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Having a suspicious mind, feeling irritable and making odd facial gestures. Required treatment?

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Practicing since : 2004
Answered : 1835 Questions
Dr i m writing on behalf of my brother as he is too rigid or he doesn't realize that psychiatrist can help him or even if he has anything wrong in his behaviour. He doesn't trust females especially related to him and always find that they are always interested in someone outside there wedlock/ or even when I was unmarried he was always apprehensive that I give extra leeway to boys in class and he attributes it to the dimnishing ethics in our society. We belong to a highly educated and well placed family. Even his educational background is B Tech MBA from top grade colleges. Our family culture was very different and we havn't seen anyone else having such attitude towards female. He has been divorced twice and both the marriage lasted for about a year. First one was a professional staying in hostel even after marriage and the second one was a homely girl without father bought up in a very conservative environment. both of them have complained that he alleges them of stairing other men and even to the level of servants and driver. I have found him very uncomfortable and upset when he goes out with him. He gets very comfortable after a initial hitch with outside females. He feels he's a very clean man and if he is talking to someone there's nothing bad involved in it. He's been very conscious about what I wear since our childhood and till date after after 15 years of my marriage at times his remarks seem quite filthy even in front of my husband. Nutshell he has problems with any female related to him having any sort of interaction with external men. He has even blamed his second wife for showing undue interest in his cousin. He attributes his behaviour to the kind of environment he has seen in his childhood when we were staying in a rented accomodation and crowd was uneducated and rustic. He gets furious very easily and at times temper is beyond control even he gets violent. Professionally he has been below average as he doesn't go along very well with his seniors as he has found them taking his credit he's a very tense person, gets upset very easily and he keeps brooding on one thing and looses his sleep. I have always found certain facial expressions very funny like pressing his lips tightly, taking his tongue out. That he does even in crowd and whenever he is alone also.
Posted Wed, 17 Apr 2013 in Mental Health
Answered by Dr. Ashish Mittal 14 hours later
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     44 year old male
•     Known case of hypertension and borderline diabetes
•     Complaints of: suspiciousness over fidelity of wife, irritability, odd facial gestures and social/occupational dysfunction.

Your brother case history is interesting and but difficult too. As we do not have any information from his side. I will try to give my best effort to help you in this problem based on current description given by you.

It appear that your brother is psychotic illness called delusion of infidelity. In which person is over-suspicious for character of his wife, which is false, firm, unshakable and do not match social/cultural/educational back ground of the person. Due to that social and occupational complication occur, like in your brother case.

In psychosis insight is absent, so person do not accept that they are ill, due to that they do not accept treatment, which make treatment difficult.

Following are cause and treatment for such disorder:
•     Side effect of substance use: like alcohol: so stop alcohol (if use is present).
•     Psychotic illness: due to increase dopamine in brain. It is a clinical diagnosis based on history. In such cases anti psychotic medicines (like oleanz/risperidone) are given after evaluation of patient by psychiatrist
•     Thyroid related problem: get thyroid hormonal assay done

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

Wish you good health.
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