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  He is withdrawn mostly, spending all his time alone in his room but not, as the CPN has recently observed "actively psychotic".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My son does seem to have delusional beliefs, he's withdrawn, he paces around and his self care is extremely poor.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

  

  • 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.

  • Former Member
    Former Member

    The main treatments for ASD are cognitive behavioural therapies (CBT) which, as I understand it, includes "mindfulness". He, and you, will have to learn what makes an autistic person different and then learn how to manage his intrinsic tendencies and reactions.

    The central problems with ASD are problems with social interaction - misunderstanding other people and their intentions. People also frequently have sensory issues such as hearing and touch but these are not part of diagnostic criteria for ASD.

    Drugs are not usually used to treat ASD as it isn't a disorder that can be fixed with drugs. However, drugs may sometimes be used to help with anxieties etc that have arisen following a period of undiagnosed ASD.

    A lot of people with ASD have narrow or obsessive interests so OCD may be part of the mix. Black and white thinking is also common so he may need help with coping with a world that operates with a lot of grey, messy and fuzzy decisions.

    There are some good books to read - Tony Attwoods Complete guide to Aspergers may be usful as a reference. i found that "Living Well on the Spectrum" by Valerie Gaus was very helpful in identifying the traits and how to live a positive and successful life with the condition.

  • In a way it's reassuring to know that there are others here who have had different diagnoses in the past.  I'm so devastated that nothing has worked for my son so far.  It's been a very long process and extremely distressing.  It's interesting what you say about picking up reactive behaviours too as I imagine this can become quite entrenched over time and hard to differentiate from other diagnoses like psychosis or OCD. 

    i'll see what is said at the appointment, though, and hope that there are still other treatments he could try. 

  • Former Member
    Former Member

    Psychiatric diagnosis can be an art as much as a science. It seems to be common for people to end up on the forum after many other diagnoses. An autistic person who has picked up a lot of behaviour that is reactive to his environment will be particularly hard to fathom. It is possible to have autism and genuine psychosis but I doubt that this is common.

    He needs help from specialist psychologists and psychiatrists who understand the intricacies of autism and its consequential mental issues. He may well have delusional or unbalanced ideas - this can be a consequence of being isolated and not having his ideas tested against normal reality.

    A diagnosis of autism should be a good thing for him - there are good chances that treatment may be more successful than the previous attempts with drugs etc.

    :-)