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Family history of bipolar disorder. Behaving odd and laughing and talking to self. Any treatment?

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Practicing since : 2004
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my daughter withdrew from the family about a year ago. Then she stopped working and paying her rent. I (father) got her when she was being evicted one month ago. She has had some delusions (Roman emperor's daughter, and other self aggrandizement). She only really interacts with me. She doesn't like her mother at all and seems ok with her little sister.
She has gone out a few times, usually to shop for soaps, cosmetics and vitamins. She spends a lot of time in the bath.
She has also had unusual sleep patterns. Now she is laughing inappropriately and talking to herself. Last night she talked to herself in bed all night. I asked her if she was talking to someone and she replied, "No, just myself. Talking about this and that XXXXXXX
When she first came, she would help with chores when asked, but this week, she started to refuse to help more and more.

She is bi-cultural (US and Japan). However, she seems to have rejected her Japanese identity. She only speaks English, responding to Japanese in English. (This started about 5 years ago when she went to New Zealand / US for high school.

I have a family history of Bi-polar. (probably Grandfather, sister) Definitely, cousin, brother, niece. And after reading the literature possibly myself.
Posted Sun, 23 Dec 2012 in Mental Health
Answered by Dr. Ashish Mittal 4 hours later
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     21 year old female
•     Positive family history of bipolar disorder
•     Complaints of: laughing-talking to self, odd behavior and delusional thi.

From your history there are two possibilities regarding diagnosis:
•     Psychotic illness like: schizophrenia
•     Depression with psychotic symptoms

Following measures will help her in establishing final diagnosis and management plan:
-Consultation with psychiatrist so that he can do her mental status examination. These patients do not have insight for their problem, so they do not accept symptoms as abnormal or part of illness, due to that they deny for need for treatment. Usually in such cases treatment of choice is antipsychotic medications. Choice of medicine depend on patient age, weight, symptoms profile, risk of harming self or others and finding on mental status examination. Till you XXXXXXX psychiatrist do not challenge her odd behavior and delusional thinking, which may lead to anger outburst.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wishing her good health.
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