postpartum psychosis - Mothering Forums

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#1 of 28 Old 04-08-2008, 08:45 AM - Thread Starter
 
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Tell me everything you know about recognizing postpartum psychosis. My SIL is in a VERY bad place right now. She has a long history of depression, anxiety and god knows what else. at 3 months pp with her 2nd child she was already pregnant again and had ppd. she is now 3 month pp with the 3rd and seems completely out of touch with reality. Completely distorting things and either outright making things up or just not seeing/hearing what everyone else is. She is cycling really quick between volitile, angry and really upset with everyone to calm and almost sedated. She convinced an MD to double her zoloft and put her on Xanax bc she was having anxiety attacks. She is an alcoholic on top of it all. I am really concerned about her, especially with two babies and an 8 year old at home. Her husband is lost and scared.

Any info you have on signs/symptoms, how to differentiate between ppd and psychosis and between pp psychosis and just an unrelated psychotitic breakdown would be appreciated. If this is postpartum psychosis how does that play out? What does treatment look like? What happens to the kids? thanks
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#2 of 28 Old 04-08-2008, 08:57 AM
 
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No matter if it is pp psychosis or ppd or depression or alcoholism, she needs help.

Can you talk to her husband and encourage him to step up and take care of his family, by helping his wife?
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#3 of 28 Old 04-08-2008, 09:17 AM
 
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talk with her family and her husband- someone needs to go to the doc with her sounds like she probably has a more complex problem than just depression- maybe bi-polar - with some psychotic episodes thrown in. you could call her doc but he may or may not listen- he certainly would not be allowed to tell you anything- the other option is to take her to the hospital when she is most out of it and they may keep her. I have a severely mentally ill sister who was not dx until after she had her daughter. And really she did not get any solid help until after she was so bad off that other people were complaining. If they had lived closer I may have been able to change the course of events but she was probably 8yrs into serious mental illness before she actually got the help she needed.
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#4 of 28 Old 04-08-2008, 10:53 AM
 
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Actually, the doctor can talk with you if it is essential to providing her proper medical care. I had to do this once - call a client's emergency contact number and explain to them that the client had severe postpartum depression and needed help because the client had shut me out. Most provider's HIPAA policies will say something to that effect.
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#5 of 28 Old 04-08-2008, 01:10 PM
 
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http://postpartum.net/support-map.html

Here is a search feature for resources in your area. The state coordinators are available by phone to answer questions, help you find good care providers, etc. They do amazing work and are used to talking with family members seeking help for their loved ones.

Megan- mama to 3, midwifery student , doula, , runner , knitter .
Violet Lane Birth Services Doula care and placenta encapsulation serving Seattle to Mount Vernon
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#6 of 28 Old 04-08-2008, 01:30 PM
 
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If you think she is a danger to herself or her children, please take her to a doctor immediately. She needs a mental health work-up to really have a better idea of what is going on and how to best help/treat her. The combination of antidepressants, antianxiety meds and alcohol can be deadly. We all know hard hard having an infant is even with good mental health, so I can't imagine where her mind is taking her...please keep us updated.

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#7 of 28 Old 04-08-2008, 01:54 PM
 
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It sounds like she needs some professional help anyways, but hopefully some information will let you know whether or not she really needs to be hospitalized and how urgent this is all needed.

I believe you said that the new baby is 3 months old, so baby blues and normal adjustment are likely not factors here.

Clinical Postpartum Depression manifests in 4 different ways:

Depression
-Depressed feelings/Anxiety
-Loss of appetite/overeating
-Isolation/withdrawal
-Difficulty sleeping (which is a hard "symptom" to diagnose)
-Loss of interest in activities, boredom
-Difficulty caring for self or infant
-Anger
-Thoughts of suicide or running away (very common, risk of action is around 5%)
-Feelings of hopelessness

Panic Disorder
-Panic attacks -- trembling, shaking, hot/cold flashes, sweating, faintness, dizziness, shortness of breath, chest pain, choking sensations
-May be combined with other manifestations, especially OCD

