Bipolar/Schizophrenia advice please?

[Captainmomtotherescue]

Hi, first time posting here. I'm looking for some advice about the "timeline" (for lack of a better phrase) after visiting the GP regarding Bipolar/Schizophrenia.

My partner (A week ago) went to the GP and explained his issues. We've known for a little bit that something deeper was the issue other than depression - Anti-depressants weren't having many if any effect, unusual behaviour/thoughts, long term history of depression etc. I have spoken to my GP the week before this about the next steps and she said it was a referral to a psychologist who would formally diagnose then come up with a treatment plan etc. However when my partner went, he wasn't sure if his referral was to a psychologist or a CBT therapist. Anyway, the GP said he is showing signs of Bipolar and some signs of schizophrenia.

I'm just wondering what the next steps are, if he's likely to have been referred to a CBT counsellor or Psychologist (if there's even a difference?) And any advice from here on in.

I don't have any personal experience with these mental illnesses, so any information would be extremely helpful. Also happy to answer any questions if I've missed anything out.

Thanks in advance! :)

[Steakandkidney]

He can only get a diagnosis from a psychiatrist and they are the only practitioners who can prescribe specialist mental health drugs like mood stabilisers and anti psychotics.
Usually you will be referred to psychology through the mental health team which you are referred to by the GP. Psychologists are the 'best' kind of therapist, they do a doctorate and study in depth. CBT is the gold standard treatment for psychosis, schizophrenia and bipolar and so he may receive this by a counsellor or psychologist, but either way they will have had extensive training.
However, given that he is quite unwell, he sounds as if he needs medication before therapy, as unusual thoughts are a sign of psychosis which is a very serious mental illness. I think you need to confirm with the GP that he has been referred to a psychiatrist. That is whom makes the treatment plan, arranges support with the community mental health team. At least in my experience.
I was seen within a week of referral. I also wouldn't have been able to remember what a GP had said, in fact I cannot remember even seeing the psychiatrist! I think you should go with him.

[Alaaya]

I have schizo affective bipolar disorder. I was referred to a psychiatrist and he made the diagnosis and recommended medication. I've been on medication ever since. No CBT although I was on a waiting list for 9 months at one point, then I moved and got bounced to the bottom of the list and then I gave up.

I do see the community mental health team every other month though, and did some group therapy for a while which I found helpful.

[Alaaya]

Oh and appointment with psych was within two weeks.

[FissionChips]

Took me 11 months to see a psychiatrist and get diagnosed, and that was after a very serious incident. No therapy offered other than CBT which I’ve been assessed as being unsuitable for. Just meds for me.

I think it all depends on where you live.

[FissionChips]

(Bipolar btw)

[Captainmomtotherescue]

Apologies I don't think I've worded that correctly. I meant unusual thoughts as in death centered? Not suicidal but 'dark'? Apologies, I don't know how to phrase it correctly. We definitely think he will need to be prescribed medication, though I know it might be a bit of trial and error to find the right combination. I'm hoping to go with him, because I want to get all the information I can to be able to help him process and understand as much as I can of what's going on.

He has been in receipt of CBT in the past a few times, however this was for depression (and although he understood/tried, it didn't work). Is their specifically tailored CBT for Bipolar/Schizophrenia or is it much the same as Depression?

[Captainmomtotherescue]

We live on the outskirts of a big city in the UK, though our GP is pretty quick with appointments and referrals, compared to our old GP's. The GP I spoke to said that a psychologist referral would take around 4 weeks, though I'm presuming it depends on how much of what he said was included in the referral?

I just want to gain a little more insight so I can be prepared for us as to what's next. I hope that makes sense!

[Captainmomtotherescue]

Oh is it a psychologist or psychiatrist that can give a formal diagnosis/medication? I'm really sorry if me being a bit dippy offends anyone here, I'm not sure of what's what at the moment as the terminology can be quite confusing..

Thankyou for the quick replies though :)

[FissionChips]

A psychiatrist prescribes and diagnoses.
At the appointment they will ask his symptoms, history etc. They’ll discuss medication and any other treatments offered (CBT, stress control course etc).
He may come out with a diagnosis there and then or it could take a few more appointments.

In my area CBT offered was 30 mins every 2 weeks, just standard stuff you could read in a self help book. Seemed geared towards low level anxiety really.

[Captainmomtotherescue]

Right, Psychiatrist, got it. Thankyou. You can tell I'm very much new to all of this! Hmm, thankyou for the insight.

If I may ask about personal experiences - with your first referral appointment - did you take anyone? If so, do you think it helped or hindered?
Don't feel obliged to answer, I don't want to make anyone uncomfortable by asking (potentially) intrusive questions.

