My sister has serious mental health problems - she is delusional. Advise please

[amscaredforher]

Am a regular but have changed my name in case my sister ever finds out my usual name.

Well here goes: My older sister is 33, she is single (has never had a relationship and for the past 15 years or so has had episodes of severe anxiety/ irrational thoughts. Over the past 5 years these have become much worse and she has been hospitalised several times, once having taken an overdose and almost causing severe liver and kidney damage.

She has few friends, few social skills, a serious speech impediment, and is hugely overweight due to her anti-psychotic medication she also has terrible skin which flares up, and she picks at it causing scabs and infections. Her scalp is constantly flaking huge chunks. As you can probably picture, she looks terrible. It's so sad.

As yet the only diagnosis she has been given is 'anxiety disorder'. I suspect she is autistic (one of my boys is, as well as several members of my extended family). She was recently assessed for this at the Maudsley but she came out with a score of 8 when to be diagnosed she would need a score of 10.

She has been on a college course to develop skills for people with mental health problems. Recently she was asked for help by a college friend to shut down a computer. She did this perfectly fine, but then started worrying about it and eventually concluded that she had managed to corrupt the entire computer system and everyone in the college was going to lose their work and fail the exams. She also thought that she was going to go to prison for this and be expelled. SHE DID NOTHING TO THE COMPUTERS, it was all in her head

Then the other day she ordered some merchandise from the Robbie Williams website. She is a huge fan. She has now convinced herslef that she filled out the order form wrong has has completely messed up his website. But of course she didn't, and the stuff all arrived perfectly fine. But she thinks she is in trouble with the Robbie Williams website and the stuff wasn't properly ordered so she sent it all back today recorded delivery. She now wants me to reorder the same stuff (because I have a different surname).

It so so sad and she really believes that these things are true. Does anyone know what I can do to help her? Is she having delusions of grandeur - thinking that her small actions are having such a big effect?

I don't know whether to go along with it or to refuse to order the stuff. I have told her that there is no way she could have messed up the website but she just says 'I know what I did'.

Help.

There are also some other mental health nurses on this site. Hopefully they will come and post on here too x

They can be a bit 'does he take sugar' but Rethink might be able to help you, or you could try MDF (the bipolar organisation) even though she doesn't have the diagnosis - I think both have advice lines and message boards where you can chat to other people in your situation as well as people coping with similar symptoms themselves. Also look for a mental health advocate in yours or your sister's area as they can help with accessing services and just general support.

Rethink
MDF Bipolar
UK Advocacy Network

and even Sane although their press statements really irritate me, they have an advice line and a message board.

OK will do Awen.

just called my mum and her medication 10 ml olanzipine, 40 ml citolopran

Thanks so much vacua

As far as the delusions are concerned you can say that you accept and believe they are totally real for her but that you see things differently because of x,y and z - that way you are not ridiculing her or challenging her, just explaining your own point of view and applying a bit of reality in a non-threatening way. I think it's important to tread carefully and to be respectful of what must be a very frightening experience, without adding fuel to the flames.

But if the person is stressed/anxious unbearably so, why not just say, ill pick up that bug dad because i can see its bothering you. Or, of course ill order the robbie williams stuff for you. Dont worry, ill sort it type thing.

Im not saying that if they were attempting to jump off a cliff to say oh yes what a marvellous idea.

Its just a family way to help a loved one who wants support no matter how bizarre. A nurse has different reponsibilities - you are looking out for different things.

I worked as a nurse for 5years and just left practice recnetly. General nursing. I have though encountered lots of mental health patients. Whether it be the little old lady who just had her hip replaced and is totally mentally overwhelmed. Or, drug addicts who react totally unpredictably.
Whichever i have ever come across i have alwys found the best way to nurse them was to keep quiet and to agree ie play along then twist it round to my advantage.

An antipsychotic, olanzapine, and an anti-depressant, citalopram.

very well put vacua My preg brain is failing me.

Sorry but still disagree Haychee as this is not how i have trained or practiced, neither have the nurses i have worked with.

And,
My dad had a mental health assessment at home the other day. A dr and a nurse visited him and stayed for 2hours. Not once did they not play along with him, when discussing his hallucinations. They wanted to know all about the bugs and didnt attempt one single correction of his mindset.

If playing along is soo the wrong thing to do then why did they do it for 2whole hours to my dad??

They werent playing along they were finding out about his delusions as you said. That isnt playing along is it? That is conducting an assessment. Did they say, 'oh we can see them too, would you like me to move them?'.

Surely an assessment like this would challenge him too? To discover his level of certainty?

Im not meaning to get your back uo awen. I do genuinely feel strongly that this poster should order the robbie williams stuff for her sister.