Obsessive Compulsive Disorder
-Intrusive, random, disturbing thoughts, mostly about harm coming to the baby
-Typical OCD symptoms (hand washing, turning lights on and off, making sure doors are locked, checking on baby obsessively, etc)
*It is a good thing to note that moms who have thoughts about harming their babies statistically almost NEVER harm their babies, and you can tell these moms this. The thoughts come from the anxiety and worry about things that can happen to the baby, and thoughts come from this FEAR of such. This usually makes mothers hypervigilant, AND this is quite different from postpartum psychosis -- which is what Andrea Yates had (many moms have the fear that they are just like her).*

Post Traumatic Stress Disorder
-Flashbacks
-Hyperarousal
-Depression
-Nightmares
-Feeling disconnected with baby
-Avoid talking about the experience or talking about it over and over
-Anger
-Birth experience was traumatic
-Woman has experienced sexual assault

These manifestations are NOT cause of hospitalization, but patients will benefit from treatment -- it may be helpful to remind women that they do NOT need to sacrifice for their babies. What babies need is a happy mom, even if that does need medication. Medications like Zoloft and Paxil (SSRIs) have no adverse effects on infants, and I would recommend that you have her go to a psychiatrist instead of a family doctor. Postpartum moms need to be given doses carefully and work up slowly, because their bodies are so sensitive to the chemicals.

Psychiatric Emergency -- usually requires hospitalization

Mania
-Feeling speeded up
-Little need for sleep
-Very distractible and irritable
-Speech is fast and pressured
-Easily susceptible to anger or disappointment
*Symptoms need to be lasting at least 4 days -- do NOT leave this untreated*

Psychosis
-Extreme confusion or distractibility
-Poor judgment
-Inability to distinguish reality from fantasy
-Delusions
-Hallucinations
-Impulsive actions
-Disorientation
-Irrational changes in mood

Psychosis is WAY different than thoughts about harming the baby. It's more than worries, it's beliefs that only make sense to the mother. For example, Andrea Yates thought she was the devil. To her, if she killed her children, she would get executed, and this would kill the devil, thus saving the world. To her, it made sense. See the difference between this and OCD PPD?

Mothers HAVE to be medicated for mania and psychosis, but usually the mother cannot breastfeed while on these medications. Make sure you reassure her that what she needs is to be better for the baby, and even if the baby has to have formula, it'll still be better than her being miserable. Check with friends or a milk bank for extra breastmilk, if it's been tested for AIDS and Hepatitis. Exercise with caution.



I think it's important that we not try and diagnose the mother, because we're not really qualified to do so. The best thing to do is refer her to a psychiatrist immediately, because it sounds like there are many factors at play here.

Hope this helps!
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#8 of 28 Old 04-08-2008, 03:15 PM
 
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I was thinking that they would talk to another provider but not always family. I know that the first question out of my sis's case workers as well as doc's mouths is do you have permission to know this info... there are permission papers that need to be signed and filed. the other thing I find a bit frustrating is the "danger" to self and others , I think that anyone who is psychotic is basically a danger to themselves because they are not able to judge what is real and what isn't, no they are looking for particular self-harm or harm to others thoughts.
I strongly recommend not dx but calling and telling the doc what is happening People with bi-polar disorder who are treated for depression only, the anti-depressant can trigger mania ... so her meds may be making things worse.
my sister has psychotic episodes, god has told her she is the peace keeper of the universe. She walked around making movements and when asked about them she was pulling knives out of people's backs or the TV has particular messages for her-- could not walk past the bible without genuflecting, her pupils were huge and visually not able to focus well on things. One of the kids were visiting friends and she was sure the mafia had kidnapped them.
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#9 of 28 Old 04-08-2008, 03:48 PM - Thread Starter
 
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The problem with my SIL is that she is in therapy. She has a very manipulative personality and we are pretty sure she convinced the therapist to write a referral for the MD. She went to this really crappy MD who didn't even do a psych eval, hasn't seen her in over 3 years and agreed to double her zoloft and put her on xanax. Her husband right now is really scared and overwhelmed. She won't listen to a thing he says. Right now he is just totally focused on keeping the family afloat and making sure he brings home a paycheck and the kids are okay.

She is REALLY mellow today and yesterday after being completely manic for like a week. There is a chance that she has just adjusted to the meds and so things are kind of in the clear now. But I'm more worried that she is just cycling between mania and depression because she is oddly mellow, like almost sedated. Up untill yesterday she seemed like she was high on drugs (she used to do a lot of speed and my dh said she was acting like she was on speed again) and then suddenly just completely quiet and subdued. We're all really concerned.

