I read your article on bipolar/mood disorders. I have a friend who was recently hospitalized for viral meningitis. She was given
anti-viral drugs for about 10 days. However, she had some underlying emotional problems (never dealt with) and she became
delusional, paranoid, mentally confused, and emotionally challenged (crying/happy) highs and lows. The doctors treated her with
Haldol injections while hospitalized, then Prozac (but not sent home with this). Currently she is still experiencing confusion,
paranoid thoughts, insomnia. She is on Resperidol (anti-psychotic), Ativan, and Cardizem (her BP went sky-high). During her
hospitalization (on the neurological ward), she had to be restrained several times due to possible violence to herself. I am very
concerned that she has had some type of psychotic break and would like to know the best way to help her. She has an
appointment with a psychiatrist next week. This is totally unlike her previous personality traits. She calls me at odd hours and
babbles about things. She can't remember anything from one minute to the next. She will repeat things and feels that people don't
want her around. Any information that you can give me will be greatly appreciated.

Thank you,


Dear Ms. Maddox -- 
Sorry for the delay in my reply, which may come now after your friend has seen the psychiatrist.  You may have learned, then, that psychiatry is limited to trying to treat the symptoms rather than knowing just what went wrong in her brain and going directly after that.  So she might get a diagnosis of "psychosis due to a general medical condition (her meningitis)".  Or the doctor might invoke bipolar disorder, which could have been "latent" and triggered by this brain insult (a temporary injury from which she has already recovered, but leaving the bipolar disorder it was the final straw in producing).  

In either case, we're stuck trying to treat the symptoms themselves: in her case, some loss of contact with reality ("psychosis") and some behavior changes that sound potentially "bipolar-like"; treated with "antipsychotics" and "mood stabilizers" respectively.  

Obviously you'd want to know what is likely to happen now -- will she recover and be like her "old self", or will she stay like this, to some degree?  Given the clear trigger by an infection, but the possibility that something much less severe was "latent" before the infection, it's basically impossible to say what her "prognosis" is at this point.  My personal goal would be to keep trying medication approaches as though she had bipolar disorder per se, therefore with a target of full recovery of her previous way of acting, thinking, talking -- but we wouldn't know whether this was necessarily fully achievable or not.  

Good of you to worry so for her. 

Dr. Phelps

Published March, 2001