[BippityBoppity87]

I went to my first psychiatric appointment after a crisis. I had never been to one before, but I had to have an urgent referral the same day.

I had to speak to them on my own, I think for about half an hour. My DP came with me, as I was in no state to be on my own at the time, he sat in the waiting room. Then afterwards I was asked if my DP could come in and review what had been said.

I'm not sure if it would hinder anything, I suppose it depends on how much you have to say if they ask, give as much info as possible, don't not hold back. Be brutally honest.

[FissionChips]

I didn’t take anyone and I’m glad. Some of the questions are extremely personal, about sexual stuff etc.

[BippityBoppity87]

That's funny FissionChips I never got asked any of that. But I suppose it's different depending on who you're speaking to and why you're there.

I actually brought up that stuff myself and it was kind of just brushed off.

[Captainmomtotherescue]

Thankyou for sharing. This is all very helpful! Is there anything that anyone thinks I should definitely be aware of? In terms of what's to come?

I'm so glad I posted, thankyou all for your honesty and insight!

[FissionChips]

I’m starting to think the psych I saw was some type of quack BippityBoppity87 .

Does DH drive op? You should be aware that some mental illness need to be declared to the DVLA and can result in the license being taken away or given short licenses for a year or so. Can affect work depending on the job you do and the meds you take.

[BippityBoppity87]

Haha FissionChips Nah, the psychiatrist I saw seemed a bit, well not embarrassed, but didn't really want to go into any detail about it or anything when I brought it up. I think, from what I remember, when he was asking about past events etc.

[Captainmomtotherescue]

No Fission he can't drive at the moment. He has plans to in the future but I guess will cross that bridge when we come to it. I can't drive either but we have always been in agreement that I'd be the main driver anyway because I actually want to.

What sort of limits will he face work wise? It's a bad patch for both of us at the moment anyway, as we're on benefits at the moment. I'm hoping to go into work and for obvious reasons DP is finding it hard to even think about full time work so that isn't an option currently. He wants to but mentally isn't ready for it. He has had jobs in the past but nothing for an extended period of time. We think he's gone a long time undiagnosed.

I've had experinces with a couple of doctors like that Bippity.. skirted over sexual/personal aspects of issues. Well, more a brief question then moved on quickly!

Past events. Okay, that's useful information. DP hasn't had a great run of things so it can be quite difficult and uncomfortable to talk about his past. A chunk of significant negative events he tends to block out unless he gets a specific question, if that makes sense?

Fingers crossed he gets his appointment sooner rather than later then we can deal with things properly. At the moment it's kind of put on the back burner as there's currently not a lot we can do until then. I'm just doing research to gain a better understanding and prepare for different scenarios.

[Captainmomtotherescue]

The GP just said that his symptoms (the ones he listed) are that of Bipolar and he had some symptoms of Schizophrenia. Which we hadn't even looked into. I'm not "worrying and preparing" for the impact. I'm preparing for his first appointment. If there's anything that I can be knowledgeable about, I'd hate to think my partner is walking in blind and he'd hate that too. I'm doing this so my partner doesn't struggle when we get the letter through for his appointment. It has taken us a long time to get here - him even more so - and I'm going to do everything I can to support him through what is a difficult time.
GP also asked about family history - DP's mom has Bipolar and he has another family member with Schizophrenia. Both diagnosed formally.

He has quite a few symptoms of Bipolar and hallucinations aren't part of his symptoms.
I'm just trying to get a bigger picture. The more I understand - the more I can support him. All throughout the years, he's been back and forth to the doctors and they repeated that he has Depression and anxiety. Prescribing him sertraline, highest dosage. No matter what my partner told them. They prescribed him with Anti-depressant after Anti-depressant. Nothing was working or it was continuously making him worse. He's had several forms of counselling for his "depression" including regression, CBT etc. Again - had little to no positive effect, just the negative.

He had a bit of a meltdown about 2-3 weeks ago, which is what lead us to bipolar. I wasn't aware Dmil had it until about 3 days ago.

All I'm doing, is trying to support him. Please don't make me feel bad about that.

[PtangyangkipperbangOi]

I am bipolar, I have always known I am different and got an official diagnosis around aged 30 after a breakdown.

Dark thoughts- Yes I have them. I can be driving down the road and imagine my car crashing into a wall i am passing and it's almost like I can see it play out in front of me. I get really intense feelings of impending doom. Not unusual for me to become over worried about a possible disaster. So I went through a phaze of being petrified of crashing my car into water and my kids being stuck in the back. It was triggered by the family that died after it happened to them. So for me, the best way to deal with that is to take steps to know I have done everything I can to have a positive outcome if it did happen. So I bought 6 safety hammers for mine, my sisters car ( just in case) and had a talk to my kids about what we would do if it happened. I also worry about fires, brexit and zombies.