It is also REALLY hard to tell if she is manipulating people and making things up or if she is really out of touch with reality. (For example, I asked her to not text message me the other night becuase i was putting the kids to sleep and that i would call her first thing in the morning, she called my mother in law up in hysterics saying that i told her she could never speak to me again and that she was never allowed on any of my property again)

My mother in law and I are going to give it another day to see how she is and I am going to have a long chat with her husband tonight. Unless things seem completely cleared up, my mil and i are going down there and may check her in to a hospital.
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#10 of 28 Old 04-08-2008, 06:46 PM
 
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Did you know that antidepressants like Zoloft are the wrong medication for someone with bipolar psychosis who is cycling. She has to get on anti psychotics. Antidepressants without a antipsychotic medication are known to make cycling worse.

You are correct that you need to take over her decision making. The family has to impose help on her, she is not in the right mind to help herself, and she is seeing the wrong doctor. She must be taken to a psychiatrist that is familiar with postpartum mood disorders.


The alcoholism is connected to the bipolar, it is a classic coping mechanism
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#11 of 28 Old 04-09-2008, 12:17 AM
 
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Bipolar disorder requires mood stabilizers, not antipsychotics. Otherwise you're right-putting a bipolar person on an antidepressant without a mood stabilizer will cause rapid cycling.

Her sudden mellowness could be a combination of alcohol and xanax-which would put most of us to sleep for a week.

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Did you know that antidepressants like Zoloft are the wrong medication for someone with bipolar psychosis who is cycling. She has to get on anti psychotics. Antidepressants without a antipsychotic medication are known to make cycling worse.

You are correct that you need to take over her decision making. The family has to impose help on her, she is not in the right mind to help herself, and she is seeing the wrong doctor. She must be taken to a psychiatrist that is familiar with postpartum mood disorders.


The alcoholism is connected to the bipolar, it is a classic coping mechanism
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#12 of 28 Old 04-09-2008, 12:19 AM
 
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I don't have any specific advice, but if you didn't see this article and the sidebars in Mothering Magazine last year, I thought you'd be interested:

http://www.mothering.com/articles/pr...losing-it.html

Best wishes for helping your SIL find the help she needs.
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#13 of 28 Old 04-09-2008, 12:49 AM
 
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I would err on the side of caution for sure and either get her into treatment with a psychiatrist immediately or ensure that she is never alone with the children until psychiatric care is found. The combination of substances and mood issues you describe is a dangerous situation for sure. No one here can tell you if it substance abuse, PPD, PPP, or another mood disorder or a psychotic episode. What we can tell you is that a mother on that many drugs, with that many warning signs sound never be alone with her children because it is unsafe.

Good luck finding help for her.

Megan Davidson, Labor & Postpartum Doula, Breastfeeding Counselor, Anthropologist, Mom to August (9) and Clay (4), Partner to Shawn.

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#14 of 28 Old 04-09-2008, 08:07 AM
 
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Hugs Kristen, I don't have anything to add but if you need anything let me know...
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#15 of 28 Old 04-09-2008, 09:15 AM
 
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Quote:
Originally Posted by BrooklynDoula View Post
What we can tell you is that a mother on that many drugs, with that many warning signs sound never be alone with her children because it is unsafe.
I agree with everything BrooklynDoula said, but wanted to add I don't think she should be alone...period.
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#16 of 28 Old 04-09-2008, 10:01 AM
 
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Quote:
Originally Posted by jengacnm View Post
Bipolar disorder requires mood stabilizers, not antipsychotics. Otherwise you're right-putting a bipolar person on an antidepressant without a mood stabilizer will cause rapid cycling.

Her sudden mellowness could be a combination of alcohol and xanax-which would put most of us to sleep for a week.
Wow, I did made a mistake, I'm sorry, I meant mood stabilizers. :


Best to your family.
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#17 of 28 Old 04-09-2008, 12:37 PM - Thread Starter
 
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well, she seems to be doing better. everyone seems to think that this was just her "adjustment period" to all of the psych meds, which the dr told her would happy. It is just so scary to me that they would knowingly put a mom on meds that would this when they know she is home all day with a 1 yr old and a 3 month old. She is finally lucid, clear headed and seeming stable at the moment. Hopefully things stay this way. Thanks for the support!
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#18 of 28 Old 04-09-2008, 04:23 PM
 
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It's good to hear she calmed down.
The family should still take her to a psychiatrist that is experienced in postpartum mood disorders. I would also make sure she has a lot of help around her for a while.

