Hello my son is 19 and will be 20 in July. When he went away to college he had his first episode and was diagnosed as Bipolar 1 Schizophrenia Manic at 18. He was in the hospital for approximately 5 weeks. When we brought him home we immediately got him a psychologists and Psychiatrist. He had been taken his medicine faithfully until 3 months ago. He stopped taking his medicine (1- 2 mg Risperdal and 2-500mg Depakote) and going to his doctors, he said: It makes him tired and sleepy. It is hard for him to concentrate and or understand what his professors are saying. When he is not on the medication he get’s A’s and B’s when he is on the medication he get’s D’s and F on test and quizes. He gained approximately 40 pounds. When he is on the medication he does not care about his appearance, but when he is off his medication he takes care about his appearance. It is hard for him to control his bodily functions.
When he is not on the medication he is very angry and it is very difficult for my husband and I to control him, he is very disrespectful and he refuses to listen to reason. As a parent we are frighten for him and his life. Can you please give me any advice on how to handle him, as he can become very violent and we do not want him to go to jail as he will not be able to handle it, he is very arrogant and thinks he is untouchable. We have tried to get him to join support groups but he has decided that he should self medicate himself At the same time i am living in a BAD nightmare.
It’s very common for persons with a diagnosis of Bipolar Disorder, Schizoaffective Disorder, or Schizophrenia to have the illness first appear in the late teens and early 20’s. It’s often very difficult for the patient and their family to digest, because teens that had done well academically and behaviorally throughout high school experience such a change in mood and behavior when the illness first strikes. So first, realize that the struggles you are going through are, unfortunately, all too common.
Your son’s diagnosis is a bit confusing to me, because the three items you list are sort of parts of other diagnoses. Bipolar Disorder Type 1 is, according to the DSM-IV TR, an illness that most commonly surfaces in the late teens an early twenties, and whose symptoms must include at least one manic episode (defined as a period of at least a week of self-inflated esteem, decreased sleep, racing thoughts, and distractibility), and may include depression or hypomanic (defined as a manic period of shorter duration) episodes. BP1 can have a modifier of BP1 with psychotic features, where psychosis, defined as a period of time where the patient loses contact with reality through delusions and/or hallucinations, is present during periods of mania. Schizophrenia is a different illness, with both positive and negative symptoms. Positive symptoms include visual and aural hallucinations, delusions, disorganized speech and thought and, often, movement issues such as catatonia or repeated, rhythmic movement. Negative symptoms include flat affect (no outward show of emotion), little speech, lack of planning, and in many cases, cognitive issues such as poor attention and poor executive functioning (complex thought). Schizoaffective Disorder bridges the gap between Bipolar Disorder and Schizophrenia, as the patient experiences both the mood issues of Bipolar Disorder and the thought disorders of Schizophrenia, even when not manic. From your description, it seems that your son might be experiencing Bipolar Type 1 with Psychotic Features, or Schizoaffective Disorder, Bipolar Type.
In any case, medication is a big issue for many people with these types of disorders. Depakote in particular is notorious for causing weight gain, and many have the sedating side effects that you describe. Lots of patients refuse to take meds because of the side effects, and it is often a trial and error approach between doctor and patient that must take place before the right med combination can be found that alleviates symptoms, but mitigates side effects that the patient can’t tolerate. I’d encourage your son to work with his psychiatrist and explain the side effects of his current medication and what other options could be considered to help him mitigate his symptoms and also eliminate as many unwanted side effects as possible. There is no way to eliminate all side effects, unfortunately, it’s a tradeoff between alleviation of symptoms and what your son is willing to live with as far as side effects go.
It’s interesting you say he cares about his appearance off the meds but not on. In my experience, it’s the other way around. I know my son is heading into psychosis when he stops caring about his hygiene. The irritability and rage issues are not uncommon, and can be scary. You have to decide what’s best for your son and for yourself and the rest of your family. You can’t have a violent, unstable person at home and feel safe. I would strongly suggest you encourage him to go back to his doctor and describe the issues with his meds that caused him to go off of them, and work with his doctor to try alternative medications that might be easier for him to tolerate. If he – or you – doesn’t feel the psychiatrist you’re currently working with is receptive to working collaboratively, find another. It’s essential to have a doctor that is a partner in your son’s care, taking in suggestions and input as well as making recommendations and prescribing medication. Some doctors are better at it than others. I would also suggest you get in touch with your nearest NAMI office. NAMI, or the National Alliance on Mental Illness, can help you with referrals to doctors, support groups for patients and groups for their family members, and get you more information tailored to what you and your son are going through. You both need support of peers, and NAMI can provide that to you, free of charge.
