Waiting for crisis team - menopausal psychosis?

[Lindylu74]

Mg sister who is 53 has been having mental health problems on and off for 2/3 years with the menopause but in the last week, it has got a lot worse and in the last 48 hours, I think she may have developed psychosis.

She is delusional, thinks she has done something wrong at work to do with data protection and wants to hand herself in to the police. She keeps packing her bag to go to prison and has asked me to look after her now adult kids while she is in prison. It has come to a point today where we have had to lock the front door and take the keys away as she wants to drive to the police station.

I’ve rung the crisis team and they’ve spoken to me and her on the phone and they’re sending someone out within 24 hours. She’s never been involved with mental health services before so I don’t know what to expect.

can anyone share what happens with the crisis team? What are the options? Is there anything I can do to help while we wait. I keep trying to reassure her but she’s so agitated, can’t sleep or eat.

Bless her x no wisdom to impart but you have done the right thing

You sound like a lovely sister - I hope you manage to get something in place for her ❤️

In general.. crisis team will talk to her and see how she presents. If she would benefit from treatment they will look at options. Could be inpatient could be via a home based treatment team. If she doesnt agree or isn't capable of agreeing then they will arrange a mental health act assessment where 2 doctors and an approved mental health act professional (or amhp) will assess whether she needs detention against her will.

Its not a quick process to find beds at present. If you think shes a risk to herself or things escalate, A and E is a place of safety.

Good luck xx

I'm a mental health nurse.

Crisis teams usually provide intense support to try and keep people out of hospital. They will ask a lot of questions and assess her risk. They will want to avoid her being detained (or informal admission).

Assuming she is taken on to crisis caseload and they don't call an immediate mental health act assessment (which I doubt unless she's a significant risk to herself/others), she should get a fairly speedy medic review. She may be offered a type of drug called an antipsychotic, which should help with the delusions. They might give her something like Diazepam to help the agitation. If she doesn't engage with or respond to treatment, due to her agitation levels/the risk of her going missing, she might need hospital treatment.

On a side note, this usually happens with older people, but make sure you check if she has any UTI symptoms, as a UTI can cause delusions/confusion/acute change to mental state.

Is there anything that will distract her, OP? Can she concentrate enough to do something like watch the TV? Would going for a walk together help burn off a bit of the agitation? If she's that agitated it sounds like she's very preoccupied with the delusions, bless her.

If you feel you can't cope with her presentation, don't hesitate to take her to A&E. There are mental health teams in hospital who specifically see people in A&E/on the wards, so that's an option if you're struggling to manage.

Thank you all for reaching out. It’s so horrible to see her like this. She’s totally disengaged from reality and I can see she’s exhausted. I’m hoping they will be able to give her some medication and we can keep her at home. She’s definitely not a risk to others but I’m not sure whether she might harm herself so I’m keeping a close eye. I’ve had a call from the team to say they’ll be here in an hour which is good as I was worried how I will manage for 24 hours as she keeps trying to leave the house. Thanks for explaining the process and the options.

Could you try something physical but undemanding like cleaning out her kitchen cupboards to redirect the adrenaline and agitation? Might help to ground her a little bit.

Sorry, just read your update. If they’re coming within the hour I actually wouldn’t try any grounding activities, because i’d want them to see her at her worst. Really help they give her something to break the cycle tonight, and then a plan going forwards.

By the time they came out, she had calmed down a bit and didn’t present like she had earlier. I don’t know if she was trying to do that because she kept saying she didn’t want to go to hospital so she wanted them to think she was ok or she genuinely felt calmer. She said she didn’t want to harm herself or go to the police but she had said all day she would do both. They were very understanding and sympathetic with her and have recommended we get an urgent GP appointment this morning which we’ve done. But it’s only a telephone one. I’m hoping they’ll ask to see her and prescribe something to give her some temporary calm. After they went she slept for a bit but then got up and asked to go to the police station again in the early hours so she’s definitely not well.

Hi OP, good to hear your sister has calmed down. As you mentioned her mental health being related to menopause, is she on HRT and has she recently made any changes to it? It can sometimes be challenging to find the right treatment. I have a friend who ended up in A&E after trying one of the patches (I don’t know exact details) however another type worked well for her..

The calm didn’t last unfortunately. I’ve brought her to the GP but she keeps trying to leave to go to the police station. Managed to keep her here. I just really hope they can help her. I’m not sure what else I can do. She’s tried patches and gels but her oestrogen levels never rose. So now she’s on oral oestrogen. She’s also on mirtazapine.

