Hiya, My name isXXXXX a Mental Health Nurse. May I try to answer your question for you?
ok i couldnt tell if you received my reply thank you
Yes, I am here and receiving your messages.
I would like to ask you some more questions to try and provide an accurate response to your question is that ok?
Ok, from reading your question...it looks as though this behaviour did not begin until you nephew was 19?
yes very nice kid stable home
ok, and when these behaviours have occured, aggression etc. Is this usually under the influence of alcohol or does this occur when he has not been drinking?
both raging with anger when sober as well
ok, and you have stated that he goes through periods where this does not happen.does he have periods of time where it happens frequently and then periods where it doesn't happen at all?
yes, but long periods , model student this fall winter spring then been on ranpage for 3 months now
ok, and before this period...how long since you saw these negative behaviours? How long was he well for?
his whole life , then went off like you hit a switch 2 years ago
yes I understand this began 2 years ago, but in the last 2 years. Does he misbehave for 3 months, then behave for 3 months, then mis behave for 3 months etc?
all I want to know is does the behaviour come in waves?
seems to be ok during school yr tyhen goes crazy late spring and summer, how ever first episode was in feb of 2010 so hard to pinpoint but seems like its mostly late spring and summer, but for long perioods of good and bad behaviour
does he have any mood disturbance?
seems like hes on rampge for months viloent raging is best answer
ok, during these times is he able to have a logical conversation? does he have any odd behaviours or is it purely the rage?does he ever speak about any unusual thoughts, beliefs or appear to be speaking to people when there is nobody around?perform any unusual rituals?
he does sat things like ive got all kinds of money and im going to school this fall in arizona, all not true either diloushinal or jus shooting his moth off, then he knucles down during school year
ok, its difficult to assess what may be happening at these times via the internet but you have not described any psychotic symptoms or evidence that suggests a major psychiatric illness.I would advise you however, if he is experiencing periods of uncontrollable rage the cause for this needs to be addressed.If he becomes agitated or you are unable to de escelate him verbally when he becomes angry, you should contact your local crisis time to come to your home where they can perform an assessment.
whats it sound like to you, ball park me
its impossible to say without seeing the patient and observing the behaviours for triggers etc.If he is voicing ideas about having access to large sums of money and moving away which is not true this could be psychotic but it would be highly unusual for these symptoms to just disappear during school time.My guess from the information you have given would be drug or alcohol use but you said this is not the case.
another query would be if he has experienced any form of abuse of a traumatic life event, school may act as a distraction but given lengthy periods of time without a need to focus could allow these past thoughts or feelings to re vent.
ok thank you, XXXXX XXXXX you satisfactory rating i appreciate your , but would like to get second opinion, can you forward to anotherv dr
ok, I can do that but I assure you from the information available and without seeing the patient anything more than what I have given would be purely speculation at best.
If your nephew become aggressive you can actually have an assessment by professionals at home free of charge.
ok i undertsand,
If you provide me your state and location I can give you the number for you local 'mental health crisis team'this wouldn't cost you anything, they are trained professionals in your local area that could confirm what I have told you and if necessary attend your home to assess you nephew.
Are you still available here?
Like the prior expert, the information provided is speculative to help you understand what may be going on with him.
A possibility may be traits of Intermittent Explosive Disorder. A person can have traits of different conditions w/o meeting full diagnostic criteria.
In this condition, you'd be looking at such behaviors/symptoms according to the DSMIV/ Mental Illness diagnostic manual :
"The essential feature of Intermittent Explosive Disorder is the occurrence of discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property
The degree of aggressiveness expressed during an episode is grossly out of proportion to any provocation or precipitating psychosocial stressor.
A diagnosis of Intermittent Explosive Disorder is made only after other mental disorders that might account for episodes of aggressive behavior have been ruled out.
The aggressive episodes are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma, Alzheimer's disease)
***The individual may describe the aggressive episodes as "spells" or "attacks" in which the explosive behavior is preceded by a sense of tension or arousal and is followed immediately by a sense of relief. Later the individual may feel upset, remorseful, regretful, or embarrassed about the aggressive behavior.
Several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property.
The degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors.
The aggressive episodes are not better accounted for by another mental disorder and are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma)
Aggressive behavior can occur in the context of many other mental disorders. A diagnosis of Intermittent Explosive Disorder should be considered only after all other disorders that are associated with aggressive impulses or behavior have been ruled out. "
Other possibilities may be pent up anger/frustration being displaced onto family (those closest to him because it's safer to do so) An onset of another disorder i.e. Antisocial Personality Disorder (traits at least), Bipolar or cyclothymia (depressive conditions)