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Suggest Treatment For Frequent Mood Swings And Negative Thoughts In A Person
Question: My son is 23 years old, Diagnosed with ADHD- asperger. He keeps repeating the the same question over and over again. and always talk of negative things. He was sacked from school when he was 15 years as he hit the teacher. but a gentle hit, and now he keeps telling that he was sacked because he touched the teacher each day several times. and becomes violent. his command of language is very good and his memory is also very good. how can we cure him? He taking meds from small days on words, but no improvement at all.
Brief Answer:
need some more details.
Detailed Answer:
Hello
Welcome to HCM.
I can understand your concerns for your son.
I think there is some diagnosis-treatment mismatch in your son's case.
Kindly provide some more details about his health issues to help me guide you better:
1. He reapeats same question again and again. Have you noticed similar repetetions in his other behavior? Fixed routines? Change in routine disturbs him?
2. He talks of negative things. Can you give 1-2 examples of what negative he talks?
3. He was sacked from school because he misbehaved with teacher. Do you used to get frequent complaints about his behaviour from school? Disturbing others, not waiting for his turn, not sitting in class attentively and running here and there?
4. How is his social interaction? Friends, relatives? Facial expression?
5. Any abrupt mood swings?
6. Does often gets aggressive, is overtalkative and extravagant?
7. Any attempts of self harm?
8. Drugs of abuse like alcohol etc? Family history of mental illness?
I know this quite a long list. But the answer to these questions will help me to reach to a definitive conclusion for your son.
Correct diagnosis will help to decide appropriate treatment since he is not responding to current medications.
Hope to hear from you soon.
Thanks.
Dr. Shubham Mehta, MD(Psychiatry).
need some more details.
Detailed Answer:
Hello
Welcome to HCM.
I can understand your concerns for your son.
I think there is some diagnosis-treatment mismatch in your son's case.
Kindly provide some more details about his health issues to help me guide you better:
1. He reapeats same question again and again. Have you noticed similar repetetions in his other behavior? Fixed routines? Change in routine disturbs him?
2. He talks of negative things. Can you give 1-2 examples of what negative he talks?
3. He was sacked from school because he misbehaved with teacher. Do you used to get frequent complaints about his behaviour from school? Disturbing others, not waiting for his turn, not sitting in class attentively and running here and there?
4. How is his social interaction? Friends, relatives? Facial expression?
5. Any abrupt mood swings?
6. Does often gets aggressive, is overtalkative and extravagant?
7. Any attempts of self harm?
8. Drugs of abuse like alcohol etc? Family history of mental illness?
I know this quite a long list. But the answer to these questions will help me to reach to a definitive conclusion for your son.
Correct diagnosis will help to decide appropriate treatment since he is not responding to current medications.
Hope to hear from you soon.
Thanks.
Dr. Shubham Mehta, MD(Psychiatry).
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor,
1. He reapeats same question again and again. Have you noticed similar repetetions in his other behavior? Fixed routines? Change in routine disturbs him?
- He only repeats the same question .Yes it does disturbs him if the routine is changed.
2. He talks of negative things. Can you give 1-2 examples of what negative he talks?
- I must hit that woman
- I will break the piano
and he tells the dates in advance and has done it on that day sometimes.
3. He was sacked from school because he misbehaved with teacher. Do you used to get frequent complaints about his behaviour from school?
Disturbing others, not waiting for his turn, not sitting in class attentively and running here and there?
- Yes it has happened
4. How is his social interaction? Friends, relatives? Facial expression?
Very poor and does not maintain eye contact
5. Any abrupt mood swings?
Yes. for this we are taking Valparin- alkalets 1000mg per day. and Risperidone 4mg a day.
Is this medicine correct? or what do you recommend for this sort of behavior.
Will behavior therapy improve his present position in addition to the drugs he is taking now? What is the behavior theory you recommend.
6. Does often gets aggressive, is over talkative and extravagant?
Yes, but we believe that the medicine keeps him under control to a great extent.
