Psychotic Depression

[annalisa1]

Hoping someone can help. Looking for some info as I have a relative who is currently in hospital being treated for Psychotic depression. The nurses do not give much support and I understand everyone presents differently but I just would like life experience I suppose. People who have been through it or know someone who has. How long can recovery take? Is it common not to want to see family members etc. Anything that can help me make sense of it all. Thank you

[Ploddingon2016]

Please could someone offer some advice? Anything will do! I'm desperate to get my head round it all.

[Baressentials]

My ex had psychotic depression (apparently - the 'diagnosis' kept changing.)
2 1/2 years later he is still in hospital voluntarily. He wasn't fussed about seeing his family at all. I spoke to him recently for the first time in 2 years (we have children together) and he claims to have no recollection of having children. Have tried to speak to his named nurse but they never call me back nor offer advice/support on how to deal with the situation. Previous hospitals he was in were fantastic with communication.
Not sure if that is any help!

[NanaNina]

Sorry I don't know very much about psychotic depression (I have the common or garden type) it's usually part of bipolar disorder I think (elevated mood and then dipping into depression) but I think you can have psychotic depression when "ordinary" depression gets very severe.

Psychosis means that the person is out of touch with reality and so may say bizarre things or have deluded thought processes. I think it's quite common for people not to want to see family when the illness is a its worst. The meds work reasonably well I think and you might find this person wants more contact as she starts to get better.

I know the nurses aren't very supportive and just seem to be sitting in the office or giving out meds. I've been an inpatient twice and I was really appalled at the lack of care. I'm not sure about recovery - I think it depends on how well the person responds to the medication.

You could look on the MIND website for more information.

[dontrunwithscissors]

I have bipolar and havr had psychotic depression a couple of times. Most recently (Nov 2015) I could smell myself rotting and believed I was evil and had to die. The symptoms very much reflected the depressed moodvery morbid and deeply suicidql. I think that's an important part of itthe psychosis manifests in ways that are part of the depressed thinking/feeling. I was vaguely aware at some points that these thoughts weren't right, but couldn't fully rationalise that it wasn't real.

I was in hospital for 3 or 4 weeks (voluntarily). Once my meds were increased, I started to come out of it--within 48 hours, although it took much longer for the psychotic symptoms to go and even longer for the depression to lift.

I can only speak for myslef, but I separate myself from my family because I needed to keep them away from the 'badness' in me. It out of my need to protect them that I felt had to leave.

I tend to come out of these epaiodes quite quickly because I know the warning signs (as does my husband, CPN and psychiatrist) so things tend to be put into place quickly and the meds work. If this is a first episode for your relative, I would imagine it would take much longer. Finding the right medication really is trial and error.

Is your relative sectioned? If so, presumably they have a nearest relative who is part of the detention? Either way, they should have a named nurse. I know my local ward has someone who helps relatives.

[Ploddingon2016]

Thank you for the replies.
It is interesting and sad to hear people's experiences of the hospitals. I was thinking it was just the unit I have been experiencing but clearly not. In contrast the first hospital my relative was sent to (there were no beds locally) were excellent with communication and never made me feel a nuisance for calling.
I am assured to hear it is common that when the illness is acute the contact with family stops or cuts down.
I hope the meds start to work before too long but I understand they may need to find an alternative if no signs of improvement are shown.
I was under the impression other methods of treatment such as CBT may be used to help with recovery but I asked about this today and was told the nurse speaks with patients on a daily basis but I wouldn't really call this treatment!

Bareessentials, I am sorry to hear of your situation. That must be very hard. And it is appealing they do not contact you or offer support.
I assume your ex partner is still ill? Is the diagnosis still psychotic depression?
The diagnosis thing never seems clear either. I imagine it must be quite hard to diagnose some things but they are so non commital.

I have looked at various websites and am looking into support groups and counselling but I just wanted real life input! Experience of those who may have been in a similar situation or who have been ill themselves. Just to try a and gauge what I can expect as it is clear the nurses are not willing to support.

[Ploddingon2016]

Thank you don'trun. It is very useful to hear your story. I am sorry you have experienced psychosis and those feelings. It must be very frightening. I am glad you managed to come out of the episodes quickly.

It is the first episode. And my relative was an inpatient at first and then sectioned as the psychosis became worse and they wanted to leave the hospital, believing they were well. They are under a 28 day section at the moment. I imagine as I am next of kin I am part of the detention? This does not mean I am given information. I have had one meeting with a Dr and this was at my request. As far as I am aware there is no person who helps relatives and I have only spoken to the named nurse twice and she was very rude to me.