I’m sorry op I had exactly the same with my sister two years ago

i caught her trying to climb out of a window she was so disoriented and disassociated from reality it was absolutely petrifying.

I sitting the crisis team any help at all,I also struggled to get help from the gp other than meds which take a while to kick in and then need adjustment.

we had a really terrible time but I will say pls push push push for help

if it continues take her to a and e and really push to get some help because the service is so strapped you’ve got to really fight to get help

i really feel for you and I had daily contact with my sister whilst having my own family business kids etc etc and it was brutal.

shes a lot calmer now bless her but will never be the same person again

it took us twelve months on the list to get counselling and she had six cessions and that was it.
please keep pushing for help

if she still presenting this way the crisis team may well make a referral to the responsible AMHP team for a mental health act assessment.

Maybe contact Dr Louise Newsomes clinic https://www.drlouisenewson.co.uk/
she is supposed to be very good

Your poor sister. She needs urgent help both with her mental health and menopause. In my experience most GPs are just not equipped to deal with this. I was not as bad as your sister but was very mentally unwell and unhappy, thoughts of ending it all, really weird sense of being out of my body and an observer. Very odd decision making and looking back things I felt were normal and reasonable were really very much not.

once this crisis is dealt with, help her to push for an urgent referral to a menopause specialist or clinic.

I can sympathise, my DF had a mental health breakdown after retiring and was delusional- lots about making a big mistake and work. He was also a master of masking in front of professionals.

Key tips - keep a diary of incidents/delusions with times and durations, and any other unusual behaviour (involuntary moments, tics etc).
Try to record behaviours on film, difficult and unpleasant to do, but can be useful for showing reality when patient is able to mask. Try placing your phone somewhere capturing the room and leave to record so it’s not obvious.
Don't put yourself in danger, call an ambulance or police if she becomes agitated and is trying to leave, don’t restrain her yourself if it comes to that.
Call an ambulance or take her to A&E is she threatens to harm herself.

Has the GP scheduled a follow up appointment?

The GP has prescribed diazepam and she’s been taken on by the mental health crisis team for home visits. She’s got a follow up GP appointment on Wednesday.

She lives with her husband and one of her adult children. He’s very supportive and looking after her but he’s finding it hard. I’m supporting him and we’re taking turns to look after her. She hasn’t threatened to harm herself today but she did yesterday. They’ve told us she has to have someone with her 24/7 so we’re making sure that’s happening.

I’m hoping the diazepam helps calm her down but I’m not sure what will help with the delusions. We are at a loss, just keep trying to be there for her and hoping there will be some improvement soon. It’s so upsetting seeing her like this.

@Lindylu74 please don't let them obsess over hormones and so on

Paranoid delusions are a feature with schizophrenia - they must look at that.

I think she would be better in a facility to be honest once the delusions have taken hold, they are very powerful

Sorry but this is nonsense. The Crisis team will be well aware that there are a number of illnesses which can cause delusions. It is also very difficult to get NHS inpatient treatment.

OP, you sound like a wonderful caring sister and she is lucky to have you and her DH to advocate for her. 💐

How’s she doing, @Lindylu74? Been thinking of you.

She saw a psychiatrist today and has been diagnosed with depressive psychosis. She will get a daily visit from the mental health crisis team and she’s been prescribed medication. I sat with her tonight for a few hours to give her husband a rest. She was less agitated but was detached. I find it so upsetting seeing her like this especially when I leave her and go home. But I can’t really talk to anyone about it as I feel she wouldn’t want me to so I’m just trying to focus on being of practical help.

That’s really positive that she has seen a psychiatrist and been given a diagnosis.

Has she been given some medication or a plan for treatment?

You sound a lovely sister and I hope your sister recovers swiftly. Sorry this is happening x

Yes they’ve increased her antidepressant and prescribed diazepam in the short term. They’re considering which antipsychotic to give her. The thinking is that this should stop the delusions and calm her. At the moment it just doesn’t feel like her, she’s like a different person and that’s what is so upsetting.

💐

This sounds more like very severe OCD than psychosis- convinced she's done something wrong and wanting to confess. It's often misdiagnosed. Hopefully the picture will become clearer once the antipsychotic kicks in and she is calmer. I hope she can get specialist help. You sound like such a lovely sister.