Doctors' Answers to "Frequently Asked Questions" - Mental Health

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Mental Handicap & Short Term Memory Loss Questions  [posted 12/02/98]
Question: I have an 11 year old son who has c.p. and some mental delays. (I don't like the word retarded), anyway, his teacher has commented a couple of times that she thinks he may have short term memory loss, and I was wondering where I can get some info on this problem?? He can remember things when he wants to like if we tell him we are going somewhere he remembers us telling him where we are going but he keeps asking when even after we've told him 100 times, he will ask the same questions over and over again. We are having a hard time teaching him his letters and numbers and colors. show him something red and 1 min later ask him what color it was and he doesn't remember. same with letters and numbers. Show him pictures of objects and he will usually remember them though. Some people tell me he has selective memory, if something doesn't mean anything to him he just doesn't remember it. if it is important to him he will. Last night his father had to work late, he must of asked me at least 10 times what time is dad coming home?? I told him 10 times too, then he say, "oh I forgot". Any help you can give me on where to go to get more info would sure help I don't know anything about memory loss, short or long term.

Answer: The best thing is to get some formal testing from a Clinical Psychologist who can do Psychometric Testing. I wouldn't recommend the school since I've never been impressed with their ability to test/diagnose anything, but, it would be cheaper and might be a start. You need to quantify the problem and see if there are alternatives to the problem. For example, some are verbal learners, some audio. Information intake at a different level might work, singing for example will occasionally work when talking will not since the body processes these in different sites.

 Info Regarding Medical Advances for the Mentally Handicapped  [posted 11/24/98]
Question: What is the best information on brain research related to treating or finding a cure for mental retardation? Also this question relates to research seeking ways to increase intelligence through some type of medical or surgical procedure. Thank you for your help or suggestions. This question is a result of our study of the story version of   Flowers for Algernon by Daniel Keyes. 

Answer: National Institute of Health would be the place to start, but this is a huge topic.

Schizophrenia/Family Problems
Question: Everything I have read with regard to Schizophrenia suggests it is not an easy diagnosis and there has to be testing along with the physician working with the family to help the person who is sick. Since last year, however, that has not been the case for our family. We had to make a very difficult decision last May to commit our 29 year old daughter to county mental hospital because she was delusional, anorexic ,homeless, hostile and in denial that anything was wrong. Our impression from the social worker was that we would be contacted by her social worker, who would keep us informed of what was going on with our daughter. Since she was an adult, without her permission, the doctors would not speak to us and she would not give her permission because she was angry at us and didn’t feel she belonged there. She would not cooperate with them or take any kind of medication. Her social worker would not ever return our calls and was not helpful at all. He did not even inform us of a hearing for her. If we did not call and inquire we would never have known about it. He would share nothing with us. It was like we signed our daughter over to strangers to do whatever they wanted to do with her. Not until her hearing did we hear a doctors evaluation (weeks later). The doctor said she displayed symptoms of paranoid/schizophrenia and needed medication and counseling. My daughter disagreed and emphatically told them at the hearing she would not take medication. The judge decided that she would remain there for more evaluation. We could not speak with her doctor, but we did get to speak to her social worker who was of no help. He said he would keep us informed, but he did not. When we went to visit her the next day she was not there. They sent her to State Hospital without notifying us. In the 3 months she was at the state hospital we could not find out one thing about her diagnosis, prognosis, or how to cope and/or help her when she came home. No one ever asked about her past history either. They did not want to know what kind of family she came from, what was her background. No one would talk with us and she would not give permission to let us know anything. She came home after 3 months, but swore she never took medication and that she was not on any. She said she forgave all of us and wanted to get on with her life. For 5 months she seemed normal. However, in late January and early February she was showing signs of hostility and started to become reclusive. She is now living with us and does not speak to anyone. She wakes up at 6:30 am, showers, gets dressed, and puts on her makeup (her appearance was always very important to her). She always worked out and was aware of what she ate. She keeps her area neat, she takes care of her own dishes, and thanks us for her food, but does not talk with us. Most of the time she sits in her room, eats toast, drinks juice in the morning and eats nothing until dinner. She then comes out of her room around 4:00 PM If you ask her how she is she will tell you fine. If you try to get into conversation with her she won’t answer you. When we voice our concern over how thin she is becoming she tells us to mind our own business and that she is just fine. She will not see a doctor and says she was never on medication.. Since she has no medical insurance and clinics are the only places she can go, but cannot get her to go there. We cannot even find out from the state hospital where she was and what clinic they referred her to. They won’t even confirm or deny she was on any medication. Is it possible for someone to be sent up to state hospital for 3 months and not be on any medication? I find that hard to believe. We are at a stalemate right now, trying to keep a quiet atmosphere, and trying to win her trust. But am afraid the longer we wait the worse she will get and maybe won’t be able to function as well if we had done something sooner. Is this common with adult children who experience this kind of illness at this age? Family members are denied any kind of feedback or not able to give any input into the background of the ill person.

Answer: This is a fairly common problem. In our social rush to protect individual rights the family and parents are often kept in the dark. This type of problem can only be reversed by legislation in your state. I would recommend that you write your legislator. However, the general direction of treatment of the mentally disabled is to more individual rights not less. This puts treating physicians and families in a large bind. If the person is competent , they can refuse medications. However, deciding on competence is legally difficult. Most states allow commitment - usually by two physicians, and not by family commitment. Your daughter needs to be seen by ongoing Psychiatric care. You are in for repeated episodes of this problem and will get increasingly more frustrated. Try having your daughter sign for your access to her medical records when she is on her medications and doing well. She may not comply, but if she does you will generally have better access.

Psychosis/Infection
Question: I've recently heard that acutely psychotic persons such as schizophrenics are much less likely than the general population to fall ill with an acute bacterial or viral infection. Is this true? If this is true, what accounts for their increased resistance to these pathogens?

Answer: This is news to me. Some of these people will have poorer nutrition or living arrangements, but given good nutrition and living arrangements there is no difference.

Mental health
Question: My father-in-law had a mini stroke about 6 months ago. Now he has had his stomach close up and is on a feeding tube. His behavior seams to be worse at night when only his wife is around. He says things about maybe hurting her or his self. He says he could do it but doesn't want to. What does this sound like and what should we do?

Answer: Probably dementia from the stroke. Waxing and waning of mental processes is common in demented individuals for reasons that are not clear. Ensure his physician knows so that drug levels, etc. can be checked. Many things will contribute to delirium or dementia so that small changes in medicines, etc. may yield large gains in orientation. If this fails, holoperiodol in the evening is the usual drug of choice for this problem.

Mental health
Question: Is there any evidence that pentoxifylline/ oxpentifylline/ trental is useful in the treatment of vascular dementia.

Answer: Not that I'm aware of. This drug started with a lot of hoop-la; but, isn't used very much any more since it rarely works.

Genetic Link
Question: After my mother had her last child, she developed a severe case of post partum depression. following that she was diagnosed as a paranoid schizophrenic. I understand that this can be genetic. What is the probability of me or a sibling ( male and/or female) acquiring this disorder or any other mental problems? Also what seems to be the best medication? She is currently on haldol, which works, when we can trick her into taking it.

Answer: Schizophrenia does run in families; but, the inherited character is not currently known. Much research has gone into identifying the genetic material which would predict problems-currently not available. I wouldn't worry too much about yourself; but, there will be a higher incidence than change of mental problems in your families including depression, etc. Haldol is fine as long as it works. It is one of the first drugs tried and no other medication will be necessary as long as it works. Judge by effects.



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