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  He is withdrawn mostly, spending all his time alone in his room but not, as the CPN has recently observed "actively psychotic".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My son does seem to have delusional beliefs, he's withdrawn, he paces around and his self care is extremely poor.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
  • The psychiatrist seemed very sure of her ground in making this referral to the autism team.  And, funnily enough, on our first contact with services the CPN asked whether we'd thoughta bout "high functioning autism."  Well, my husband is a teacher and has a little experience of working with adolescents with various labels and at the time we both thought, no, there are no striking features and the behaviours are so extreme that a boundary has been crossed - the loss of contact with "reality" that is the hallmark of psychosis.  But now we are wondering.  And also about our own blind spots.  It may well be that we all have features and I really want to know.  

    Looking back over the years I've had a lot of problems, usually involving my relationships with others in more formal settings.  OK 1:1 and doing exams etc (it's between me and a bit of paper, so that's OK).  But major difficulties in groups and ongoing problems with driving (cos others can judge me and it seems like a set up for conflict) and speaking in front of others (more negative judgement and not feeling I can appear quite normal for long enough).  It's fair to say that I haven't lived up the the early promise suggested by my exam successes - the theoretical world seems to me to be much safer than the real one!       

Reply
  • The psychiatrist seemed very sure of her ground in making this referral to the autism team.  And, funnily enough, on our first contact with services the CPN asked whether we'd thoughta bout "high functioning autism."  Well, my husband is a teacher and has a little experience of working with adolescents with various labels and at the time we both thought, no, there are no striking features and the behaviours are so extreme that a boundary has been crossed - the loss of contact with "reality" that is the hallmark of psychosis.  But now we are wondering.  And also about our own blind spots.  It may well be that we all have features and I really want to know.  

    Looking back over the years I've had a lot of problems, usually involving my relationships with others in more formal settings.  OK 1:1 and doing exams etc (it's between me and a bit of paper, so that's OK).  But major difficulties in groups and ongoing problems with driving (cos others can judge me and it seems like a set up for conflict) and speaking in front of others (more negative judgement and not feeling I can appear quite normal for long enough).  It's fair to say that I haven't lived up the the early promise suggested by my exam successes - the theoretical world seems to me to be much safer than the real one!       

Children
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