Q. My cousin has limited himself to his room. He does not talk for days together. What could it be?

Answered by
Dr. Ravi M Soni
and medically reviewed by iCliniq medical review team.
Published on Jun 01, 2017

Hello doctor,

My cousin is a 23 year old student who is good at academics. He has limited himself to his room. He is not going out at all. Nowadays his exams are over. He does not talk with our family members. He does not have food for days together. If anyone, even his mother tries to talk with him, he shows aggressiveness or sometimes weeps. He is not sharing any of his problems rather states he is fine. It has been very hard to convince him to visit any counselor or doctor. But, he is in touch with some of his friends alone. He does not pick call from anyone. This problem has been persisting for about six months. Please advice about the kind of problem he is experiencing. What should we do?

Dr. Ravi M Soni

Geriatrics Psychiatry Psychologist/ Counsellor Sexology
#

Hi, 

Welcome to icliniq.com.

Depending upon the symptoms you have described, in 23 year old student, there are two possibilities:

1. Psychic breakout:

  • He might have experienced some psychic breakout in this age like, failure in the exams, scolding from the parents or teachers, failure in love and attraction, quarrel with his best friend, exploited by somebody, sexual molestation etc.
  • So, in this case it is very important to talk to him calmly and thoughtfully.
  • You must explain to him that you will be with him in every stressful situation and stand beside him to support.
  • You should also ask him whether he has done something that he should not have done.
  • He might be suffering from guilt due to the wrongdoing.
  • Particularly when someone is not willing to consult an expert, it is a duty on the part of the parents that they should talk to him and persuade him that you people will be with him in any situation.
  • Once he understands this and starts believing you, he will open up and will start sharing his inner thoughts.
  • You should also ask him about his feelings about life. Also ask him if he is feeling depressed, nervous or stressed.

2. Psychosis: 

  • Another possibility is of any psychotic illness, because he has restricted himself from the outer world and has become less social.
  • You should ask him for any unusual experiences like, feeling of being watched or stalked.
  • Ask him whether he is feeling that somebody is talking to him when he is alone and when there is no one in the surrounding and whether he is feeling that somebody is controlling his thoughts. Also ask him if he feels like somebody will harm him and if he is afraid of someone or something.
  • He might also have a feeling that people are talking about him or conspiring about him.
  • So, you should start talking to him in a relaxed environment, persuade him that you are willing to help him and he can trust you and share his problems with you.
  • Gradually when he starts sharing with you, understand his thoughts and accordingly you can ask him for consultation with a psychiatrist.
  • When he is ready for that you should take him to a psychiatrist without any delay and start on medications as per expert's advice.

Consult a psychiatrist online for further follow up --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

Hi doctor,

Thank you for the explanation. Please see the attached files for the same problem. I am waiting for your valuable advice.

Dr. Ravi M Soni

Geriatrics Psychiatry Psychologist/ Counsellor Sexology
#

Hi,

Welcome back to icliniq.com. I have read through all details observed by you and his facebook posts over the last one year (attachment removed to protect patient identity).

  • First of all I must acknowledge that the observations made are really appreciable as it is uncommon things to make such good observation due to poor knowledge about mental health and other factors. I must also acknowledge that despite the best efforts to connect points I am not able to make a 100% diagnosis of his mental condition.
  • From the observed behavior and provided history the first diagnosis is psychosis NOS (not otherwise specified).
  • A kind of mental or psychotic disorder which is characterized by suspiciousness, aloofness, slow change in behavior over progress of time, disturbed sleep (although I do not have details about his sleep) in addition to abnormal reaction to good behavior by close family members and others.
  • Person with this disorder react abnormally to most close persons in family because of perceived threat and suspiciousness. Sometime they talk to self and hear voices which are not audible to any normal person. 
  • The point against this disorder is his complete normal reaction although there is 10 percentage chance that person with this disorder can have normal behavior in between.
  • The second possibility is depression. As he has most features of depression like crying, self isolation, low confidence and loss of interest or motivation in almost all activities. The strongest point against depression is no effort to seek help.
  • People with psychosis have poor insight knowledge about their mental condition and do not believe that they are sick. But, person with depression feel the pain and seek help when offered or available.
  • Considering this fact there is high possibility of psychosis which is treatable condition. I understand that he is not convinced to visit a doctor or counselor, but we have responsibility to give some help even if it is not acceptable to person in question.
  • In your country, there are legal provisions to get him admitted through magistrate order in psychiatric facility for treatment and rehabilitation. Many of the parents consider this option as extreme and that scenario it is better to give treatment in hidden form.
  • I understand that it is wrong but since it is done in good faith and it is need of the hour as other options are unable to make roads to start treatment.
  • Medicines are available which are colorless, odorless and can be easily mixed with food to start treatment.
  • I request you to discuss these issues in family and start treatment by any means even if efforts to convince him are not successful. I must assure you that with right treatment a normal to near normal life can be lived for this young boy.

For further information consult a psychiatrist online --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

Hi doctor,

Thanks for your advice. I have gone through your reply and consulted with the parents of the patient. With regard to disturbed sleep, apparently not so has been observed. One of his problem, may be of any correlation, he gets headache with the ceiling fan running in the room and cannot bear the same. Thus, he prefers to bear with the sweating in rather than use a fan even in peak summer. Since, last incidents whatever I have already mentioned in my previous query, recently one of his close relative young chap of his age, doing job, visited him and tried to counsel or convince him for moving with him for job, but he bluntly refused. Initially he was friendly with him. Since, his friend had persistently insisted, he became rude and angry. Even he smashed his mobile by throwing away. He made great hue and cry to get attention of the neighbors. Since, he having a stout and strong physique, every got scared. Now, often he is threatening his parents of dire consequences if they insist for anything or have any anticipation from him. He is also stating whenever he feels better he will move out or think about carrier etc. Now he had completely ignored his personal hygiene and care. Only activity, he is involved in, visiting his facebook pages through his mobile, commenting on some issues, etc. So, the situation is as it is till today. After going through your advice, it seemed to me that the remedy is not counseling, rather problem is psychiatric. Nevertheless, if there is any possibility, please consider the same through facebook interaction. Lastly, no other options other than medication. Please prescribe the medicines and advice accordingly.

Dr. Ravi M Soni

Geriatrics Psychiatry Psychologist/ Counsellor Sexology
#

Hi,

Welcome back to icliniq.com.

  • With additional information provided and his complete negligence toward cleanliness and hygiene I am almost convinced that he is suffering with psychosis as described in last query.
  • Sleep is usually disturbed but it may remain normal in little percentage of patients.
  • Patients with this disorder are mostly hostile to close family members who are most concerned with his health. The person with this disorder behaves normally for large group of people but when it comes to self and close family members and friends the reaction is completely paradoxical.
  • It is due to the fact that people with this disorder develop suspiciousness and show hostility when approached.
  • You are right in saying that primary treatment for him is medication and psychotherapy have little role at this stage.
  • If you are not able to convince him to visit hospital on one or another pretext such as going to meet a relative in hospital or you have pain and you want him to accompany you, etc., you are requested to pursue legal course as with magistrate order concerned hospital can admit and treat him against his will.
  • Nobody can prescribe any psychiatric medication without seeing the patient and checking all pitfalls. I am sorry to say that I have similar obligation to law system of land and I will not be able to suggest medicine without seeing him in person.
  • At another hand even if you procure medication somehow he will not accept them and may show more hostility and suspiciousness which can be dangerous for both him and his family.
  • I hope this makes sense and you will act according to law of land in betterment of patient.

For further information consult a psychiatrist online --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

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