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Avatar universal

anxiety to psychotic episode to complete break down

read the whole thing or skim through... just any suggestions would be DEEPLY appreciated.

p.s. there's more below the actual post...

This is about an 18 year old male, who in good health is 100 lbs.

History:  
-born premature
-gets B12 shots every month, because of necrotizing entercolitis
Recently:
-oral surgery to remove wisdom teeth and a growth on his tongue; used a general anesthesia and was given follow up meds(Ibuprofen, amoxicillin, and methylprednisolone)

Day after surgery:
-insomnia (he didn’t sleep at all)
-had to settle for a liquid for his mouth to heal, but then began to lose his appetite completely…  when he did try to eat, he made facial expressions that made it seem as though its flavor was unpleasant, but this could be due to the sores
-grew paranoid over his health and insisted on getting multiple tests done, but tests showed no unusual results

Next Day:
-he had lost 9 lbs since surgery.  It was to the point where sit was uncomfortable on his tailbone… and this worried him.
-continuation of symptoms above
-discontinued surgery meds, because we felt that he might’ve been having a bad reaction to it

Day 3:
- same as above
-began going around to his friends and family, saying “I love you” in a sad/fearful manner
-pacing around and showing signs of much anxiety

Later that night:
-went up to his brother and said “this is the night, I’m going to die”
-began to have a psychotic episode:
~began to cry
~told us to stay away from him, get out of the house, “get away from me, I might hurt you”, “im going to die”… later…”are the cops coming?”, “don’t do it”, “don’t kill me”… etc….  he was trying to make himself vomit… was making a “dry heave” noise??... like metal music… etc black metal growl noise… ???
~was dragging himself around the room… and at a certain time, was trying to bang his head against the wall  
~still no sleep that night
20 Responses
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Avatar universal
I think issues of rights and privacy can be extremely complex.  Especially when there are safety issues (or perceived safety issues).

Yes, that's correct.
When I was sectioned I was medicated without my consent and was threatened with ect which I absolutely refused to consent too.
When you are in that situation you are pretty much powerless to do anything.  I believe even the judicial system lets patients down.  In my situation I was just plain fortunate.
Since hospital I have no respect for the mental health services and I have limited for our justice system.

Again, these are extremely difficult issues.  I don't know how a balance can be achieved between an individuals and an individuals family's rights.

Even treatment is confusing.  A high profile prisoner in our country (he killed and maimed people when on p) committed suicide yesterday in his cell.  He was said to be high risk and his mental health was said to have deteriorated.  He was placed on 15 minute observations.  This seems absolutely ridiculous to me.  This is considerably less than what I received when I was in the psych ward.  Do people place a value on people's lives??
I think people and services let vulnerable people down.

I don't think there is an easy solution though nor do I think there is a particular solution.

J
Helpful - 0
Avatar universal
I agree with you.The family should only be informed with the consent of the patient like in any other illness-for example if a patient went to see a doctor for an std the doctor would have to maintain confidentiality.
To make it any different with mental illnesses is inadvertently reinforcing the stigma of it and taking away the patients power.
The focus should be on empowering the patient but it seems in some instances medication and/or other treatment is being given without the prior consent of either the patient or the patients family-is this correct?
Helpful - 0
Avatar universal
I'm not familiar with a 5150 but I understood that to mean that he was sectioned and so was being compulsorily assessed and treated.  In this situation they don't need a person's consent.

I have issues with family/ caregiver(s) being informed.  What about the individuals right to privacy?
I accept that a lot of this has to do with the relationship the individual shares with significant others.  I still believe the individuals wishes should be respected.

J
Helpful - 0
Avatar universal
Hows your friend now?If i was you(im assuming your a member of his family) i would have demanded to know what medication was being given to him or threatened them with a lawsuit.You cant just give someone medication that could be potentially harmful without informing and getting the approval of that person and family and without the family not having thorough prior knowledge of side effects,dose etc.
Helpful - 0
Avatar universal
He home now.
He seems to act.... not normal, but better than before.
He seems less natural than he was at the hospital.
He laughs at a lot of random things.
He relates things that dont really relate too well...

