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It was tough for me to tell if lithium is available as a long term injectible. Some of the other meds are available as long term injectibles.
As you know meds for bipolar are touchy. If lithium as worked for the last 60 years that sounds like the best course of action.
I'm so sorry you are going through this. Sadly in the U.S. it is legal to have untreated mental illness and it can be very tough to get anyone to go for treatment if they are 18 or older.
My uncle had untreated schizophrenia for about the last 15 years of his life. My brother had bipolar. My sister most likely has bipolar. She was hospitalized for 6 weeks. Got out. Told Mom
that she was misdiagnosed and did not have mental illness. She has been untreated for several years and it is very rough.
Sometimes as frustrating as things are you simply have to back off. Can you drop foods/groceries off for Mom at her door once or twice a week?
I've been reading up a lot on aging and bipolar. General consensus and studies appear to be that bipolar can get worse as one gets older particularly if one is not on meds.
Currently I'm reading up on the L-E-A-P system which is supposed to be helpful. Listen-Emphasize-Agree and Partner and I'm going to reach out to NAMI.
Best wishes to you. I think this disease is worse on the family members than the one suffering.
If she is paranoid you can call 911 and tell them she is having UTI symptoms and see if they can get her to the ER. Do not tell them she has mental health issues or suspecting dementia since these are not medical emergencies. Once at the ER, it may be possible to get her in as a social admit, and possibly keep her in a psych wing until she accepts treatment. I don't know how medical staff will figure out if she has dementia or not, given her history. Checking her for a UTI won't hurt and if she does have one and accepts treatment, may simplify her symptoms so that other treatment progress for her may be possible.
Sadly when someone suffers with any form of chronic depression, they are at a much higher risk for developing dementia when they get older. That is a fact.
And the fact that your mother is now paranoid, hallucinating and forgetful means that she's now suffering with dementia and not bipolar, so you need to have her see a neurologist to have her tested to see what kind of dementia she may have.
So your mother doesn't needed to be treated for being bipolar, but now needs to face the truth as do you all that she's suffering from the horrible disease of dementia, which unfortunately isn't treatable and has no cure.
I wish you well in getting your mother diagnosed and in educating yourself about dementia, so you're better prepared for what is to come.
Wishing you the best.
Do know that this discussion should include whether or not the bipolar is the only problem right now. There are often with aging a combination of conditions that may occur.