Q:  Bipolar and Delusional Jealousy



I was diagnoised with BPD-2 in 97 and last month was diagnoised with BPD-1. After 12 years of a jealous free and completely trusting marriage I started to get "paranoid" about my wife having an affair. A few months after that started I was awaken to the sound of a man's voice in the middle of the night saying "I'll be going now". My mind instantly told me this was her lover leaving. A week after that a suspicious car drove by the house and again my mind told me this is her lover. Needless to say a break down of sorts happened. I lost 30 pounds in 3 weeks, my wife has denied any wrong doing. I went to the doctor and they determined it was a hallucination and a delusion. Risperidone, then Zyprexa, then Haldol and I am still struggling with believing her and accepting that the voice was a hallucination. It's been 3 months now and I go from believing to being paranoid and debilitated thinking it was true. I love my wife dearly and hold her high in value and like I said I was never this way before. The hallucination somewhat ! played into the "theme" of it being a rival. Is this common? Have you seen this particular delusion with Bi-Polar? It's been 3 months now, any idea how much longer I might suffer like Othello? This is the pits! I am currently on 1800 MG of lithium and 150 mg of Wellbutrin. I was doing better for a few weeks and have just tappered off of the Haldol. Any info on this particular delusion, the hallucination attually playing into the "theme" of the delusion, and how long this may last would be greatly appreciated.

Thanks Doc,

Mike

Dear Mike -- 
Paranoid delusions are clearly a feature of bipolar I, although they are often interpreted as "paranoid schizophrenia" by doctors who think that anyone who hears voices is schizophrenic and not bipolar, an unfortunate widespread viewpoint.  To have the paranoia be of a jealous nature, and very clear, and very focused as you describe has not been common among my patients -- but I have definitely seen it, almost identical to your story.  In fact I saw that gentleman back in my practice just last week: he had been doing very well for several years but came back in because his once subtle cycling was becoming more dramatic.  Interestingly, after our first treatment with a mood stabilizer (carbamazepine, in his case) his jealously was gone and did not return.  His cycling did return, though even with that he emphasized that he was far better than he was when he first saw me.  

Hallucinations generally play into the theme of a delusion, unless a person's thinking is extremely disorganized and nothing is making any sense at all.  

I hope your experience soon begins to follow that of my patient.  Good luck. 

Dr. Phelps


Published May, 2001