I am writing you this e-mail because I would really

Hello,
My name is ***** ***** I am writing you this e-mail because I would really appreciate if you could give me your opinion on a case.
In fact, the patient it’s my younger brother and I would really need your opinion about his condition. He is a healthy, 19 year old men without any health problem except an inguinal hernia operation last year and a pylorus stenosis operation in the childhood. Approximately 7 months ago, he started to present the typical symptoms of depression becoming more irritable, with a depressed mood and gradually losing interests in his usual activities. ( I also noticed that sometimes in periods of stress he walks on the tip of the toes but he never presented autist behavior and he had very good social relationships and excellent results both in sports and school). We tried to help him and we organized a excursion in Europe for some tennis tournaments, since he and his brother train as professional tennis players. Unfortunately, he experienced several traumas (death of our grandfather, robbery attacks) that I won’t go in detail. When he arrived back, he was for the first time crying in the car as we took him for the airport.
He became more and more retreated and he became to change his behavior. He never had hallucinations but he started to change his alimentary habits preferring to eat leafs from trees and he refused to eat meat he usually loved.(Nevertheless, he once said that there is too much pain in bread and he can’t eat meat because he don’t want animals to be killed). He also mentioned ideas about somebody wanting to steel information, and later he believed that people he knew were controlled by that somebody. In the following month, he became more and more sad and he eat less and less and he had recurrent tentative of suicide : trying to drink corrosives, to stab himself with a knife for instance. He started to think he needed to kill himself to save us and he wanted us to be always near him because we were in danger. He also complained of severe headaches that were very intense at the point of causing important sub-conjunctival hemorrhages. We went at the emergency and he got and his blood workup and a non-contrast CT-Scan were normal. He didn’t start any medication however because we didn’t mentioned his suicidal behavior. Three weeks later he wasn’t able for four days to eat, nor drink at all even though he told us that he wanted to eat. Also, he looked scared or he couldn’t go to the bathroom, having several episodes of urinary incontinence ( he was’t talking so we don’t know if he didn’t want or couldn’t urinate). We went again to hospital and they started 10 mg Zyprexa (Onlazapine) daily. When he was reevaluated the doctors told us he had catatonia and he was given a dose of 1 mg Ativan (Lorazepam) intramuscularly. He responded very well, and he began to talk normally, to eat alone and to be the one that we knew before. However, the benzodiazepines was stopped by error and he had only Zyprexa for the following day. His condition substantially worsened and he was completely unable to talk or eat by his own again. The Ativan was reintroduced, this time 2-3-4 mg per day orally(they oscillated a lot) and the Zyprexa dose was doubled to 20 mg. He was really unwell for the following two weeks but gradually improved and was able to walk and sometimes eat by himself after they reduced the Zyprexa at 10 than at 7.5 mg OD.
He cried several times during this hospitalization and once he asked my mom what happens when he is blocked. We managed to have several outdoor activities and one weekend he was able to do his tennis training with my youngest brother and with me as he used to with fluid movements and rapid reactions. He also went to the swimming pool and with the bicycle but his reactions are very variable and he is always better in the late evening. The docter also introduced Wallbutrin 150 mg OD last week which was then raised to 300 mg OD. Now, after 4 weeks of treatment he still has a profoundly decreased initiative and minimal responsiveness. He doesn’t eat nor drink by himself but if we push his hand when he keeps the spoon in the soup for instance he completes the movement. He has a tendency to stare passively and although before he was occasionally responding to questions or commands after a long delay, since last week he has a total loss of speech while the speech understanding is preserved.
The plan for the next Monday is to change the Ativan for 2mg intramuscular three times a day while keeping Zyprexa at 5mg OD, and Wallbutrin at 300 mg OD. If this doesn’t work I think the next step will be electroshocks but I’m really scared since I don’t have a precise diagnosis. Can you please tell me what do you think about his condition and treatment?
Thank you very much and I’m looking forward for your answer.
Diana