Q: Paranoia and Bipolar Disorder
My parent has had manic depression many years and takes Lithium and
has levels checked routinely by the DR...
Our family has noticed much paranoia (although always was this way to some
extent) that is getting worse and worse and is causing great problems. She
does not see this and will not see a Dr about it, just feels that everyone is
against her. My question is: if levels are correct does that mean she has been
misdiagnosed or has additional diagnosis or is this common even when being
treated properly. Also, how does a family go about getting help for someone
when they are not seeing the problem or are not willing to get checked out?
Dear Son/Daughter --
Paranoia is definitely a feature of bipolar disorder, though many (including
many physicians) don't know this. In several studies (summarized by Dr.
Jamison, among others) it has been shown to be quite common in this
disorder. So that means: a) you don't need to consider another
diagnosis; and b) if your parent is paranoid, the bipolar disorder is not
fully controlled with lithium alone. Another mood stabilizer; or a
higher lithium level; or perhaps a low-dose new-generation antipsychotic (my
least favorite choice, as usually when there is paranoia there are other
bipolar symptoms this medication may not reach, such as mood lability (easy
tears, easy anger)) should be considered.
Published July, 2001