[AbandonGups]

Hi. My father went through this last year. At first I was really concerned that the nurses were so 'cold' and matter of fact about everything. Maybe because they've seen it all before (whereas for me it felt like world coming to an end). However - in retrospect....maybe they just knew that recovery takes time.
I did however feel like I could call for updates at any time - and I did. Someone always took the time to talk to me when I visited. We were perhaps lucky with the unit he went to - but as our (ie my family's) relationship with the clinical team developed I felt very well looked after by them. I guess what I'm trying to say is that although it was all so overwhelming at first, things did get better.
Somehow, slowly, my father returned to normal. He was sectioned for a while, there was talk of ECT, and I was grieving as i felt I had 'lost my dad'. But he's 'back' now. It's absolutely amazing.
I am really sorry to hear that you are going through something similar, and that not everyone will have the same outcome as my dad. We also know that we have to watch him closely as it might happen again.
However we are so amazed to be entering 2016 in such a positive state as I honestly didn't think I'd get him back. I wish you the same positive outcome. Hope to give you light at the end of the tunnel etc.

Re visitors: from memory he didn't really want us to visit much initially. And he didn't know we were even there sometimes. But hopefully things will get better and your visits will be welcomed more.

Interesting that we had the same comment from psychiatrist re talking therapies. Our Dr said that the nurses were doing this all the time through their interactions with him, and that they wouldn't be referring for anything else. Like you - I question this, and I guess I am concerned that he's so reliant on medication rather than any other psychological coping strategies.....but I'm not a professional and so long as things seem to be working and he is well and happy then fingers crossed we're going to be ok.

[AbandonGups]

Sorry OP - I X posted my 'essay' with your last post. Really sorry that you're not getting the support you need. The mental health act advocate (who had to contact me about the section....can't recall her proper title) was really useful as a liaison point - I wonder if they could help you too?

[Ploddingon2016]

Thank you Abandongups. It's is so helpful to hear your story and I am happy your father is well again. Can I ask how long the episode lasted? And how old he is please?

The first section (which lasted less than 24hrs) I wasn't contacted at all. I had to contact them and found out that way. And this time I spoke with the Dr prior to the section so was aware it may be happening but it wasn't confirmed until the nurse and a social worker contacted me later. I have not spoken to a Dr since then and everything I have found out is through my calls to them but it is hard trying to find out anything. I understand it is because they are familiar with the time it takes to recover and daily there is no change really, it can take weeks for meds to work, but as this is so new and unfamiliar to me I feel I have to call daily just incase.
Things were not so bad at first admission as an inpatient but they have got worse and at the moment things are the lowest they have been. I was able to visit before and even speak on the phone. It is hard going from this to not feeling like I can do anything.
I have been told it is common and that families can be blamed for people being in hospital, although it was voluntary at first then things became worse and the paranoia and suspicion seemed to get worse.

[AbandonGups]

I agree - just keep calling staff as often as you need to - you'll be important in the recovery process.
I lived along way away at the time, but would go as often as poss, with DB going every day, and eventually the nurses said to be kind to ourselves and look after ourselves and not to necessarily go every day - that was so hard, but they were right. It's a long slog, and perhaps made it even harder for my dad as he didn't want us to leave, or started to panic when we were there.

dad was 66 at the time. I think he was an inpatient for about 3.5 / 4 months. The first 2 + month were like a rollercoaster - he def got worse for a while. Often 1 step forward, 5 back. They needed to keep trying diff meds, which confused him and made him more paranoid - so he stopped taking anything voluntarily and stopped eating. The section was to give staff the ability to give him IV fluids etc.
I know every case will be different, but in those first 2.5 months it all felt so desperate. Then when they hit on the right meds and sorted him out physically the fog seemed to lift and discharge was pretty speedy.

Really sorry as I know every case must be different.

Like you, I couldn't understand how they could fix on a diagnosis. Mental health is such an unknown world

[Ploddingon2016]

AbandonGups. Thank you. You have been most helpful to me.

Similar age and case it seems. Although every person is different so maybe recovery will be longer or something else will vary it is good to know that someone can come out on the other side.

It has been suggested for my own care I don't go until I'm likely to be seen. I think maybe as you suggest it can make it worse as they don't want me
To leave and I seem to make them more anxious and paranoid. But at the moment it is not just me, it is most people. Close relatives are the worst though as they are the most trusted and then become the most untrusted.

We are on the first set of antipsychotic and a low dose of antidepressant.
I don't know how well they will work. It has surprised me how it is so up and down. Didn't seem so bad on admission but has got so much worse since. It is awful.