Oh! and he has trouble stopping himself from eating... he doesnt know when to stop or something...
its strange.
we have to tell him that he just ate two servings of pasta, etc.
Helpful - 0
Avatar universal
Thanks for the update.

I hope the neurology appointment goes well.  It is always good to eliminate possibilities.

I had a CT of my head in icu several weeks after being discharged from the psych ward.
There is a history of subdural haematoma's on my mother's side of the family plus I became depressed after I nearly drowned.

I guess it's good to be able to rule out (or treat if necessary) epilepsy, brain tumors, etc.

This just reminded me that they did do basic neurological testing after I was admitted to the psych ward.  It involved reflexes and a lot of other stuff.
Also at a later date the psych registrar did more tests.  I was asked to follow his finger with my eyes.  This triggered a seizure.  I had forgotten all this.

It sounds like the hospital are still medicating him.

Your friend's experiences will have affected him so from this perspective he will be different.
His medication(s) may be adjusted after discharge (if he is on medication) so he may become less slowed down.
If the neurologist finds anything then it's possible his behavior could get worse.
People are generally pretty resilient and bounce back over time.

I hope his appointment goes well and he is discharged home (if he is well).

J
Helpful - 0
Avatar universal
okay.
where to start.
so we visited him at the psych hospital, he seemed better.  the first night he started communicating with me, he couldn't talk much.  i came u with the idea of just asking him yes or no questions about how he felt.  i tried to listen to him, and in return, he listened to my advice.  in our little chat, he explained to me that he thought the meds were making him feel bad/worse. etc. (i asked him a lot, and we finally got the opportunity to listen to him)....    

More recently:
he's been talking, asking to see people, asking for cherry limeade from denny's and just expressing a lot more than the previous nights. two nights ago, he pretty much ate everything anyone told him to eat, and since he hasn't eaten in FOREVER, his stomach freaked out.  he spent the night in the ER vomiting.  
we were told on sunday that he was being discharged from the psych hospital.  we were all pretty excited.  he stayed at the hospital over night into monday.  MONDAY, we were told that he might be sent back to the psych hospital.  the doctors at the ER think it is something in his head.  he will be seeing a neurologist today...

as far as his behavior goes...
he's acting a lot more like himself, although i will admit that he is not completely the same.  his motor skills are definitely slower.  he takes longer to respond.
im not really sure if the hospital is giving him meds, though.
im kind of scared that the way he is acting now is the new permanent him.  
:-\

well... i'll be checking in and out.
Helpful - 0
Avatar universal
yeah, what you went through seems to be a mirror image of whats going on here... my friend is being held under a 5150.  it IS a prison.  he cannot legally leave.  :-\
frustrating is right.
i'll post more later tonight.
Helpful - 0
Avatar universal
Your  right psych hospitals can be less then forth coming about treatments of a patient. It is also like a prison in there for a patient who had no prior mental illness. You are in lock down and the only way to get some fresh air in these places is to go out on smoke break. How fresh could that air be if you are a non-smoker? My friend when in the hospital couldn't eat,literally, he walked very stiffly not even swinging his arms. When leaving though let me tell you he literally ran from the building!! He made vast improvement upon leaving even eating again. We still think he has been misdiagnosed because they only met with him for about 40 min. before determining what his diagnoses was. We have been told that for his diagnoses it takes at least 6 months to determine. We were never able to speak to the doctor directly only a social worker. So continue to try to get as much info. as you can. We didn't know any better at the time, but this web site has been quite helpful. Also try to get info on treatment from them because we were unable to do so and now we are paying for it. All they would tell us was to go to the support group that meets once a month. Not very helpful, but thanks anyway. Hope everything turns out better for you.
Helpful - 0
Avatar universal
One of the best web sites I have come across for information on psychosis is www.eastcommunity.org. For treatment guidelines click on the link “Resources for Professionals”, then scroll down to “Mental Health Clinicians” and then click on the “Practice Guidelines”.
Helpful - 0
Avatar universal
Gould and Jake32:
I'm not sure if he's been given anti-psychotics.  The psych hospital doctors won't tell even his mother, who is paying for all of this, what they are giving him.  It's strange since they have no problem telling us somethings, but other things they bring in the rules... a little fishy... *shrugs*

Nuamor:
pus cell: not investigating too much.  they just called a doctor who specializes in that area, and he said its nothing to worry too much about.  I think they left it at that.
"snap"?:  well, at this point... I'm thinking this whole thing was caused by a combination of things:
surgery meds > insomnia > deeper anxiety and paranoia and etc(each night adding more)
anxiety (his everyday stuff)> whatever... i don't exactly know, but everything all seem to be overlapping.
Since anxiety seems to be playing a big role in this, my friends and I are already thinking of how we could help him with that, if/when he gets well again.