7. Any attempts of self harm?
No. Never.
8. Drugs of abuse like alcohol etc? Family history of mental illness?
No.
1. He reapeats same question again and again. Have you noticed similar repetetions in his other behavior? Fixed routines? Change in routine disturbs him?
- He only repeats the same question .Yes it does disturbs him if the routine is changed.
2. He talks of negative things. Can you give 1-2 examples of what negative he talks?
- I must hit that woman
- I will break the piano
and he tells the dates in advance and has done it on that day sometimes.
3. He was sacked from school because he misbehaved with teacher. Do you used to get frequent complaints about his behaviour from school?
Disturbing others, not waiting for his turn, not sitting in class attentively and running here and there?
- Yes it has happened
4. How is his social interaction? Friends, relatives? Facial expression?
Very poor and does not maintain eye contact
5. Any abrupt mood swings?
Yes. for this we are taking Valparin- alkalets 1000mg per day. and Risperidone 4mg a day.
Is this medicine correct? or what do you recommend for this sort of behavior.
Will behavior therapy improve his present position in addition to the drugs he is taking now? What is the behavior theory you recommend.
6. Does often gets aggressive, is over talkative and extravagant?
Yes, but we believe that the medicine keeps him under control to a great extent.
7. Any attempts of self harm?
No. Never.
8. Drugs of abuse like alcohol etc? Family history of mental illness?
No.
Brief Answer:
ADHD with co-morbid mood disorder.
Detailed Answer:
Thanks for the posting the details.
It has really helped me to understand the scenario better.
Keeping all the details in mind, I think that your son is having ADHD along with superimposed mood disorder.
I do not think there is a possibility of Asperger's syndrome.
And the drugs which he has been prescribed (risperidone and valparin) are appropriate for him.
I will tell you the reason why I say so:
1. since he has frequent mood swings, a mood stabiliser is needed in his case. Valproate (active ingredient of valparin) is an excellent mood stabiliser.
2. The aggression will be best controlled by risperidone.
Both the drugs (risperidone and valparin) work in synergism and provide a spectrum to control most of his behavioral issues.
3. Since his behavior is controlled by these drugs (as you have mentioned), he must continue with these drugs. Other options could be olanzapine and lithium.
I also think that addition of stimulant medications like atomoxetine or modafinil (prescription drugs) should be considered for him.
Please avoid antidepressants drugs like SSRIs (fluoxetine, escitalopram etc) and TCAs (clomipramine, imipramine etc.) or other antidepressant drugs. These drugs might precipitate his condition.
Since this condition is very difficult to manage (the limitations of medical science), he might require a long-term drug treatment.
Regarding your query about behavior therapy, such therapies are given to those clients who accept and understand that they have mental health issues.
Does your son accepts that he has some behavioral or mental health issues? If yes, only then the behavior therapy would work for him.
The behavior therapies are usually framed depending upon individual's condition.
Social skill training and group therapy might help him, if only he accepts to go for it.
I hope I have answered to your queries satisfactorily.
Feel free to discuss further if you have more doubts.
Kindly close the discussion if you are satisfied with the responses and give your valuable feedback.
If you wish, you can also approach me with a direct query at your convenience.
I wish good health for your son.
Take care.
Thanks.
Dr. Shubham Mehta, MD (Psychiatry)
ADHD with co-morbid mood disorder.
Detailed Answer:
Thanks for the posting the details.
It has really helped me to understand the scenario better.
Keeping all the details in mind, I think that your son is having ADHD along with superimposed mood disorder.
I do not think there is a possibility of Asperger's syndrome.
And the drugs which he has been prescribed (risperidone and valparin) are appropriate for him.
I will tell you the reason why I say so:
1. since he has frequent mood swings, a mood stabiliser is needed in his case. Valproate (active ingredient of valparin) is an excellent mood stabiliser.
2. The aggression will be best controlled by risperidone.
Both the drugs (risperidone and valparin) work in synergism and provide a spectrum to control most of his behavioral issues.
