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DocRob
DocRob, Doctor (MD)
Category: Parenting
Satisfied Customers: 84
Experience:  Doctor & Father
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My son is 24 yrs old. He has dropped out from Engineering Degree

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My son is 24 yrs old. He has dropped out from Engineering Degree Course. Subsequently, he took addmission in flying school. That also he is not doing. Throughout the day he is playing computer games. He is forcing me to purchase very costly gagets repeatedly. He is refusing to go to psychritist. Please advise.
Submitted: 2 years ago.
Category: Parenting
Expert:  DocRob replied 2 years ago.
Welcome to Just Answer. I truly hope that you will be able to benefit from my many years experience both in paediatrics, and as a father! I will aim to provide sensible, common sense help, but I need you to read and agree to the contents of this paragraph.
Basically, this conversation can not be used as a substitute for a face to face patient-doctor consultation. Therefore, all information is for educational purposes only. It is simply impossible to give correct medical advice without seeing a patient. Whilst I will give suggestions for you to look at, I cannot diagnose or recommend treatment online and I cannot be held responsible for the consequences derived from the information given here, under any circumstances. Finally, I would be very grateful if you could rate my answer when completed; I strive for level 3 or above in this but if you feel that you my advice warrant’s negative feedback, please remain in contact with me to see if we can resolve any issues before leaving the feedback. If you still feel that my answer was poor and that negative feedback is warranted, I will then fully respect your wishes.
If you continue this conversation, you are accepting these as our “terms”.

This is a very difficult situation for you to be in, I can truly sympathize with it. However, I do need more information if at all possible:
you mention that he has been seen by a psychiatrist (or at least that this is in the offing) and hint that he has been prescribed medication. Could you please elaborate on whether he has a diagnosis of any sort, and what medications he has been prescribed?
It would also be useful to know if there have been any major life events over the last few years such as remarriage on your part, loss of a long term girlfriend and so on.

I think you are in a very tough situation and I hope that I will be able to offer you some worthwhile advice when you have returned.

Warmest regards,
Rob
Customer: replied 2 years ago.
4 years back he was diagonised as having ADHD. He was given 'Axcepta', 'Inspiral' etc. A month back, one psychriatist identified as having NPD, but I don't agree. He may have Narcissitic traits but not disorder. There was no major life events on my part. Regarding his girl friend, I do not know. How he can have a girl friend if he is always at home?
Expert:  DocRob replied 2 years ago.
Thank you for getting back to me. The girlfriend question was just an example of a major "life event"; I was simply trying to trigger thought in that direction. Obviously I have no idea if he does or doesn't have one: if he is on the internet allot, it is possible that relationships exist that you are not aware of. This however, would be speculation, and best left for now whilst we dealt with the current issue at hand.

ADHD is a difficult condition as I am sure you are aware; also, due to its nature, it would be difficult for a person not to show traits for NPD since sufferers can be very single minded and self focused. Personally, I take issue with psychiatry's use of personality disorders the point of using NPD is to help get a better understanding of a persons treatment to help better manage it: invariably though people get fobbed off with "personality disorder" as untreatable and get ignored. I tend to fight against that for my patients unless I have strong feelings that it would help. see http://en.wikipedia.org/wiki/Axis_I_disorder#Multi-axial_system for more information on how to relate the different "axes" of psychiatric diagnosis.
As for your sons current predicament, not taking his medicines is a major issue. He seems trapped in a cycle of needing stimulation and overstimulating in the wrong way - we need to break this obviously somehow. I work for a charity (the doctors support network) and know several doctors who can relate to this story, and who through proper medication have found themselves holding down good solid careers. Since you are currently giving him largely what he wants in terms of gadgets have you considered bargaining with him? for example, if you want X then you need to take your medicines for 1,2,3,4 weeks depending on the cost of the gift? It may be that in the short term, getting him to take his medicines in this way would help you to open the door to then get him off his computer as he starts to stabilise in his condition. I know it wouldn't be a quick fix but it could be a start... what do you think?

Customer: replied 2 years ago.


No bargaining works with him. In that case, he starts shouting, abusing, stop taking food at home etc.

Expert:  DocRob replied 2 years ago.
I see. This will make things more difficult as confrontation and a firmer hand will probably be needed. Do you think this could be the way forward for you. I fear that unless boundaries are set, and strictly enforced, you may find that things continue to remain in the status quo...
Expert:  DocRob replied 2 years ago.

