Dr. Krishan Kumar Sharma
Psychiatry
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Patient's Query
Hello doctor,
My son is 17 years old. He is doing odd things, such as calling the police for ear pain. He is under a lot of stress from national exams and high expectations. He does not sleep much, but his appetite is well. After calling the police and talking to them, he was back to his room studying. Late evening he told me that he is doing well and not to worry about him. Overall, he is distracted, and his grades are dropping. I am desperate as I am in the health field and I know that can mean severe pathology or simply a reaction to stress.
Hello,
Welcome to icliniq.com.
It seems he is not in touch with reality, like calling the police for ear pain. Can you tell since when he has ear pain and how it started? Since how long has has such odd behavior and sleep problem? Does he express any other odd behavior? Is there any history of substance abuse or truancy? He might be suffering from adult ADHD (attention-deficit hyperactive disorder), depression, anxiety and ATPD (acute and transient psychotic disorder). The management depends upon the disorder he is suffering from. Thank you.
Patient's Query
Thank you doctor,
He told us about ear pain after he called the police. As per my son, it was very acute and resolved immediately. Sleep problems for a long time, but odd behavior is recent. He recently told us that we manipulated him and he asked why. No substance abuse, he is an excellent student. He had some signs of ADHD but not officially diagnosed. Can ADHD present with this odd behavior and delusional thoughts? My impression is that he does have depression because he got frustrated, expected to be first at the science fair and he got third place award. He did not pass at the second round of chemistry olympiad. And he is under a lot of stress for the AP and SAT exams. Can depression resent with this odd behavior that resolves quickly? My biggest fear is schizophrenia, there is a short duration of symptoms and are brief. What do you think? I am very much concerned, I am getting depressed myself and non-functional.
Hello,
Welcome back to icliniq.com.
First of all do not get disheartened. I am not confirmatory about all these diagnosis as I have not examined or interviewed him. Even if he is suffering no need to worry. Nowadays better medicine or depot present and with them any can live normal life. As you have mentioned that he had acute and short lived episode resolved early, this might be possible in ATPD means acute and transient psychotic disorder. It is an illness from psychotic spectrum. Is there any history of talking to self, smiling without any reason, suspiciousness, odd thoughts (to rule out schizophrenia). If you are not sure about ADHD then you can do things like search Wander Utah ADHD rating scale for adult. If his score is more than 46 then there is a strong possibility of it. Adult ADHD in usually diagnosed retrospective, ADHD can be comorbid with bipolar disorder, anxiety and substance dependence according to various studies. You might be right that he done all of this due to frustration, but tell me his version, his explanation and relevance of calling police. One more thing, why are you ignoring his sleep disturbance problem without taking any step for that? You take him to a counsellor for brief psychotherapy, to improve his coping skills. If depressed or having anxiety feature antidepressants might help him. Thank you.
Patient's Query
Thank you doctor,
When I asked him why did you call the police, he replied that my ear hurts sorry. An ambulance came with the police as well. Acute psychosis is possible. He does not talk to himself, and he has no hallucinations. I agree about his sleep. It is a significant issue, and I tried to give him Melatonin, but he does not want to take anything, not even vitamins. I agree about brief psychotherapy but when I mentioned it to him, he said I am fine, it does not hurt to talk to someone, and I got relieved.
Hello,
Welcome back to icliniq.com.
You denied for any other frank psychotic symptoms, no symptoms like a hallucination or delusional, no other weird behavior, I think currently there are no symptoms suggestive of schizophrenia. Regarding ADHD, you will rule out by that scale I mentioned (tell me later whenever you apply it). Currently, it is not clear depressive symptomology like sadness, low mood, lack of interest, self-harm, hopelessness, helplessness, guilt or weight loss. For now, tell him one thing if he ever repeats such incidence, he has to go with you for proper assessment and psychotherapy session. Please rule out any other trauma like a breakup, lost some close friend or any slightest possibility of any abuse of an adolescent. Try to be friendly with him, tell him that study is a part of life and our life still has many domains. Explain that you have faith in him and you will love him unconditionally no matter what grade he get. For improvement in sleep take help of sleep hygiene practice like wakeup on a fixed time irrespective of sleep hour in the night, moderate exercise in the morning and a brisk walk in the evening, avoid stimulating agent like coffee, tea (caffeine). Can take a bath in evening with lukewarm water. No sleep in the day time, take dinner at least three hours before bed. The bed is only used for rest, not for any other activities like chatting, tv, etc. Can take help of reading some books in the night, do not try hard for sleep, be relax, can practice meditation or yoga. Thank you.
Patient's Query
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Psychiatry
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