3. Since his behavior is controlled by these drugs (as you have mentioned), he must continue with these drugs. Other options could be olanzapine and lithium.
I also think that addition of stimulant medications like atomoxetine or modafinil (prescription drugs) should be considered for him.
Please avoid antidepressants drugs like SSRIs (fluoxetine, escitalopram etc) and TCAs (clomipramine, imipramine etc.) or other antidepressant drugs. These drugs might precipitate his condition.
Since this condition is very difficult to manage (the limitations of medical science), he might require a long-term drug treatment.
Regarding your query about behavior therapy, such therapies are given to those clients who accept and understand that they have mental health issues.
Does your son accepts that he has some behavioral or mental health issues? If yes, only then the behavior therapy would work for him.
The behavior therapies are usually framed depending upon individual's condition.
Social skill training and group therapy might help him, if only he accepts to go for it.
I hope I have answered to your queries satisfactorily.
Feel free to discuss further if you have more doubts.
Kindly close the discussion if you are satisfied with the responses and give your valuable feedback.
If you wish, you can also approach me with a direct query at your convenience.
I wish good health for your son.
Take care.
Thanks.
Dr. Shubham Mehta, MD (Psychiatry)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor,
With the medication one day he is ok and the other day he is not. He gets worked up if we dont answer his questions. And becomes violent and trys to hit us.
and when his father Fails to answer his calls he gets worked up.
And if we decipline him or hit him he keeps that in his mind and hits someone else or break something and says that he did that coz we hit or deciplined him.
and after doing all that with happily he says that he did it and laughs. How can we tackle him? We are unable to handle him.
With the medication one day he is ok and the other day he is not. He gets worked up if we dont answer his questions. And becomes violent and trys to hit us.
and when his father Fails to answer his calls he gets worked up.
And if we decipline him or hit him he keeps that in his mind and hits someone else or break something and says that he did that coz we hit or deciplined him.
and after doing all that with happily he says that he did it and laughs. How can we tackle him? We are unable to handle him.
Brief Answer:
Change of drug and environment is needed.
Detailed Answer:
Good to hear from you again.
Dear,
I would suggest a drug change first.
In my opinion, he should be continued with risperidone.
In place of valproate, Lithium should be considered for him.
Consult the local doctor and you can discuss about this.
Second, I have certain suggestions for you which can help you to tackle with his behavior:
1. Never get angry over his behavior. (easier said then done, but try your level best)
2. Never argue with him. This will increase his aggression.
3. Never criticize him, especially in front of others. This will create your negative impression in his mind.
4. Do not fulfill his irrelevant demands. Never reject straight away but give him rational reason for not fulfilling his demands.
5. Praise his good deeds and achievements. You can acknowledge him with a small gift for each of his good behavior.
6. Move away from the situation when you sense that he is getting angry. This will reduce his anger-provoking external stimuli. Slowly his anger will decrease.
7. Try to involve him in the activities he like. Join him in this. A friendly attitude of yours will increase his trust in you.
8. Always remember that he is a grown-up now. Respect his autonomy and privacy. Give him his space. Do not try to control him.
9. Make him realize the negative consequences of his behavior but in a non-judgmental way.
I understand that some of these suggestions might be difficult to follow. As I told your earlier, such behaviors are very difficult to manage, but you have to be persistent in your efforts with him.
Hope this helps.
Feel free to discuss further.
Take care.
Thanks.
Change of drug and environment is needed.
Detailed Answer:
Good to hear from you again.
Dear,
I would suggest a drug change first.
In my opinion, he should be continued with risperidone.
In place of valproate, Lithium should be considered for him.
Consult the local doctor and you can discuss about this.
Second, I have certain suggestions for you which can help you to tackle with his behavior:
1. Never get angry over his behavior. (easier said then done, but try your level best)
2. Never argue with him. This will increase his aggression.
3. Never criticize him, especially in front of others. This will create your negative impression in his mind.
4. Do not fulfill his irrelevant demands. Never reject straight away but give him rational reason for not fulfilling his demands.
