Medical Literature

Why Does my Husband Stop Communicating?

QUESTION:

Dear Dr. Heller:

I am mid 50’s and my husband early 60’s. Been married 25+ years. We become close to other couples and suddenly my husband stops talking to them! No explanation. The couples ask if they have done something wrong as they don’t understand. There is no response from my husband. He is an extremely domineering person but has mellowed some with time. This disassociation problem seems to be getting worse. I cannot make excuses and feel the problem must be confronted but don’t know the problem nor the way to proceed. What do you suggest? Any help, much appreciated.

Thanks.

 

ANSWER:

There are many possible explanations, including seizures. The screening test I use for my patients will likely be of enormous use. Counseling, and EEG (brain wave test), and that screening test seem an excellent start.

 

2000 February Questions

 

Ask the Doctor

 

QUESTION:

Dear Dr. Heller,

I understand that you are a very busy and in demand person.  I have read your book Biological Unhappiness and feel that my husband probably has the BPD.  However, there are some things that don’t quite fit.  And, there are criteria in the other causes for biological unhappiness that do fit.  He is currently in a really bad period and says that he thinks about suicide all the time.  He saw a Jungian therapist for almost 10 years and then had a really terrible depressive episode where he quit therapy, had an affair, and then become so frightened by the suicidal thoughts that he checked himself into a hospital.  They kept him for only about three days.  Once he felt safe, he was rational again and they felt he didn’t need to be there.

He changed therapists and has been seeing someone for about four years now and things were going pretty well until about April of this year when he started getting stressed about money and his job/lack thereof.  Now he’s back to almost as bad as he was four years ago when he went to the hospital.  I need to know if there is a doctor/psychiatrist in our area that can help him using your methods.  He is very sensitive to medications and chemicals of all kinds – MSG and nitrates in food seem to make him sick with severe stomach cramps and diarrhea.  The normal household cleaners like bathroom cleaner or waxes can trigger great agitation and sometimes anger.  So, it is vital that he have adequate supervision and support for using medications because he is so sensitive to chemicals.  He has tried some things, but is afraid of most of them or says that they don’t work.

Please, give me your help.  I don’t want this bright and basically kind man to kill himself or turn into someone he hates because when he gets like this he says and does things for which he has a hard time forgiving himself.

 

ANSWER:

The BPD rarely exists by itself, and the other diagnoses he has worsen the BPD, just as the BPD worsens the other diagnoses.  I consider the BPD the most significant illness because of the risk of violence and suicide.  Generally those with severe intolerance to chemicals like MSG and nitrates have the generalized anxiety disorder also.  This could temporarily cause a problem. His depression is scary.  If he has the BPD, Prozac 20mg daily for a week followed by Tegretol should have dramatic effects.  If the Prozac makes him agitated during the first week he’ll need temporary medication.  In my practice I usually prescribe Seroquel in the evening until the patient can take the Tegretol.  Sometimes Seroquel is needed in the morning as well.

This page should be of enormous help as well: http://pks.947.myftpupload.com/AskDoc/First-Do.htm

QUESTION:

Dear Dr. Heller,

My sister (age 39) has been in and out of mental hospitals 4 times over the last 4 years.  Her first hospitalization occurred 6 weeks after the birth of her 3rd child.  There is a suspicion that there has been mental and emotional spousal abuse that has just come to light.  She has been diagnosed obsessive-compulsive, manic depressive and one therapist even said that there may be schizophrenia.

There is no prior mental illness in our family.  Her main symptom is that she has gone into a “religious” mode in saying that God doesn’t love her because she has been very bad.  This is all she can focus on.  She believes a demon has entered her body and at one time, upon hospitalization, she believed that she was Satan.  She is currently going through a divorce from a controlling husband, which is taking a toll on her mentally.

My question is this: Should we be seeking counseling from an abuse center, or continue seeking a psychotherapist?  No one has agreed on a diagnosis.  And if we continue seeking psychotherapy, how does one go about finding the best in the field, in our area?  She has seen 4 doctors, all who disagree on a diagnosis.  We are at our wits end and would like to see some progress.  I do know at this time, she is on Depakote, and other drugs.  Should these drugs be “helping” her, because I don’t see much improvement.

ANSWER:

You brought up the most important issue – what is the diagnosis (or what are the diagnoses). When everybody disagrees, the family and the patient are stuck in the dilemma you have.  This is a situation where you need to be knowledgeable.  Carry a DSM-IV with you to a psychiatrist or therapists office and ask why a diagnosis is being made, and review the criteria with the professional.  It’s very reasonable to ask why the diagnosis is being made.  It can be difficult finding someone you like and feel confident with.  Friends and others can give recommendations, but you may have to “shop” physicians to find someone you (or your sister) feel comfortable with.  Sometimes it’s worth traveling to an academic center for an opinion, like a University.

QUESTION:

Dr. Heller,

The books are on order from Amazon.com but, in the meantime: – my friend is a woman, 39 yrs., who I think may have BPD.  The symptoms match but she has suddenly gotten much worse since her GYN put her on a combination hormone to stop excessive menstrual bleeding.  She is supposed to take this all the time, NEVER stopping to have a period!  Do these hormones disrupt the serotonin and dopamine balances?  – Now her mood swings happen within minutes and she is angry most of the time; threatening violence to herself, her friends and her pets.  She is also confused, illogical and falls down frequently.  Is it BPD or a brain tumor?  Or both?  – She also takes: a T3/T4 thyroid replacement: Thyrolar, for low thyroid function, and glyburide for Diabetes I1 .

ANSWER:

A brain tumor is highly unlikely.  Both overtreated and undertreated thyroid can cause mood swings, as can some estrogen levels.  An “estradiol” blood test would determine the blood level of estrogen.  If she’s been moody and angry prior to these hormones, the BPD makes sense.  Hormone irregularities can make the BPD worse, but won’t cause them.