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How can I help my brother who has a psychiatric problem?

Q: My brother is suffering from depression and violent behaviour for 19 years. He has received psychiatric treatment from many doctors who gave sedative drugs, injections etc. Now my question is can such patients recover or not? My brother sleeps day and night during depression and all of sudden becomes violent and during an attack, he never takes any medicine, he does not even sleep at night and creates a lot of trouble for us. He eats tobacco daily. Because of this he is unable to do any work and is frustrated. He has a wife and a daughter. He is living with my parents along with his wife and daughter. Once the violent attack begins we never know when he will become normal and give him medicines forcefully. Is there any new medicine for such type of patients?

A:I understand from your query that your brother is suffering from depression and violent behaviour. Also that he has been taking psychiatric treatment since a long time. Before, I can conclusively answer your query I would need to know to know a few more details regarding his symptoms and the specific medications that he has already received. Is depression the diagnosis given by the psychiatrist or is it a symptom, which you feel he is suffering from. During the phase when he sleeps night and day, how is his interaction with other members, friends, relatives etc. Does he make reasonable, adequate, meaningful conversation during that phase? Does he take care of personal hygiene during that phase? Regarding the phase of violent behaviour: can I kindly point out that violent behaviour can be secondary to various psychiatric diagnosis viz: bipolar affective disorder, alcohol use/dependence, schizophrenia, impulse dyscontrol etc. When your brother gets violent all of a sudden, would you be able to let me know if there are any precipitating events, which provoke this behaviour. During this time does he report feeling suspicious about the motives of people or feeling that they might be trying to malign/ harm him? Has he reported hearing voices during this period? Does he talk about odd, topics during this phase? Is he physically or verbally abusive during this phase? How is his behaviour controlled during this phase. How is his mood state during this phase. As yet there are no injectable antidepressants available in the market. So, when you say that he has been receiving injections, what are the injections that he has been receiving? Has he received these injections once in a fortnight, or in a different time interval? What are the medications that he has received till date and currently? A number of new psychotropic medications are currently available. It also needs to be pointed out that seemingly your brother requires consistently, adequate dosages of medications in both the phases of the illness. However, based on some of the answers to the above questions, and the information about which particular medicines have been tried in the past, it would be apt to visit a psychiatrist who would be able to take an appropriate decision into the best psychotropic.

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