Q. My wife has delusional disorder but believes there is nothing wrong with her even though several doctors have diagnosed her with this disorder. When she is medicated she acts pretty good but unfortunately she manages to somehow not take her meds even with me watching her. If we cannot find a medicine that we can guarantee she is taking we will have to send our children away to live with family or risk losing them to foster care. I have heard that there is a extended release injectible medicine called Depakote used in the treatment of delusional disorder that lasts three or four weeks long. Does anybody know anything about this? She is afraid of needles but has agreed to take a shot as long as it is only once or twice a month.

A. There are a few injectable medications available for psychotic disorders (delusional disorder would fit under this category) and most of them (if not all of them) are antipsychotic medications. I am not sure if Depakote is available in an injectable form at this time. Medications such as Risperdal, Clozaril, Haldol and Prolixin (all antipsychotics), and possibly a few others are currently available in an injectable form. It’s best to contact your wife’s doctor to see if Depakote is available as an injectable form and to discuss the pros and cons of an injection for your wife at this time.

It is not uncommon for a person with a psychotic disorder to not believe they are ill. A symptom of schizophrenia, a related psychotic disorder, is the inability for a person to know they are ill. This symptom is referred to as lack of insight, or anosognosia. People who lack insight into their disorder seem unable to know they are ill and as a result refuse treatments. Many people who do not believe they are ill even generate alternative reasons to explain away their condition. This may be the situation you and your wife are facing.

If your wife is willing to take the injectable form of medication, this may be a very positive step for her and your family. This may mean she realizes that she needs treatment and by getting the injectable medication, she can finally remain stable. As you are beginning to recognize, there are severe consequences for her and your family that can occur as a result of her stopping the medication. My suggestion is that you immediately discuss this with her doctor and work with him or her to find the right medication for your wife. If she is willing to take the injection, this could save you, her and your family untold amounts of hardship. If done correctly and under the supervision of a doctor, injectable medication has the potential to stop the cycle of illness relapses. I wish you luck.