What's wrong with my mother?

QUESTION:

Dear Dr. Heller,

My Mother has had situational episodes of mental health problems in the past.

This episode has been brought on by problems with the youngest child (27 yrs old), who is caught up in drugs real bad.  Mom has been trying to shield all the details from the rest of the siblings in an attempt to protect her (my sister) from more heartache, etc.

In this instance, her speech is periodically syncopated, like ("got to wait--too much") almost like she's in the middle of a sneeze, but it doesn't come.  She's not communicating in whole sentences for a bit, and then she will speak very normally for a couple of minutes.  (CAT Scan was normal, neurological exam was not remarkable.)

She also has minor paranoia, and seems mildly manic.  She is taking Vistaril every 5 to 6 hours and taking Trazodone (200 mgs) at bedtime.  This therapy just began 3 days ago and she doesn't seem to be improving.

Could these symptoms be GAD?  Should I seek professional help outside of her neurologist, with whom she is very comfortable, and has been seeing for four or more years for unrelated problems?

ANSWER:

There's significantly more wrong than the GAD, which may or may not be present.  It's usually a genetic diagnosis.

If her neurological exam and CT or MRI are normal, she needs psychiatric assistance.  If her personal physician is knowledgeable about treating people like her, that would be fine.  If not, consultation with a good psychiatrist is warranted.  She's most likely depressed with psychotic features.  She could respond dramatically to Zyprexa or Seroquel along with an antidepressant.  I've never been impressed with Trazodone as an antidepressant.