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Differential Diagnosis

Jenny Butterfly

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  He is withdrawn mostly, spending all his time alone in his room but not, as the CPN has recently observed "actively psychotic".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My son does seem to have delusional beliefs, he's withdrawn, he paces around and his self care is extremely poor.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

  • I just tried it and seem to be borderline with a score of 31.  As to what this might mean, I'm not sure.  It seems to me that I could nudge the score a few point in either direction depending upon my mood on the day.  Or that, say, 10 years ago my score would have been higher.  30 years ago it would have been higher still.  So then my question would be whether such a diagnosis would usually remain stable over time.  But I'm also curious about my own perceptions of what I consider to be the problems.  I might, being a bit of a sensitive type, be magnifying them such that a slight difficulty to me seems much bigger than it actually is.  Or I might be underplaying them - after years and years of going against the grain and trying to fit into situations I really wanted to avoid, I might finally have developed various strategies that work for me. 

    My other area of concern: when I was a teenager I thought I was very nervous and highly strung and this was basically fed back to me by various others in my family and my teachers too.  Words like "shy" and "timid" were often used.  And I often preferred solitary pursuits.  But that could just mean I'm more of an introverted person, still with various associated problems (in a world dominated by extraverts), but just a bit of a loner.  I'm wondering when something that could just be seen as personality becomes diagnosable.  And also what this might mean for my son, who has all of the traits I had but then with some very distressing beliefs added in. 

    The heritability bothers me too.  I come from a long line of sensitive people.  Some did very well, others dropped out and/or developed significant problems (severe depression, alcoholism, "weird" behaviours that made them stand out).  It would be very hard for me to say what made the difference and I would hate it to be all down to uncontrollable factors.  One uncontrollable factor, for example, seems to be that the males in my family seem to fare worse than the females.  I suppose that when it comes to genetics I would have to hope that there would be lots of hope in the field of epigenetics to counterbalance my fears. 

     

Reply

  • I just tried it and seem to be borderline with a score of 31.  As to what this might mean, I'm not sure.  It seems to me that I could nudge the score a few point in either direction depending upon my mood on the day.  Or that, say, 10 years ago my score would have been higher.  30 years ago it would have been higher still.  So then my question would be whether such a diagnosis would usually remain stable over time.  But I'm also curious about my own perceptions of what I consider to be the problems.  I might, being a bit of a sensitive type, be magnifying them such that a slight difficulty to me seems much bigger than it actually is.  Or I might be underplaying them - after years and years of going against the grain and trying to fit into situations I really wanted to avoid, I might finally have developed various strategies that work for me. 

    My other area of concern: when I was a teenager I thought I was very nervous and highly strung and this was basically fed back to me by various others in my family and my teachers too.  Words like "shy" and "timid" were often used.  And I often preferred solitary pursuits.  But that could just mean I'm more of an introverted person, still with various associated problems (in a world dominated by extraverts), but just a bit of a loner.  I'm wondering when something that could just be seen as personality becomes diagnosable.  And also what this might mean for my son, who has all of the traits I had but then with some very distressing beliefs added in. 

    The heritability bothers me too.  I come from a long line of sensitive people.  Some did very well, others dropped out and/or developed significant problems (severe depression, alcoholism, "weird" behaviours that made them stand out).  It would be very hard for me to say what made the difference and I would hate it to be all down to uncontrollable factors.  One uncontrollable factor, for example, seems to be that the males in my family seem to fare worse than the females.  I suppose that when it comes to genetics I would have to hope that there would be lots of hope in the field of epigenetics to counterbalance my fears. 

     

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