Sadly, and regardless of your sons condition, you sound to be locked in a very negative spiral that he is "manipulating" to keep his status quo. Strops and tantrums cannot last forever; although when I am not the one living with them, that is easy for me to say! I would of course be happy to advise you further on firm, but consistent methods but this is essentially just that: the approach would need to involve sitting him down, telling him that things will change and what you expect (for example, take you r meds when under my roof or you lose the computer, or you dont get the new gadget - in general positive incentives ALWAYS work better than negative punishments as motivators). He then WILL rebel, he WILL push the boundaries and he MAY even become "nasty" as he goes through his last phases of trying to keep his status quo. You would obviously need supreme levels of support from other members of family and friends for this ... is that something that you can rely upon?

Expert:  DocRob replied 2 years ago.
Hi, thought I would check up on you to see if you had given any thought to my last post, and if we can take things further. Remember that you can ask me an infinite number of questions on this thread as part of the discussion ... I really do want to help you, even though I accept that what I advise may not be what you agree with, I hope you value the alternative perspective. Regardless, please take the time to leave positive feedback in acknowledgment of the time and effort I have put in. Thanks, Rob
Customer: replied 2 years ago.
,I am sorry, I could not correspond to you as I was busy managing him and out of office. He did some worse thing day before and returned late. This time, unlike my normal act, I tried to set limit and locked his Laptops, iPAD etc. Next morning he became really nasty and violent. He could manage to get the things back. But while he is showing his anger and violence, intermitantly he is shedding tears. A few times he has told that he would commit suicide.He is always negetive - image of his mother, but more violent.Please advise.
Expert:  DocRob replied 2 years ago.
Sorry for the delay in responding. I tend to have most free time at this point in the day.

Firstly, let me say well done for setting the limits. that is an important step. The anger and frustration are expected responses to this strict behaviour. Unfortunately consistency with this approach is the only way that it will work; letting him off sometimes and pushing it at other times sends mixed signals. He needs to learn to respect you more, and to show you that respect in his actions: in order to earn that respect he needs to learn that you are consistent and firm in your approach.

His protestations of suicide are more difficult; on the one hand they could be a manipulation to get you to "fall into line" but on the other they could be a genuine part of a depressive illness that he appears to have been entering in the descriptions you give. Since I cannot assess him myself, I would have to advise caution with how you approach this topic. However, once again, reassuring him that you are there for him no matter what, and love him unconditionally will always be tempered by a requirement upon him to follow your rules and regulations. Following them is rewarded by allowing him time with his gadgets, not following them, result in removal of treats and gadgets (as opposed to active punishment).
In Summary, and answer to your question:
A firm but loving tone and approach is, in my opinion, the way forward for you and your son.
you need to use this to get your son to take his medications; a reward/bargaining system will be very useful but ONLY if consistently applied
he may have other problems: depression seems present, and there may be a degree of NPD "traits". UNtil his ADHD/autistic symptoms are better managed we cannot be certain about this though; and for that you need to get him on his meds some how.

All of this is my personal opinion and cannot replace a face to face discussion with both you and your son in "family therapy", and it doesn't replace either the advice of your treating doctors or therapists.

Good luck with your situation. I truly believe that with consistent application of firm rules within a loving framework will eventually reap the rewards you so richly deserve for your patience and dedication as a mother. However, I accept that this will not be easy.

Warmest regards, XXXXX XXXXX luck
Customer: replied 2 years ago.

Thank you Rob.


 


But one last query. Yeasterday I only (as I can not take my son, he is against it) visited one psychiatrist, he pescribed 'Olimelt2.5mg(Olanzapine). What I know through net that this is used for treating Schizoprania. Please advice.


I'll wait for this answer and then give feedback.


 


I received a good and worthy guidance from you.


 


Once again, thanks and regards XXXXX XXXXX

Expert:  DocRob replied 2 years ago.
Thank you very much. PLease hit the accept and positive feedback and/or bonus button if you value my work - it encourages me to keep going on this site!

Olanzapine is what is known as an atypical antipsychotic, and it is true that its first uses were in the fields of schizophrenia and bipolar (its primary "labeled indications"). However, we only have a limited number of drugs that work on the brain, and use of the drugs "off label" is common practice. This drug for example is prescribed in depression, personality disorders, anxiety disorders and much more. IN your sons case, the psychiatrist may well have prescribed it for the angry outbursts, and mood swings. It has increasing recognition in both these areas and is proving to be a good mood stabilizer. It will however, make him very tired to start off with. If this fails to benefit him, many of the drugs from the atypical range could also be helpful, most notably quetiapine, which has potent antidepressant properties in addition. I hope this answers your question.

Although our chat is coming to an end, I have no problem with you continuing to ask related follow up questions on this thread, even after an "accept".




DocRob, Doctor (MD)
Category: Parenting
Satisfied Customers: 84
Experience: Doctor & Father
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