Looking for diagnosis from a qualified Dallas Doctor

[Pearl166]

My son is in his late thirties and has been diagnosed with having a bipolar disorder.  I believe he might have Asperger's
as well or maybe Schizoaffective disorder.  I am looking for a Doctor in the Dallas area who can make a proper diagnosis.  When he was in elementary school they said he had ADD and at the time a Dr. put him on ritalin...it was a terrible experience and we soon took him off of the meds... In Jr. high we had to put him in a school that had a much smaller teacher/student ratio to help keep him in school.  At around that same time (14yrs old) we had to put him in Terrel State Hospital in the adolence unit for bizarre type of behavior.   Later in his early twenties...he went on Lithium and again...horrible experience...He gained 50 lbs and then got acne...on top of everything else...so I was at that point afraid of meds of any kind but of course as a Mom still looking for answers that might help him.   Three years ago he had a breakdown that included weird thoughts and so forth....after doing research myself I though that Abilify might be a good choice because it didn't seem to have as many of the side effects as some medications...and then he went to a Dr. and was subscribed those meds...Abilify did help some but he has now taken himself off of it.  He does drink...mainly when he is having his mania to slow himself down...of course that doesn't go very well with the meds.  He does suffer from deep depression as well.
He is constantly looking out of the windows in his house.  He cannot always leave the house.  When he is having a good day...he will leave maybe once a week to go to the grocery store...I tell him you have to drive your truck at least once a week to keep it running.  When we go to the store together...we have to talk about how much time he will need...its always about 15 mins because he can't wait to get out of the store.  In the car he is very quiet and hangs on like there might me a wreck or something.  Sometimes when he is doing better he will go outside of his home...but we have to be very quiet.  He becomes obsessed with subjects...Ron Paul, stock market, big vocabulary, over pronounces words.
When I visit him which is at least one or twice a week...I set on the sofa while he paces back and forth. He whistles as communication sometimes and really its very sweet...A good day is a two whistle and a bad one only one.  I have to make sure that he stays clean because sometimes he will go awhile without bathing...although he is doing better with that.  He cuts his own hair...and does a great job...No way would he go to a salon.  His eye contact is sometimes off.  
He's a good looking guy, funny and has a great singing voice and he is the light of my life.  Please help...Thankyou.

[mjthewriterdad]

Wow!  He seems to have so many things going on.   We can't make any armchair diagnosis here.  It seems to me he needs to have an ongoing relationship with a mental health professional.  Maybe a multi-disciplinary team of many professionals well versed in each area of concern can do a better job than one professional specializing in one area.

Each specialty looks for different things and then they get together and come up with a concensous.

[Pearl166]

I thought I send a response to you...but it's not showing up.

Did you recieve it?

Pearl 166

[mjthewriterdad]

Yes, it's in my message box.  Just a public note to my private message to you:

To Everybody on this forum:
April is autism awareness month.  We have a long way to go in the United States of America to get autism spectrum treatments recognized by the health insurance industry.  We are being held hostage by the health insurance industry.  It's time to make some noise!  Write your state legislators, write your free press, march, yell, vote.

I have a girl with autism and I vote!  

[Sally44]