Medication- Please, PLEASE do your research on any medication. The NHS will want to drug your OH up as that is what they do. It makes you more compliant and easier to deal with but the antipsychotics can kind of steal your soul. I have been on valproate, lithium and quetiapine. Nobody tells you but some of them are terribly addictive. Which is fine if you are ok on them but they also often cause liver issues which means you have to come off them and....well, withdrawal is horrific. I have been drug free for 5 years and I havent had a good night sleep since coming off Quetiapine. It is an anti histamine as well so giving up a 400mg dose caused my entire body to be covered in hives and welts. Lasted for weeks. I also have shocking short term memory and tardive dyskinesia. So think long and hard about drugs.

My life was changed massively after I had intensive CBT and mindfulness therapy delivered weekly by a psychologist and I have been pretty much drug free for the last few years ( in terms of my mental health). I still get mania and depression but I take short term measures and focus hard on clean eating as a very healthy diet makes a big difference. I have drastically changed my lifestyle and meditate, do yoga and clean sleep. This has all made my life much better and my bipolar is under control drug free for say 8-9 months out of 12. I use sedatives in the summer to reduce mania and blue light therapy/SAD/D3 in the winter to improve mood and energy. any blips in mood is treated by IDing the trigger and addressing the issue and then either sleeping through it or increasing my activity levels.

[Captainmomtotherescue]

Apologies if that come across as rude/horrible in any way. I've just watched my DP go through him thinking the worst of himself, think that he's "unfixable", every avenue he's tried has failed miserably. His childhood after 7 is abysmal. I appreciate fully that it might not be Bipolar or Schizophrenia, or just the one. But his symptoms are that of someone who suffers with Bipolar and he's been suffering with them since early teens. He's late 20's. I've watched him have "breakdowns" and watched him cry that he's just a complete failure at everything. How he brings negativity to everyone's life and taints those that he loves and it breaks my heart. I know he can get extremely overwhelmed, especially with information about himself, and how negatively it effects him.

[Captainmomtotherescue]

Thankyou Ptang. I'm sorry that those things happened from the medication you were prescribed. But I'm glad you're able to cope to some extent without them, that's positive.

The only way I can describe his thoughts - as an outsider - is that he has death centered thoughts on a daily basis. He's told me he's not acting on it, but if it happened, he's okay with that. Almost like an acceptance of the scenarios in his head? He has tried to act on them in his teenage years in multiple ways.

He's had this awful belief that he can't be helped. He's such a wonderful man, I hate what he's been dealing with. Watching him being derailed is just horrible.

[FissionChips]

A chunk of significant negative events he tends to block out unless he gets a specific question

Write those events down and get him to take them in with him.
He’ll be asked things like :
*examples of times he’s experienced being high/manic.
*what were his thoughts during that time ^^ what was his behaviour like.
*times he’s been low. How low does he go, for how long?
*does he get periods of feeling “ok”?
*how long do the mood changes last
*are there any triggers to mood changes
*has he ever heard voices
*had he ever had hallucinations
*family history of mental illness
*how has he reacted to medications in the past
*what stops him killing himself
*how are friendships, does he struggle

I hope that helps a little, those are the things I can remember being asked .

[Steakandkidney]

I'm going to go against what was previously said and be supportive of taking medication, psychiatrists have experience more than us and it has helped me.
I don't mean to sound horrible here, but your GP should never have insinuated that he has symptoms of bipolar or schizophrenia, that is irresponsible. The family history is relevant but the psychiatrist will take that into account. It doesn't mean he has either. Thoughts of death can be OCD or anxiety based. Furthermore for a lot of people with bipolar antidepressants induce mania, rather than just being ineffective.
I think you need to stop trying to diagnose and read up on diagnoses, and go presenting the facts as they are. Anything else will bias the assessment and perhaps result in an inaccurate picture and inappropriate treatment, which sounds like he has had already.
You don't need to 'prepare', it isn't a trick, and you certainly don't need knowledge of different mental health problems at this stage. With respect, you need to make notes of his symptoms, not what they may be, or what may be symptoms of conditions you have researched. Just what he has, when, and how they affect his life.
You are a carer, a wife, not a mental health professional. Let them do their job and you do yours, which is to provide them with information and let them decide. And then, when he's referred to a community mental health team, they also have support for carers. Don't take it all on yourself, you need your energy to be for supporting you all, and you need to look after yourself as well.
I hope that doesn't sound abrupt x

[FissionChips]

I agree with everything Steakandkidney just said^^.