Q:  Manic States & a Person's Recall of Them

In a manic state does the person recall the thing that he says or does?  For instance he threatened to kill his son and had a gun loaded when he went to his house.  Had him phones me on speaker phone and said I had 10 hours to get there before he started killing him and then come after me. But all the time saying he loves his son and me.  Now he denies the whole thing ever happened. Is this possible? And if so how can his memory be triggered to remember the situation?

Any information will be greatly helpful.  I don't think he is stable yet although the doctor put him on amblify.

Thank you,
Cindy
 

Dear Cindy -- 
I wish there was a simple answer. Your situation needs one.  Many people don't know this, but the "confidentiality" restrictions do not prevent you from leaving a message for his psychiatrist describing this incident or others like it if they occur.  The doctor cannot give you information about her patient, but she can take information from you without restriction. So if something like this happens, its important to make sure his doctor knows about it -- because obviously he isn't going to go in there and describe what happened in the way that you would. 

Now, to get to your question: well, in my experience the answer is "sometimes yes, sometimes no", I'm sorry to say. I've definitely had patients who cannot remember things that happened, although usually they remember the event, they just have a different way of explaining what happened.  If they literally can't remember it at all, then we might sometimes think about a neurology test called an EEG (electroencephalogram) to look and make sure the person isn't having some sort of seizure-like thing happening.  Not all seizures are obvious, but several types of them involve complete memory loss for a period of time. And there is some sort of relationship between seizures and bipolar disorder, so that sometimes people seem to have aspects of both. 

On the other hand, I've had patients who had "catatonia", a severe version of mania (also technically seen in schizophrenia, although I always wonder if that's really "schizophrenia" when this occurs) in which people can't talk or even move much, who told me later when they recovered that they could remember in detail what people said when they were lying there unmoving.  They can remember what nurse said what, what doctor said what -- which can be tricky because people sometimes assume that the patient, who is not responding to conversation at all, is somehow "not there". 

But the memory lapse you're talking about is pretty common, as long as it's not the complete blank I mentioned above. People often don't remember the aspects of their behavior that were manic, although they remember all the rest of what happened.  If you write down in "objective terms", meaning no opinions, just observations, what happens during episodes like this, and get that information to the psychiatrist, that is a very helpful thing to do (at least most psychiatrists would find it so; just be careful to offer it as something you think they might not be hearing from the patient and note that you understand she can't call you back to comment). 

Dr. Phelps
 

Published September, 2005