PATIENT PROFILE
Age: 35
Gender: Male
Topic: Psychiatry
Chat Rating: star star star star star_half
Location: Mumbai

cyclic mood changes every 3 or 4 months

Dr.
Please enter the Patient's name
Please enter the Patient's name xxxx
Dr.
Hi xxxx , Ms. xxxx will take up your case.
Dr.
Good Evening xxxx! I am here to help you, please tell me more about your problem.
my husband and i have been married for 5 years and have a 2 year old daughter
Dr.
U want me to call now ?
no i would prefer to chat if thats ok
Dr.
Yea sure
Dr.
Tell me
my husband and me are both doctors,while he is practicing,im not after my daughter was born
Dr.
Hmm
I'm concerned about the mood changes he has
Dr.
Explain
It's like a cycle
It's like a cycle
Dr.
Tell me about the cycle
It starts with him feeling down, doesn't feel good despite nothing really wrong, he gets upset about the most trivial of things,and stays upset
Dr.
Hmmm
and would withdraw and be sulky
Dr.
Ok
i would then get very disturbed by his behaviour and try to pacify him and end up apologising for no actual fault of mine
i would remain tense and fearful
this would keep getting worse over about a month
Dr.
Ok
where he would better for 1 dayr and then some other matter would upset him so again he would be back to upset
after this phase comes the phase of anger and resentment mainly towards me
fault finding and also some emotional abuse
This would also escalte over a few days
Then it led to physical abuse
so after the physical abuse, either immediately or after a few days, he has remorse guilt and insight
Dr.
Hmmmm
after that he is his loving caring self
during which time he seems quite mature and understanding
Dr.
Hmmm
and then again the cycle starts
How should we handle it?
Dr.
Ok I want to ask few questions
is it something organic?
sure
Dr.
If we remove these episodes how's the life otherwise ? Smooth ? Any stress
Since these episodes have been occuring for so long and the accompanying emotional abuse its been very difficult for me
so i have actually come to my parents house
Dr.
Before these episodes began ?
Dr.
Since when has this problem started
since 5 years, it started within months of getting married
Dr.
Ur marriage was peaceful was there any stress at that time
and he admits to having these Mood cycles even before marriage
Dr.
Has he ever been on treatment for this
there was a lot of stress, love marriage
no not for this,but about 3 years before we got married he was told he might be having a mild case of ocd and was given treatment for 3 months
Dr.
Ok so..
which he didn't tolerate very well
Dr.
First
Dr.
There is one phase
Dr.
Where he gets very sad withdrawn doesn't like anything feel helpless hopeless worthless cry feel suicidal loses sleep a petite negative thoughts right which goes on for around a month
Dr.
Then sometimes in between he gets normal
Dr.
Then there is second phase
yes
Dr.
Where he gets very aggressive feels less need for sleep but feels very energetic talks a lot says rubbish things .. his inhibitions goes down and he feels he is some vip and talk big things spends extra money unnecessarily and sexual desire increases etc ?
no that's not right
Dr.
Ok
Dr.
Part of it
Dr.
How's his mood in second phase
The first phase is followed by the phase of anger, resentment and abuse
then apology ,guilt
Dr.
Ok
Dr.
Mam this behavior is not normal
Dr.
It's indicative of
Dr.
Mental illness
Dr.
Depression or bipolar mood disorder
Dr.
And needs treatment through medicine
but he doesn't seem to go into mania
Dr.
It could be hypomania
Dr.
But definitely depression is there
Can abuse and aggression be a part of depression?
Dr.
Not always
Dr.
Schizo affective can also be the case
but its possible?
Dr.
But it can said by examining the patient
Dr.
Ya
Dr.
Agitated depression
schizo affective?
Dr.
It seems more like depression
ok
Dr.
Ya some features of schizophrenia some of mood disorder
Dr.
Tell him to consult a psychiatrist
Dr.
And seek help
Dr.
He can get alright
he was prescribed fluoxetiene about 15 years back
for a bout of depression
Dr.
There u go
Dr.
He needs proper course of medication
ok
Dr.
Go for it
he has undergone some sessions of counselling
Dr.
Won't help much. Medication is the best way
ok will try to convince him
Dr.
Great
Right now its phase 1
Dr.
Yes he will get convinced
so i don't think he will be open to it
Dr.
Once he gets normal
Dr.
Then u tell him
does agitated depression have cycling?
Dr.
Can sometimes
ok that fits then
can you give me some advice as to how should i handle him in difficult situations
Dr.
See
Dr.
Whatever he is saying or doing
Dr.
Is because of his disorder
Dr.
Remember that
Dr.
So try to be aware of this
Dr.
And have less conversation with him
Dr.
Avoid talking much and reacting
Dr.
Just try to remain calm
Dr.
Let it pass
ok not trying to talk to make him feel better
Dr.
Yes.. otherwise it will create more stress arguments
Dr.
N very important he should take medicine
i try that but im scared that i will be blamed by him that i don't care
Dr.
That's OK that's temporary it's out of disorder don't worry once that goes he will forget it
ok
i have also become very scared and afraid of him over time
Dr.
I understand that.. anyone would be
i tried being calm in front of him but was so agitated inside,this led to him not noticing the distress his abuse was causing me
i tried being calm in front of him but was so agitated inside,this led to him not noticing the distress his abuse was causing me
so i couldn't take it anymore and moved out
for the past 2 months
Dr.
U did good
Dr.
He will be fine after treatment
but we are trying to make it work
Dr.
Coax him for that
that is a relief
Dr.
Yes
Dr.
All the best
but what do you think will the duration of treatment be required
Dr.
Depends on diagnosis
Dr.
Minimum 3 years
ok
i hope it isn't bipolar or schizo affective
Dr.
Hope so
because it will be difficult to treat
and limited response
Dr.
Hmm Let me know... if he agrees for treatment
would you recommend online treatment?
because he is really reluctant to go see someone
Dr.
It's best to see someone personally
since he believes it would affect his own practice if word travels
Dr.
Doctor keeps it confidential
He is overly concerned
Dr.
Tty to convince
Anyway Thank you for the advice
That was very helpful
Dr.
Yes all the best
thanks
Dr.
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