Can you suggest a medicine to control aggression in bipolar disorder?

Question

Hi doctor,

My mother has been diagnosed with bipolar disorder, and no medicine help with her aggression. She is currently on Zolam and Clonafit. I have also attached her other prescription reports for your reference. My mother beats and abuses our maid. She defecates in the room whenever she wants to punish the maid and us. She is more aggressive with females only. Can you suggest any other medicine to control her aggression?

Answer 1

Hi,

Welcome to icliniq.com.

I have read your query and I understand your concern. First of all, I feel that she is developing dementia as defecating in the room is not a characteristic of bipolar disorder. I understand she punishes other family members, especially maid, but this is not something a person with evident bipolar disorder does. For clarification, I request you to get a CT (computed tomography) scan or MRI (magnetic resonance imaging) brain of her mind and post a detailed follow-up query. I am sure that she is exhibiting signs of dementia, including forgetfulness, difficulty in keeping personal hygiene, agitation, difficulty in identifying time and place, especially during evening hours. Regarding her aggression, considering the history of bipolar disorder and the possibility of dementia, I suggest the following: Consult her specialist doctor and get the dose of Quetiapine increased. As I can see from the previous prescription, she received only 75 to 100 mg of Quetiapine. This dose is not enough for any person with bipolar disorder. The dose is generally 400 to 600 mg per day, and I think the dose of Quetiapine can be increased to at least 200 mg to control her aggression. The second alternative is lithium. Lithium is a proven agent for bipolar disorder, and considering her age, a dose of 600 to 900 mg can be used safely after getting the renal profile from your nearby laboratory. Thank you.