Helpful - 0
Avatar universal
I'm not taking it personally.
If I was in his position, I'd be angry, confused, scared, etc.
...so I guess I understand if he is doing it on purpose...
If he isn't doing it on purpose, I wouldn't be too surprised, because something about language comprehension came up as a symptom in one of the possible causes I looked up.
I hope its not permenant...
Any information is still appreciated from anyone.
The symptoms may be less disturbing, but it doesn't mean its over, as I'm sure many of you may know...
so, like I said, info is still useful to us.
Helpful - 0
Avatar universal
It's great if he's feeling better.

Being locked up in a psych facility can evoke a lot of emotions (plus with all the physical things: his wisdom teeth, drug reactions, etc) -he may need some space.
I guess it's not very helpful if he's not communicating his needs to you.

Give him time, be patient and don't take his behavior personally.

J
Helpful - 0
Avatar universal
He seems to be in better condition...
He's not shaking anymore, bobbing his head, or anything like that..
He seems to be having unpleasant taste, but that could be because of the oral surgery...
He didn't say a single word the whole time we were there, and he was ignoring everybody.  I asked him to look at me for a second and he did, so I guess he can hear us.  Maybe he is just choosing not to respond??
Does this point to anything else??
Helpful - 0
Avatar universal
I know, it was a little weird to think it was mad cow... but I was using that WebMD symptom finder application...
I'll write more of an update later today.
Helpful - 0
242532 tn?1269550379
MEDICAL PROFESSIONAL
Your description of day five suggests you ask the doctor about tardive dyskinesia as part of this syndrome.   If this detail narrative  truely starts with a healthy person who has not had any signs of psychiatric disturbances, then it is imperative that your doctors explore every possible organic cause of this psychotic experience before seriously considering the psychological causation. Keeping that focus first is what you have to think about, and think about in terms of an acute onset...not something like mad cow's diseease, but s omething related to the surgical b eg inning of this saga...and also something related to his weight,and enterocolitis.
Helpful - 0
Avatar universal
I take they have put your  friend on an anti-psychotic drug perhaps Respidol. One of the side effects is tardive dyskinesia. The effect of this drug can be reversed but needs to be taken care of right away. Look up tardive for information on it and see if it fits your friends symptoms.
Helpful - 0
Avatar universal
I had my wisdom teeth out in April last year (under IV sedation).  The dissolving stitches left a very unpleasant taste in my mouth.  (I tried to pull mine out but I was also somewhat cautious because my teeth had been in my sinus).
Anyway, I found having the stitches there quite distressing.  More for the smell, taste and nuisance factor than anything else.

I was wondering if your friend had an eating disorder.

Those post-operative meds sound normal: pain relief, antibiotic, ?anti-inflammatory.  Maybe it was the GA meds?

Side-effects can cause some people to be restless and to pace.  Akathesia is one.
I think the increased HR could have been due to the psych meds he was given.  People can react to anti-psychotics -which I assume he was given.  There are other meds that can be given to counter this effect.

Stressful events, such as surgery, can trigger pre-existing conditions.

It sounds like you already have a collection of conditions to choose from.

How about you let the doctors do the diagnosing.  You can always ask for a second opinion if you have questions about a diagnosis.

The doctor here may better be able to assess what is going on.  I've been reluctant to admit it, but psychiatrists do have a wealth of information.  It makes me feel hopeless having so little clue.

I hope your friend is much improved when you see him next.