There is very little other family so I am more alone in this. Hence why I am asking for information and advice on here! I have tried to go to professionals but they haven't suggested anywhere for me to contact. And I don't feel I would like a support group situation. Maybe I will have to try that if there is nothing else available.

Thank you again.

[smileyforest]

Plodding....really feel your emotional pain, is it your parent that's been sectioned? My son became ill last October with Psychosis.....It's frightening...Was assessed x2 for sectioning but managed to avoid and I've been caring for him at home. Refuses medication. He hasn't spoken properly for 2 month's, wears a black beanie and covers his face with a mask. Not washed for 2.5 month's, hair has grown long and he stays in bedroom with laptop. Lots about a stone in weight. It's been the worst experience of my life...I have had to take time off work to cope with it. He has just recently turned the corner..bit of light...Taken a shower, hat and mask off....quite confused now, doesn't know what happened to him...quite depressed...He is still very cautious of me which is very upsetting. If your next of kin, you should be notified of any change. I know this illness takes a long time for the person to recover from. It has made me ill seeing my son and grieving for the son I lost (if you understand). It's true, you need to look after yourself. I hope your relative recovers, but will take time before you see any change.

[smileyforest]

He also went missing x2 which was frightening..but still medics refused to section him, yet I felt he was very unsafe.

[Ploddingon2016]

Sorry to hear your story smiley. You are very brave looking after your son at home. I hope he continues to get better.
It is frightening.
It is my mum who is ill. I couldn't look after her at home as I have 2 young children and as she has got worse I didn't want my eldest to see her like that. He is difficult at the moment and I don't want it to get worse over anxiety about his Grandmother being ill.
I am coming round to realising that it will take a lot of time for recovery so I am trying not to look after myself and my family so I can be strong for when mum starts to get better and wants to see me again. I am trying sending cards etc as an alternative way of keeping in touch. This was suggested by the unit as something that may be helpful.

I'm surprised they refused to section him when he was missing but maybe after speaking with him they did not feel he was unsafe or in danger.
I wouldn't say my mum is a danger to herself or others but they have sectioned her as she refused to take medication voluntarily and the physcosis she was/is experiencing is very strange.

Wishing all those affected a safe and speedy recovery

[smileyforest]

Yes my son got worse and refuses meds. I would send him texts. I asked family members to do the same, he will not return texts or answer phone but does look at phone. I'm sure it helps to see people do care. He is still in a very dark place. Not been easy at all being his carer, he was such a smart young lad. It's helped me to keep a journal.I write daily. I hope to give it to him when he does make a recovery. I was surprised also that my son wasn't sectioned. We have a nurse who visits but it's just once a week, not enough in my opinion.

[Ploddingon2016]

When the crisis team was first contacted for my mum they offered a daily visit, home care something it was called. Can you access the same?
Would be better than a once a week visit for sure especially as he is so ill.

[Ploddingon2016]

Another setback. Mum managed to leave the unit last night. They don't even know how. Thankfully they persuaded her to go back, though they could have used force as she is under section. I just don't know how it could have happened, specially as they are aware her bag was packed, waiting by the door, she has been wanting to leave for some time now but doesn't understand she can't. They should have been on extra alert.
The unit manager is supposed to be contacting me so I can discuss and look into making a complaint. I am not sure if it will make anything better though. It just seems to be as someone mentioned, one step forward and five back. She still doesn't want visitors.

[NanaNina]

Ploddington I think most psychiatric units hold a weekly review on patients (they should have told you about this) always on the same day and chaired by a consultant psychiatrist and there are various people there, staff nurse from the ward, Occupational Therapist (OT) the patient and patient's relative, and whoever else is involved. Maybe you could find out about this.

Can I ask if this is your mother's first psychotic episode as it's very unusual for it to come on in mid life. Do you know if there were any triggers. That's shocking that your mom managed to leave the unit last night (and it was bitterly cold) there is absolutely no excuse for that. Might be an idea to tell the Unit Manager that you are thinking of making a complaint to the CQC (Care Quality Commission) who oversee the NHS. They are always ready to listen to complaints from patients. You could get their details on google and contact numbers for the particular NHS Trust involved.

I wouldn't worry about your mom not wanting visitors - time enough for that when she is starting to recover

smileyforest so sorry to hear about your son. I have a friend whose son has bipolar and because his father is wealthy (they are separated) the young lad goes into a private residential clinic when he is particularly bad. Has your son been assessed by a consultant psychiatrist and given a diagnosis and treatment. It does seem like he should be an inpatient but I know there is an enormous pressure on beds in most areas of the country, especially for young people. Can you tell the CPN that your son isn't taking his meds, and that's one of the big problems, as when they start to feel a bit better they stop the meds, then it's back to square 1.