Especially if she is drinking and taking xanax that would mellow her out and could make her seem "normal".
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#19 of 28 Old 04-09-2008, 04:35 PM
 
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There was an excellent article in the most recent LLL Magazine about this.

Whether or not she has psychosis or not, it sounds like she could use the help of an MD.

Good luck to her and she's lucky to have you looking out for her.
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#20 of 28 Old 04-09-2008, 08:18 PM
 
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This past fall, a friend of mine lost a baby at 22 weeks. She spiraled downward, and started considering suicide. She told this to her counselor friend, but also made it very clear that she was the sole bread earner in the household, had no insurance, and would be worse off emotionally in the hospital. The friend made her call me before she left the office and TELL me that she was at risk, and ask me to call a few of her other friends as well. In the end, she got to a point at which we were beyond (well, well beyond) our scope and abilities to feel that we could keep her safe from herself any longer. I took her children in and another friend picked her up from my house and took her to an intake facility.

I tell you this because others suggested that this mother "never be alone." I agree with that statement. However, please know that it is a HUGE undertaking to make sure that that happens. Not only logistically, but emotionally. It is a large bit of responsibility to take on, especially with a family of your own to take care of. Would I do it again? You betcha. But knowing what I know now, I may have gone into counseling myself, to deal with it!

I am sorry that you are seeing this happen to a family about which you care.

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#21 of 28 Old 04-10-2008, 09:54 AM
 
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Please don't forget that this adjustment period could also be bad. This woman should absolutely NOT be alone, for a long period of time, for the safety of the childen. It is not a rare occurence that some anti-depressants can cause a different, even more severe, depression or episodes of mood swings. And they can also cause someone to be a zombie, also not good for taking care of children. My main worry here is that she will seem nearly sedated for a week, then comes a *snap* and all of these children are now in body bags. DO NOT MESS WITH MOOD DISORDERS! Even if she is very lucky to have found the right mix of drugs right off the bat (highly doubtful considering she is taking doula Zoloft + Xanax + Alcohol), she should still be under the supervision of a good psychiatrist for her disorder, and those children should be under better supervision than someone will either severe depression, bi-polar disorder, or pppsychosis...who is an alcoholic. Get that husband to realize that when his kids are dead, or worse, he will not be so worried about getting food on the table. Get this family help, FAST!!



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well, she seems to be doing better. everyone seems to think that this was just her "adjustment period" to all of the psych meds, which the dr told her would happy. It is just so scary to me that they would knowingly put a mom on meds that would this when they know she is home all day with a 1 yr old and a 3 month old. She is finally lucid, clear headed and seeming stable at the moment. Hopefully things stay this way. Thanks for the support!
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#22 of 28 Old 04-11-2008, 08:28 AM - Thread Starter
 
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Please don't forget that this adjustment period could also be bad. This woman should absolutely NOT be alone, for a long period of time, for the safety of the childen. It is not a rare occurence that some anti-depressants can cause a different, even more severe, depression or episodes of mood swings. And they can also cause someone to be a zombie, also not good for taking care of children. My main worry here is that she will seem nearly sedated for a week, then comes a *snap* and all of these children are now in body bags. DO NOT MESS WITH MOOD DISORDERS! Even if she is very lucky to have found the right mix of drugs right off the bat (highly doubtful considering she is taking doula Zoloft + Xanax + Alcohol), she should still be under the supervision of a good psychiatrist for her disorder, and those children should be under better supervision than someone will either severe depression, bi-polar disorder, or pppsychosis...who is an alcoholic. Get that husband to realize that when his kids are dead, or worse, he will not be so worried about getting food on the table. Get this family help, FAST!!

I totally understand what you are trying to say, and I am in a place of being clear headed enough to not be upset by your comments. But, for future reference, when someone's loved one is going through something so difficult talking so nonchalantly about her killing her children is not the most sympathetic and supportive thing. It is not just that simple when you are in the midst of it.
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#23 of 28 Old 04-11-2008, 08:34 AM
 
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Kristen.