5. Praise his good deeds and achievements. You can acknowledge him with a small gift for each of his good behavior.
6. Move away from the situation when you sense that he is getting angry. This will reduce his anger-provoking external stimuli. Slowly his anger will decrease.
7. Try to involve him in the activities he like. Join him in this. A friendly attitude of yours will increase his trust in you.
8. Always remember that he is a grown-up now. Respect his autonomy and privacy. Give him his space. Do not try to control him.
9. Make him realize the negative consequences of his behavior but in a non-judgmental way.
I understand that some of these suggestions might be difficult to follow. As I told your earlier, such behaviors are very difficult to manage, but you have to be persistent in your efforts with him.
Hope this helps.
Feel free to discuss further.
Take care.
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor,
Thank you very much for your valuable advise. We are going to switch the valparin to lithium.
Is it ok to give seven seas codliveroil tablet or any other vitamin which will help him to improve .
He always repeats that he was sacked because he touch a teacher. Is there any where to get this picture out of his mind.
And he always calls his class mates and askes for the 2008 timetable. Because he was sacked from school in dec 2007. Because he is missing his school life, how can we get this out of his mind.
This is the standared set of questions he always askes. several times day for the past somany years.
"Because I hit the teacher I was sacked from school , will God punish me for that. Is it because of that iam failing all the exams that iam taking?.
"
Thank you very much for your valuable advise. We are going to switch the valparin to lithium.
Is it ok to give seven seas codliveroil tablet or any other vitamin which will help him to improve .
He always repeats that he was sacked because he touch a teacher. Is there any where to get this picture out of his mind.
And he always calls his class mates and askes for the 2008 timetable. Because he was sacked from school in dec 2007. Because he is missing his school life, how can we get this out of his mind.
This is the standared set of questions he always askes. several times day for the past somany years.
"Because I hit the teacher I was sacked from school , will God punish me for that. Is it because of that iam failing all the exams that iam taking?.
"
Brief Answer:
cod liver oil, omega-3 fatty acids.
Detailed Answer:
Glad that you found my suggestions helpful.
Yes, its ok to give cod liver oil.
Other than this, omega-3 fatty acid supplements can be given to him. These supplements are being widely used in such cases to a good effect.
I think that school incident has turned out to be a huge shock for him. That is why he has been repeating such questions. He is finding difficult to erase those things from his mind.
You (parents) are the best person to help him to come out of this. No therapist can work better than you in this.
Convince him with reasonable explanations that he should not blame himself.
Let him meet his old school friends. Persuade him to make new friends.
Instill confidence in him. He might be having inferiority-complex because of those school-events. Make him realize that he should try to work for betterment of his future and forget past.
Citing inspirational short stories to motivate him to move forward in life can be a way to help him.
I wish for speedy recovery of your son.
Kindly close the discussion if you have no more queries and give your valuable feedback.
Thanks.
Dr. Shubham Mehta, MD (Psychiatry)
cod liver oil, omega-3 fatty acids.
Detailed Answer:
Glad that you found my suggestions helpful.
Yes, its ok to give cod liver oil.
Other than this, omega-3 fatty acid supplements can be given to him. These supplements are being widely used in such cases to a good effect.
I think that school incident has turned out to be a huge shock for him. That is why he has been repeating such questions. He is finding difficult to erase those things from his mind.
You (parents) are the best person to help him to come out of this. No therapist can work better than you in this.
Convince him with reasonable explanations that he should not blame himself.
Let him meet his old school friends. Persuade him to make new friends.
Instill confidence in him. He might be having inferiority-complex because of those school-events. Make him realize that he should try to work for betterment of his future and forget past.
Citing inspirational short stories to motivate him to move forward in life can be a way to help him.
I wish for speedy recovery of your son.
Kindly close the discussion if you have no more queries and give your valuable feedback.
Thanks.
Dr. Shubham Mehta, MD (Psychiatry)
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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