[Ploddingon2016]

I have asked about the weekly review or any review for that matter as there has not been one since my mum has been at the unit. They are looking into it supposedly.

Yes it is the first psychotic episode as far as I'm aware. She has never been admitted to a psychiatric unit before though has taken antidepressants in the past once or twice. She has heard voices previously apparently but this was after my father and Her father died about 26 years ago within a very short time of each other, voices when bereaved are quite common as far as I'm aware. There is quite a large factor that has possibly been a trigger for this episode, a number of factors causing stress over the past year and previous to this. I think this is what they suggest has been the cause. I have mentioned other possibilities aside from the psychotic depression but they do not seem to think it is anything else at this stage. There is meant to be a CT scan in the pipeline, although I haven't heard anything about this recently.
I am not sure what else she has told the Drs and staff at the unit as I mentioned I have not been informed of any meetings, suggesting there have not been any whilst she has been in the unit. I would imagine this has been due to the festive period, this seems to be the excuse for why she was not started on medication sooner.

If I could speak to the unit manager I would inform them I am looking at making a complaint. The manager was supposed to call me at some point today but that has not happened. I have asked again this evening for her to contact me tomorrow.
I still do not know exactly how it happened and why she was not brought back when first seen to be outside. It took a good length of time for them to persuade her to come back to the unit aswell so it seems. Today though they have removed her bags back to her room when they have been placed by the doors so that they are not a constant reminder of her wanting to leave the unit.

[smileyforest]

Plodding, that's dreadful that your Mum managed to leave the unit! It feels terrible that your Mum requests no visitors but she is in a very dark place and probably upsetting for family as she will not be the person you know. It's a very, very frightening experience for patient and family. Nana, my son hasn't been given formal diagnosis, just psychosis. Difficult eve with him, verbally aggressive, he seems to be making some recovery but confused and agitated. Psychiatrist says it's OK for him not to take tabs, very small dose. I wish he had been admitted, it's like walking on eggshells. Sometimes he will completely ignore me...and doesn't seem to like me. My son that I knew is not there.

[NanaNina]

ploddington I would just complain to the CQC and not bother with the unit. It sounds a very strange place, no reviews, no meds and allowing your mom to wonder off outside - not good at all. Look up CQC and then the NHS Trust and take it from there. They encourage relatives of patients letting them know if the standard of care is a concern, and it certainly is in your mom's case.

Smiley was going to suggest your son has a look at the website YoungMinds - he might find something useful or some support.

[Ploddingon2016]

I can understand why there are no visits at the moment it I just feel useless. Like I need to be doing something,though realistically I know there is nothing I can do.
I will be speaking to someone to complain. A difficult situation not made easier by the level of care, or lack of it.

Smiley. I'm sorry your son isn't improving. The psychiatrist doesn't sound very helpful. Have they said why the won't admit him to hospital? It's not good for you to take it on alone. If you become unwell or exhausted you cannot do as much. Is there no home enablement team? That is what we started with. They come every day and talk.

[Ploddingon2016]

I have managed to sort a potential CPA meeting for next week and a meeting with the manager to find out why I haven't been offered this before and to find out what they are doing to ensure mum (or any other patient for that matter) will not be able to leave the unit without the staff knowing again.

Abandongups, can I please just ask what your Dad remembers about his time in hospital/his illness? I wonder if when mum
Is better she will remember all these things or not.

[AbandonGups]

Hello again, I've kept an eye on the thread and am keeping you in my thoughts. Sorry to hear it's been so difficult. Hope the meting is useful.

in dad's case he doesn't remember the really bad days / periods at all. We've talked briefly about it, but I kind of don't want to give him the full detail of how horrible it all was. He said & did some outrageous things that simply weren't him & he couldn't help it. I am thankful that he can't fully remember and therefore doesn't beat himself up about it.
Best wishes to you and your mum.

[smileyforest]

My son can't remember the deep Psychotic phase , he has come out of it a little but remains confused with cognitive impairment, whether that improves with time, we do not know. It's incredibly emotional to witness someone close going through this, my son didn't wash or change clothes for 2.5 months. Really upset me because he was always so particular. There is no daily mental health care available here, in fact I'm concerned he will go into a depression now as he learnt today that he is unable to return to his college courses ( I knew anyway as too unwell). It's been a terrible journey and not over by a long way. I myself have been really unwell and after seeing my GP today have had to accept anti depressants because its really affected my own mental health.
Thinking of all on this thread.....x