Differential Diagnosis

My son has been treated by the Early Intervention in Psychosis team for nearly 3 years, with little success.  His case has not been straighforward and he has refused any kind of intervention, often giving monosyllabic answers but often quite articulate in defence of his own position.  This position is that he is strongly affected by what he calls "negative energy" from which he needs to protect himself via various rituals or even just escaping from "contamination."  He is withdrawn mostly, spending all his time alone in his room but not, as the CPN has recently observed "actively psychotic".  His current consultant (the fourth!) has said that he doesn't have psychosis and he doesn't have schizophrenia and she's referred him to the autism team.  I'm shocked, especially after all this time.

My son does seem to have delusional beliefs, he's withdrawn, he paces around and his self care is extremely poor.  This, to me , seemed to fit with the diagnosis of psychosis. At the same time though, I'm aware that there are other, longer standing features to this. He was referred to an audiologist as a very young child as he seemed to be hard of hearing, not responding to those around him.  He was, though, actually choosing to ignore people and remain in his own world.  He has always had what I call a "self contained" element to his personality.  And, although until recent years he has been quite sociable and able to join in very easily, he say's he's always actually felt like an outsider and that he didn't think he was ever really one of the group.

I'm finding it hard to piece things together.  He's an adult now (21) and he surely can't stay in his room forever.  What are the differences between psychosis and autism and how might a consultant differentiate.  I'm wondering what these labels mean and how they can be helpful to us in this situation.  So far I'm tired of hearing people saying that "He needs help" or "You need to get help" and the type of help not being specified.  I need to know what to do on a day to day basis to improve things. 

  

Parents
  • Many thanks.  I'll have a look at the books but as it stands I've no doubt that my son will refuse any offer of therapy, CBT or mindfulness therapy.  I'm quite desperate about this.  His refusal to take up any offers of any help has been associated with what the CPN has called "lack of insight" which has, until now, been associated with a diagnosis of psychosis.  I wonder whether, if the autism assessment comes back as showing at least some features of autism, more work could be done on promoting engagement or insight.  It's be good to avoid meds, though, as our experiences to date have not been good.  None of the anti-psychotics have brought any relief and there has been a significant downside in terms of effects like weight gain.     

    Whatever the eventual diagnosis is, I find it very difficult to reach my son.  It's as if he lives in a separate world which he understands in very different terms.

Reply
  • Many thanks.  I'll have a look at the books but as it stands I've no doubt that my son will refuse any offer of therapy, CBT or mindfulness therapy.  I'm quite desperate about this.  His refusal to take up any offers of any help has been associated with what the CPN has called "lack of insight" which has, until now, been associated with a diagnosis of psychosis.  I wonder whether, if the autism assessment comes back as showing at least some features of autism, more work could be done on promoting engagement or insight.  It's be good to avoid meds, though, as our experiences to date have not been good.  None of the anti-psychotics have brought any relief and there has been a significant downside in terms of effects like weight gain.     

    Whatever the eventual diagnosis is, I find it very difficult to reach my son.  It's as if he lives in a separate world which he understands in very different terms.

Children
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