about? And what's with the attitude 'your friend would be smart enough and educated enough to..." are you always so dumb and so obnoxious at the same time?

[Anonymous]

Anonymous wrote:You are concerned about an inherited disorder? It sounds like your friend would be smart enough and educated enough to follow the instructions on an at-home genetics test bought on the internet. That is what I would encourage if you are concerned something genetic is showing up. For testing, the company will most likely send the sample to Fulgent, which is the testing company currently used by Inova genetics department (in NOVA). You can research different companies and ask what testing lab they use so that the information is reputable. That would be a start for identifying an age-related neurological disorder that can initially appear psychiatric in nature.

Idiotic. Illnesses like bipolar disorder and schizophrenia involve literally hundreds of genes. There is no reliable genetic testing that will tell you yes or no or even what you have. It is the holy grail of psychiatry to figure these things out

[Anonymous]

Anonymous wrote:

Anonymous wrote:My mother was always a bit quirky, but overall was able to pass as normal. In the mid 30s she developed pretty bad hoarding and constant anxiety over economic instability. She was always worried that dad (who was also weird but functional) would lose his job and we would be destitute. Anyway she became a very bad hoarder and died in squalor and filth. I am still thinking maybe we should have ignored her rage and removed her from the filthy piles but she was competent enough so who knows. I am just glad it’s all over.

Some friends and I tried to help a woman from our church with this when she was going to get evicted. We were really confused when the minister wasn't super positive about us doing so -- he didn't say "Don't do that," but he didn't encourage it either, and isn't that what church members do? Support one another? Well, he knew more than we did -- others had already been through this with her. After days of work from several of us (while she sat and played on her computer until she would decide to get up and get upset over one of us doing something like throwing away an expired Bed Bath and Beyond mailer that had a coupon because "They usually take them even if expired") and another day with a professional organizer that another church member paid hundreds for, the apartment was passable enough for her to not get evicted. Less than a year later -- similar crisis and different people from our church who hadn't been in the go 'round I'd been in were helping her, and it was even WORSE. Mere months later after three of us working multiple days to get it passable -- it was worse. So although you could have "removed her from the filthy piles," chances are good she would have remade those piles in far less time than you would imagine possible. It's so unfortunate, but that is generally the way it is for people who hoard. I'm glad it's over for you.

This is quite a story. Thank you for sharing it. No sarcasm btw