Q. Dr. Heller,
My wife is being treated for bpd, bi-polar3, and ocpd(obsessive compulsive personality disorder). She has all the symptoms of bpd except for the suicidal tendencies, although she does threaten it occasionally when she has what I call "fits", where she gets stressed over something, could be something good, by becoming excited, or bad, by getting angry, or by being compulsive and working herself to exhaustion. In these fits, she gets glassy eyed, slurs her speech and stumbles around as if she's been drinking. When she is in this state, she craves alcohol, whereas she doesn't usually, and if she gets it, she explodes into a totally irrational lunatic. Over the last 4 years, she has been arrested 6 times, with 2 DWI's, while in this state. This behavior is so hard to describe or understand that law enforcement people don't really believe me, so on top of numerous medications, we also have fines to pay as well as the cost of replacing or repairing 4 wrecked cars over this period. She's the sweetest person you could ever want to meet in her normal state, but in this other state, an absolute lunatic! During these states, she's full of rage and can be violent. I've been bitten,(at least 25 times), clawed, hit, etc., over this time. She's been in the mental ward 3 times, twice for over a week, with numerous tests being done. Usually they just change her medication, although nothing so far has really helped, except for sedating her somewhat. So far she's been on Prozac, lithium( made her worse), Tegretol( gave her migraines), luvox, paxil, tranxene, and is currently on neurontin and anafranil. The fits used to come like clock-work every 3 1\2 weeks, though now they are less frequent. She has been tested for thyroid problems, has had an MRI, cat scan, and 3 EEG's, with no abnormalities being found. She also came from an abusive background.
What I want to ask is: Are the drugs she is currently on, common treatment for this? I really don't think her psychiatrist (her 4th) has a handle on this, even though she seems to be trying harder than the others to figure this out. And do you know of anyone you could recommend us to in the upstate SC area, who maybe specializes in this disorder or who at least has more experience in treating this. Her current dr. is Jeanne Morrow in Anderson, SC. Anything you could tell me would be greatly appreciated. Thank you.
A. In my experience the OCPD(obsessive compulsive personality disorder) is a brain switch for life and death sensations being stuck on, and these usually go away on high doses of Prozac (60-80mg daily).
She may have more diagnoses present, the generalized anxiety disorder (particularly the "cognitive component") and cyclothymia in particular may need to be pursued.
You also described frontal-temporal lobe epilepsy and/or complex partial seizures (which many of us believe are a component of the BPD). Depakote and Tegretol (probably worth another try) can be very, very useful for these conditions.