Self medication is a huge issue for persons with mental illness, but it can never alleviate the symptoms as well as prescription medication. There is some scientific evidence that marijuana use actually triggers psychosis. If your son isn’t ready to go to a support group in person, he might find some support and information through NAMI’s Strength of Us online support group for young adults. He can register and remain relatively anonymous online at http://www.strengthofus.org . He can also read about his illness and ask questions of peers. Many times patients who don’t recognize or haven’t internalized their diagnosis choose street drugs over prescription medication. Education and support can help in getting your son to realize he has a life-long illness like Epilepsy or Diabetes, and refusing medical treatment won’t make it go away.
Finally, if your son’s violence is putting you in danger, you must protect yourselves, even if he is unstable. Call your local police department or sheriff’s office non-emergency line and ask if they have CIT officers. CIT stands for Community (or Crisis, in some cities) Intervention Team of police officers trained to respond to incidents where suspects have a mental illness. Some cities with CIT teams also have a registry with their 911 system so that if your son’s violence escalates and you must call the police, the 911 dispatcher will be alerted to the fact that your son is mentally ill and special intervention is required. In any case, if you do have to call for help, always tell the 911 dispatcher that your son has a mental illness and is unstable. In most cases, law enforcement that responds to a call where the suspect has a mental illness end up taking the suspect to a mental health facility, not to jail. There may come a time when you have to put your foot down. I have many friends who have had to take the stance of, “if you aren’t on your meds, you can’t live here.” It’s harsh, but if your son is endangering you and refuses to get help over an extended period of time, you may have to make that type of decision.
As the mother of a teen with a mental illness, I want to let you know you aren’t alone. This is a marathon, not a sprint, but you don’t have to make the journey by yourself. Even if your son isn’t ready to get support, it will help you to get some from other parents who understand what you’re going through. Reach out to NAMI, ask questions, and don’t be afraid to ask for help. I wish you strength and patience. And don’t forget to take care of yourself through all of this. You can’t help your son if you are stressed or depressed – common “shrapnel” for parents like us.
Chrisa is an eCommerce marketing professional, blogger and mental health advocate specializing in providing education and support for parents of children diagnosed with serious mental health conditions. Chrisa began her journey into the world of childhood onset bipolar disorder when her middle child, Timothy, was diagnosed with Emotional Disorder Not Otherwise Specified at age 8, Bipolar Disorder Type 1 at the age of 11, and Schizoaffective Disorder Bipolar Type at the age of 14.
Chrisa began blogging when her therapist suggested she journal her feelings and thoughts about raising a child with a severe mental health condition. Her blog, The Mindstorm, catalogs the day-to-day triumphs and tribulations of raising Timothy, as well as articles on fighting mental health stigma, navigating the Special Education system, sibling issues, and parental self-care. Her blog reaches nearly 1,600 readers a week, and has received several acknowledgements, including the Wellsphere Top Health Blogger Award, Mental Health Hero Award, Most Touching Blog from WEGO Health, and it was named one of the Top50 Blogs for Special Needs Teachers by OnlineUniversities.com. During May Mental Health Month in 2011, Chrisa was honored by Chato B. Stewart, a cartoonist and contributor to PsychCentral, as a Mental Health Hero for her advocacy for children’s mental health and her fight against the stigma so many with mental health conditions face.
In addition to writing her blog, Chrisa is also a volunteer support group moderator, blogger, and social media consultant for the Child and Adolescent Bipolar Foundation, volunteer and blogger for BringChange2Mind, and has appeared on Blog Talk Radio for HealthyPlace.com and, in September 2011, The Coffee Klatch, an online community for parents raising children with special needs, and she will soon be a regular contributor to WEGO Health TV. You can follow Chrisa on twitter @ Chrisa_Hickey and follow The Mindstorm on Facebook at http://www.facebook.com/TheMindstorm.