Haychee - i think the OP should speak to her sisters MH care team and also I think she knows her sister better than you or me.

Assessment doesnt mean you challenge the client to establish level of certainty over delusions. The purpose of assessment is to gain a picture of the individuals mental state, including anmy risk factors. It isnt to treat the individual. No offence but i do infact know what i am talking about as this is my area of expertise.

I also have to agree with Awen. I'm a mental health professional and would never colude with a client's delusional thoughts. If you do so, you are then encouraging it, so to speak. The best way to handle a delusional belief is to a) tell the person that you appreciate the distress (if applicable) that there belief causes them but that b) it is not a belief that you share. However c) this does not have to then stop you from supporting the individual either emotionally or practically ie in then ordering the items from the website as has been mentioned.

haychEebeeJeebees, in order to fully assess your father's mental state, the professionals your mentioned would have needed to ask him lots of questions around his beliefs - by not doing so they would have not fully understood his thought processes which in turn would have led them to failing to accurately assess your Dad's healthcare needs. I do hope that I have explained that somewhat and that your Dad recovers quickly.

amscaredforher, I would suggest that the best plan of action would indeed be to contact your sister's healthcare worker/GP to find out who the RMO (responsible medical officer) is for your sister's mental health care. As she has recently been assessed at the Maudsley, it is probably there. As another poster sugggested, find out when your sister's next CPA meeting is (this is a review meeting to check that your sister's care plan is being actioned and updated) or alternatively, her next out-patient appointment. Request that you be invited to attend either or both, to discuss your concerns.

Psychiatrists will only make a definitive diagnosis if they are 100% sure of a diagnosis, as it can be stigmatising to be labelled. Your sister may well have borderline learning difficulties but alternatively, her poor social skills may be a symptom of an enduring mental health condition. It would be best to discuss this with her care team though, especially given your family history of mental ill health.

The very best of luck.

Of course it goes without saying that to get expert advice from the team is the right thing to do.
But in the meantime, like now, this evening, while her sister is suffering, just order the stuff for her.

I remeber one delusional patient we had who was extremely distressed. We had to wait the entire night shift with her pacing the ward like she was going to kill somebody. The only way to calm her down was to play along, to gain her trust.

summer111 - again another really comprehensive post. My brain really is shot to pieces atm and am stretching to reach the keyboard.

Amscaredforher - summer has given some very good advice.

Thanks to all for your help. I ordered the stuff £100 of tat from the RW website . I just hope it brings her some happiness

I respect both mental health workers professional opinions but you clealry have not had to wait in the community setting with a loved one who is suffering. Its all very well say this to the dr, or find out when the appointment is and go along. But that could be weeks away. At the very least a few days.
My dad has been suffering with his hallucinations since september and his consultant appointment isnt until November! That is a hell of a long time to love with someone who is incredibly anxious and distressed.
When he is having a really bad time, one day can be torture for those around him. Let alone a couple of weeks.

Haychee, you have no idea of what i have experienced in terms of caring for others but ime many mental healthcare workers go into due to experiences in their own lives (often loved ones being unwell). It isnt about being agressively challenging to the delusions, it is about reassurance, understanding and compassion, but not colluding. You are their anchor to reality and if you read summers post she explains it so much better.

it is also possible to both have hallucinations delusions, psychosis and experience it but know at some level you are not in a proper reality..if health professionals endorse your reality then it may be very confusing and disorientating

probably not a very good explanation

different however from listening or saying that you understand the reality of the patient is real to them

Yes, i agree with reassurrance and compassion.
I find my dads dp`s management of him degrading and upsetting. She gets cross and snaps at him for allowing himself to believe his own eyes.

I wonder if you came into the profession having witnessed a family memeber suffering and if you have lost sight of what its like to be that close to it.
You are speaking very professionaly correct, and comes across as very medical rather than empathetic.

Haychee, I think you are completely out of order for that last post. I also disagree with your views on this and am fully aware that this isnt the only time i have disagreed with you. I guess you see the world very differently from me, which is fine.

..if health professionals endorse your reality then it may be very confusing and disorientating

But op isnt a health professional, she is a sister who doesnt know if she should reorder the robbie williams stuff or not.

Apologies awen, was a bit harsh. I take it back.
But i do think you are looking at this one far too deeply and professionaly rather than compassionately.

i was answering you tho not the op

Just going back to the original post, there are antipsychotics that are more weight neutral - olanzapine is one of the worst for weight gain. Apparently abilify (aripiprazole) is much kinder in terms of side effects, it could be really helpful for your sister if someone talks to her psychiatrist or community team about some changes to her medication.

What you could do, specifically, is say to her "I will reorder the stuff for you because I can see how upset you are and how much you want it. But I am only doing it because you have asked me to, not because you have really damaged their website in any way."