If she's refusing treatment and your brother is unwilling to put her in treatment involuntarily, then I don't know how much you can do, except what you're doing--being worried, present, and vocal about your concerns.
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#24 of 28 Old 04-13-2008, 02:22 AM
 
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Hi Kristen,

If your SIL were my client I would be contacting Deborah Issokson, based in Wellesley. She is a psychotherapist and expert on PPD and reproductive counseling. I would want to discuss the issues, listen to what she has to say, and see if I could get a referral from her of someone experienced in PPD to see your SIL. Check out her website here...

http://www.reproheart.com/about/cv.html

I would NEVER refer a client who has some of the serious issues you have mentioned to just any MD or psychotherapist...may practitioners just don't have enough experience and training with PPD to deal with the issue properly and the outcomes of a bad patient/doctor match can be devastating.

Good luck and strength to you and your family.
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#25 of 28 Old 04-13-2008, 10:24 AM
 
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First, let me say that I come from the point of being from a family (aunts, uncles, grandparents, cousins, etc...not just immediate family) with high instance of mood disorders. On my mother's side, a very large family, atleast 75% of the family (blood-relatives) has a mood disorder, or varing degrees of severity. I also had severe ppd after my 2nd child, diagnosed depression before kids as well. AND had a friend with PPP. I promise that I do not refer to your SIL nonchalantly when I say she could kill her children. It is just a very hard truth that it could happen, in an instant. I do not believe your SIL is a bad person. I pass NO judgement on her or her situation. I just do not want to see her left alone with those babies without supervision because the reality is that she most likely does have severe ppd, if not PPP, and could very easily snap into harming them, especially if she is combining her drugs with alcohol. I know this situation is complicated and I understand that, really, I do. However, no one is going to care one bit about tip-toeing around the issues, hurting feelings, or "seeing" if the drugs have been effective if something happens to those kids. So what I am saying is, hope for best case scenario, but PLAN for worst-case. You'd never want to live with the guilt that you didn't do enough to save someone's life. KWIM?

I apologize if my original post was harsh. It was not intended to be mean. It was intended to be an un-sugar-coated reality of possiblities....that I hope NEVER happens! I want to be supportive, but with this sort of a serious issue, it is hard for me to just hope everything will be okay. Harming one's children is not a common, but we've all seen it in the news and I would just absolutely hate for it to ever happen again.

(((hugs))) to you for all you are trying to do. You all will be in my thoughts and prayers. Please keep us updated!



Quote:
Originally Posted by snugglebug14 View Post
I totally understand what you are trying to say, and I am in a place of being clear headed enough to not be upset by your comments. But, for future reference, when someone's loved one is going through something so difficult talking so nonchalantly about her killing her children is not the most sympathetic and supportive thing. It is not just that simple when you are in the midst of it.
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#26 of 28 Old 04-13-2008, 04:25 PM
 
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I just want to comment on BirthLovinMomma's post - it may have sounded harsh, but that's because the severity of what you are describing is harsh - not because she was being uncaring or cruel.

Sometimes, things put bluntly can be construed as judgmental or mean, but having suffered through PPD myself, and knowing someone who did not make it through her battle with PPP...well, I don't think words should be minced when dealing with what's going on here.
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#27 of 28 Old 04-13-2008, 06:21 PM
 
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yep , this stuff is very serious. I wrote out and erased several "warning" stories. We have a society that pretty much supports isolation. Families often have quite a bit of pressure to be in denial. One gal I knew through LLL had her 3rd baby I went by to see her all her family lived in another state. She answered the door completely nude, talked to me about some normal things and some very unusual things. Now I know that nude is normal for some folks but not her. Where is DH, well he was fed up and left her, just packed up and left her with the kids. (he felt that she was being irresponsible on purpose!) Her circle of friends were concerned but did not think that they should interfere. One or 2 could be organized to baby sit the kids , today I would have probably had her hospitalized, what I did I talked her into calling her folks and I spoke to them . Someone came to take her back home. They didn't even know DH had left, and they thought she was just a little odd on the phone. Since you have seen some unusual behavior, I would encourage you to go over and assess again spend hours, very often someone can hold it together for short burst of time.
take care
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#28 of 28 Old 04-14-2008, 04:29 PM
 
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You may also wish to be careful at her sudden "recovery" -- sometimes that can be a sign of either a break with reality (no reason to be upset/struggling if the problems "arent there") or a suicide plan (why be upset, you have a solution!). I hope all turns out well for her.
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