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?

      Thank you

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. 

Dr. Phelps

Published July, 2001