J
Helpful - 0
726143 tn?1231471799
I'm sorry to hear about your friend/family. Is it a possibility that he had an allergic reaction to some medication they gave him for the surgery? Did the doctors elaborate on the one extra pus cell that they found? Maybe someone besides doctors, should sit down with him when he is in a calm state and ask him to remember something or anything that might have happened before he had the surgery. Maybe he was going through something and did not want to really talk about it and he bottled it up. Sometimes when we bottle things up inside for a very long time, there will be a point in our lives that we "snap" so to speak. We each have a silent trigger and sometimes that trigger is pulled without us even knowing. It seems as though he is comfortable with his brother, maybe his brother can talk to him.
Helpful - 0
Avatar universal
Day 4:
-seemed to have calmed down
-took him to a psychiatrist, and he got nervous…
-difficulty communicating
-rocking…
-blank stare, but responded to his name…
-said he wasn’t hearing voices when we asked
-stiffened up when nervous
-wanted to go home, repeated it, continuously asked “where am i?”..
-responded only to the family and closer friends
-psychiatrist suggested to take him to a college psych hospital
Car ride to ER:
-one of his favorite songs came on the radio, and he started to dance… and began to act like he was at a party and started to get excited and told us to dance with him… we got excited and started to play along… this lasted until the music was turned off… immediately after the music was shut off, he calmed down and was quiet again.

ER:
-nervous… stiff… but able to play tetris on gameboy…
-was given benadryl and atavan(sp?) and calmed down to the point where he could explain to us that he remembers everything.  Described the past few days as a dream, explaining that the dream was vivid and at times he even thought of himself as an alien…
-while talking, he seemed to be normal, but a little nervous about being in the ER and was acting a little loopy… possibly due to the meds or the fact that he still hasn’t slept at all…
-psych evaluation member came to evaluate his mental state…  wrote down that he was hearing voices even though when asked he said “no”
Taken to the psych hospital:
-anxiety and nervousness stiffened him up a bit, but with comfort from his brother, he calmed down a bit…
-when the family left the psych hospital, he seemed even more normal than how he acted at the ER, except he mentioned that he dreamt of dying in that very place

Day 2 of psych hospital:
-stiffened up, still no sleep.
-we were told that he was pacing around the hospital… probably at an extremely slow pace
Morning visit:
-seemed to have reverted back to an out of reality experience, but did respond to family… however his responses had slight delays…
Afternoon visit:
-we arrived to find that he was taken to the ER because his pulse shot up to 200+
ER visit:
-family to ER, doctors tried to give him meds to calm down, restrained him to bed because he was stiffening up and freaking out and the doctors thought that he was going to hurt them… but he began to calm down when he saw his family..
-they later gave him benadryl and atavan and a tranquilizer in an attempt to make him sleep… at first, he was fighting sleep.  While he was still awake, they got a urine sample. A staff member from the psych hospital who was there to monitor threw away the sample “thinking that it was already tested”. He later slept for about 4 hrs…   I believe he was also hooked up to an IV, but not positive…
-woke him up for ANOTHER urine sample and CAT scan
-while awake, he was anxious and delusional… most likely hallucinating because he was saying that he was doing things that he really wasn’t…
-once again calmed down once his family talked to him then he was given the same meds to calm him down from before
-he attempted to sleep but he would often wake up every few minutes while they were waiting for the test results from the urine sample
-when the test was finished he got the clear to return to the psych hospital

Day 5
-he was returned to the psych hospital
-When I visited him he was unable to walk w/o help, he trouble
eating, he was back was arched back, very tense, he kept his arms up (in a similar manner to a t rex), he was rigidly bobbing his head, when he tipped over his chair he was unable to help him self back up, he was mumbling to himself the same phrase over and over
-That night he stayed in the psych hospital

Day 6
-He was sent to the ER once again  for another CAT scan
-he is going to get a spinal tap to check for brain infection
-afterwards, he was given something to calm him down… I’m not exactly sure what it was, but he got some sleep

Day 7
-spinal tap results came in negative… it did show that he had one extra pus cell

Due to the fact that we aren’t allowed inside until visiting hours, we do not know at this point what his current state is…

Please try to think out of the box, I've been asking everywhere and I seem to be getting the same answers:
schizophrenia, anxiety, brain abcess, dental abcess, brain infection, NOTHING...
i've even been looking up mad cow disease...
so ellaborate on the more obvious answers, but also more unusual possibilities are nice to suggest...

thank you very much.
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