
Suffering From Lack Of Interest In Family. Playing Only Video Games. Consulted Physicist. No Use. Suggest?

He was first taken to psychiatrist, when he failed in 1st year. MMPI was conducted and 'Axpeta-10mg' twice a day was prescribed. He refused follow up indicating lack of ambience of the place. He wants every thing high-end. The second psychiatrist also pescribed the same medicine and later on 'Inspiral'. After a few follow up, he refused taking medicine indicating 'loss of interest'. In next follow up, he showed anger to the doctor. He was prescribed 'Risnia'-1mg/ml 10 drops twice a day, which was given without his knowledge. While on this medicine for 10 days, he complained loss of control in limbs and tongue. He was addmitted in a hospital and they advised to stop 'Risnia'. A few months later third psychiatrist was consulted. 'Szetalo'-twice a day was given and aftewards, 'Olimelt' 2.5mg - once a day was given. While on this second medicine for few days, his stool became jet black. Doctor stopped the medicine, indicating it is improbale. Again treatment got discontinued. After few weeks, when he was only sleeping and gaming, his mother told him "why are you behaving like a mad fellow?" He bacame furious and forced me to take him to first phychiatrist. They told me that he came there to prove that he is not mad. They further told, there is no medicine, he is having ASPD coupled with NPD. Again after waiting for few months, I found out an homeopath, expecting homeopathic madicines would have less side effects. While on this treatment for few months, he became more violent. Doctor stopped the medicine. The last medicine given was 'Hyoscyamus Niger'. All the medicines, except a first few were given without my son's knowledge and all these times something worse happened.
Please advise me on:
1) What is he suffering from?
2) What behavioural approach I can take to correct?
3) What sort of treatments he requires?
4) A good psychiatrist in Bombay.
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.
You son case is difficult for caretakers and treating team. Even his attending multiple psychiatrist is facing problem to solve it. I will try to give my best effort to help you in this problem.
1) What is he suffering from?
Ans: Your son is multiple symptoms. Considering the psychological testing report, psychiatrist diagnosis and case history he may have following problem (In given hierarchy):
-PD (ASPD+NPD) with psychosis.
-PD alone
In psychosis he may have bipolar disorder (In one episode he had excessive demand), schizophrenia spectrum disorder or schizo-affective disorder. He need continuous behavior monitoring by one psychiatrist or admission for few weeks in psychiatric nursing home.
Personality disorder is a common and chronic disorder. Its prevalence is estimated between 10 and 20 percent in the general population, and its duration is expressed in decades. Persons with personality disorder are frequently labelled as aggravating, demanding, or parasitic and are generally considered to have poor prognosis.
Personality disorder is also a predisposing factor for other psychiatric disorders (e.g., substance use, suicide, affective disorders, psychosis and anxiety disorders) in which it interferes with treatment outcomes of other psychiatric disorder and increases personal incapacitation, morbidity, social complication and mortality of these patients.
Persons with personality disorders are far more likely to refuse psychiatric help and to deny their problems. Persons with personality disorders do not feel anxiety about their maladaptive behavior. Because they do not routinely acknowledge pain from what others perceive as their symptoms, they often seem disinterested in treatment and impervious to recovery.
2) What behavioural approach I can take to correct?
3) What sort of treatments he requires?
Ans: Following steps are useful in his treatment:
-Personality assessment by clinical psychologist or trained psychiatrist. It may take several days to make final diagnosis. This step has already completed in his case.
-Psychotherapeutic treatment after assessment in form of counseling, supportive therapy and cognitive behavior therapy.
-Treatment of co morbid illness like: Psychosis by antipsychotic medicines.
-Improvement may take weeks or months depending on the case.
-It is very difficult to bring these patient in treatment and treat them. It is better not to change psychiatrist on his demand, as he appear to not having insight regarding problem. It is better to visit nearby psychiatrist, so that you can approach them in need. Sometime he do not visit psychiatrist after initial visits, you can visit psychiatrist to help him.
4) A good psychiatrist in Bombay.
Ans: Nearby psychiatrist or hospital associated with Grant/ XXXXXXX G.S. medical college.
I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.
Wish you good health.
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For the past few months, he is seldom taking to us and when talking he is very harsh. But with outsiders he is ok. How to make him to talk to us?
If you are practicing, may I have your address so that I can visit you?
Regards.
Low dose antipsychotics work in behavior symptoms of PD like irritability. In my opinion he is more likely to have psychosis too.
There is no short method to change his behavior. For improvement steps in primary reply will help, but it will take time.
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Wish you good health.
Regards

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