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  He is withdrawn mostly, spending all his time alone in his room but not, as the CPN has recently observed "actively psychotic".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My son does seem to have delusional beliefs, he's withdrawn, he paces around and his self care is extremely poor.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

  • Over the years I have come to accept that there is certainly something "different" about me.  I've been called "weird" more than once too.  But I've kind of explored the difference, without really naming it as anything in particular.  Well, other than very general terms like intraversion which I've explored quite a lot.  So, funnily enough, Susan's book is already on my Kindle from around a year ago, plus I have, for example, Elain Aron's books on sensitivity on my shelves too. 

    Generally I would say that the world has seemed too hard-faced for me, that I react to this (some would say over-react, of course) and tend to panic or become fearful.  Needless to say, this did me no favours in the world of work, which I found quite harsh and unforgiving. 

    Now, though, I have been able to retire early (due to a physical condition) and I would say that we have quite a calm and undemanding environment here at home.  I had been hoping that providing a stable and comfortable home would help our son more than it actually seems to have.  But that's not to say that it won't ever.  In the meantime, I don't know how to help him to unravel his issues, especially since he won't accept my help, or anyone else's for that matter.  He seems to inhabit a very limited world of his own, trying to counter an invisible world of negativity and performing strange exercise rituals to help him in that.  None of this was really apparent before the age of around 16, although prior to that he had a certain self-contained quality to him, even when socialising (which he did a lot).  He also did well in his GCSEs and all of this seemed to suddenly worsen when he went to college.  It did look very like psychosis or schizophrenia (no voices, but strong delusions about being attacked by negativity, very poor personal care, total withdrawal) but now I am wondering.  Certainly the early intervention in psychosis team have been unable to unravel it all.  And, in spite of all my reading (and my own previous escape route from a horrible office job in accountancy into the softer, more bearable world of counselling) I don't know what more to do.

    Overall I suppose I'll have to wait to see what the autism team can advise but so far I've not been too impressed by the professionals.  Of course, they haven't lived it from the inside and, naturally enough, it shows. 

Reply

  • Over the years I have come to accept that there is certainly something "different" about me.  I've been called "weird" more than once too.  But I've kind of explored the difference, without really naming it as anything in particular.  Well, other than very general terms like intraversion which I've explored quite a lot.  So, funnily enough, Susan's book is already on my Kindle from around a year ago, plus I have, for example, Elain Aron's books on sensitivity on my shelves too. 

    Generally I would say that the world has seemed too hard-faced for me, that I react to this (some would say over-react, of course) and tend to panic or become fearful.  Needless to say, this did me no favours in the world of work, which I found quite harsh and unforgiving. 

    Now, though, I have been able to retire early (due to a physical condition) and I would say that we have quite a calm and undemanding environment here at home.  I had been hoping that providing a stable and comfortable home would help our son more than it actually seems to have.  But that's not to say that it won't ever.  In the meantime, I don't know how to help him to unravel his issues, especially since he won't accept my help, or anyone else's for that matter.  He seems to inhabit a very limited world of his own, trying to counter an invisible world of negativity and performing strange exercise rituals to help him in that.  None of this was really apparent before the age of around 16, although prior to that he had a certain self-contained quality to him, even when socialising (which he did a lot).  He also did well in his GCSEs and all of this seemed to suddenly worsen when he went to college.  It did look very like psychosis or schizophrenia (no voices, but strong delusions about being attacked by negativity, very poor personal care, total withdrawal) but now I am wondering.  Certainly the early intervention in psychosis team have been unable to unravel it all.  And, in spite of all my reading (and my own previous escape route from a horrible office job in accountancy into the softer, more bearable world of counselling) I don't know what more to do.

    Overall I suppose I'll have to wait to see what the autism team can advise but so far I've not been too impressed by the professionals.  Of course, they haven't lived it from the inside and, naturally enough, it shows. 

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