As well as the mental issues, it will be helpful if your son gets a diagnosis of Aspergers as well (or autistic traits), or whatever it turns out to be.  That may help any professionals to put in more specific strategies that may help with anxiety and phobias etc.
You don't say who is involved with your son at the moment, and if no one is then I think there should be a multi-discipline team involved.
From your post I think there may be some sensory issues (due to Aspergers) going on, or sometimes those with bi-polar can have heightened/dulled senses.
Alot of people with mental health issues tend to self medicate with alcohol and drugs.  But it is a two edged sword.  It may help them with some symptoms, but makes other symptoms or anxiety worse in other areas.  And, as you have found, many times there is an adverse reaction to the medication advised by doctors, which is why they tend to turn to alcohol etc.
  I have a similar problem with a sibling.  So far he has been unable to tolerate any medication, although tranquilisers have helped with the anxiety to some extent.  He has managed to reduce his alcohol intake, but he does still drink on bad days.
I think once an up to date diagnosis is made the next step (involving professionals), would be to get some kind of network in place for your son.  This would involve professionals and support groups etc, and for your son to become involved with groups of people that will understand him (because they have similar issues/interests).  It is too easy for people with bi-polar etc to become isolated, and I have found that if they don't 'use' their social skills etc they tend to retreat into themselves and lose them.  If your son also has Aspergers then he is going to have even more difficulties with social interaction and communication.
Your son sounds like he has alot of anxiety around going out of his house.  
Motivation can also be very difficult especially when the person is depressed, and containing them can be difficult when they are in a mania.
I am in the UK, and here there are schemes such as mentoring or buddying.  I don't know if you have a similar system.  It is usually accessed through Social Services and someone would be allocated to your son who has similar interests etc so that they can do certain hobbies or socialise together.  For example they may go to the cinema together.  This can be very useful if there is not a circle of friends for your son and he may feel awkward doing these things with you.  At this stage this may be inapproprate, but it might be a goal to aim towards.
Any services available that will mean social contact with your son (if he wants it and to an extent he can tolerate), will also help 'monitor' how he is doing and will help reduce your anxiety on the days when you don't see him.  That could even be something like home help, who may also be able to accompany him on shopping trips.  
I have an older sister with learning difficulties who lives in a warden complex.  She has a home help come in 2x a week and family keep in contact on the other days.  We have found it useful eventhough she has to pay for the service, simply because any problems are picked up immediately rather than 48,72 hours later.
As I am sure you are aware, not looking after your appearance/not washing etc can be a sign of depression, but it could also be down to difficulties predicting outcomes or down to planning and organisation skills.
You may find it useful to speak with a mental health charity for you to find out what is available to you and to your son.  They may also be able to give you advice on services in your area including a doctor who has experience of co-morbid conditions such as Aspergers or you may need to see different professionals for the different conditions.
Hope that helps.

[Pearl166]

Thankyou so much for your response.  We are presently looking for a new Dr. that will accept his insurance.  He does have a Dr. that he has been going to for about three years...but they really don't talk.  At first my son said he would like to talk with a Dr. about his issues...but I don't feel that they are a match.   Now he is ok with spending ten minutes and getting his prescription and getting the heck out.  Apparently the Dr. might have some issues...it seems he won't even shake my sons hand and doesn't want to talk...something doesn't seem right about that.  He has agreed at this point to see someone new.  I think a team, unless he sees them on a one on one basis might scare him.  Yes...I would like him to have a proper diagnosis...it's my understanding that you can be Bipolar and also have Asperger's.   I have often wanted to find a group or such that he could become involved with...I will work on that...I do worry about what will happen to him if something happens to my husband or myself.  I love the idea of having someone that he could visit with instead of us...I think it would help him.  It would be great to have home help as well...He has a problem with paranoia...so we would have to work on that.  Even when he leaves his home he is afraid someone might break in and steal something.

On the meds...yes...they are changed when you add alcohol to the mix...I have talked to him many times about it...and of course you need to take it everyday and not just when you feel like it...His med was Abilify.  Maybe the precription needed to be adjusted because he was trying to dull his mania with the alcohol.   He is not taking anything now...and is doing better...but I am concerned...We got his perscription refilled just in case.  

He did reach out to an old school friend and is making plans to see him...He is trying to keep it as low key as possible so as not to trigger his mania.  I said if you feel like you want to do that...then you should...He wants to expand his horizons...and venture out of his safe world...We did errands together yesterday...I drove...he is sometimes afraid to get out of his house or drive...but I thought he did good yesterday...He kept checking his watch...I said, "Do you have an appointment...or something?"  He just laughed and said he was just seeing how long he had been away from home...it was a big day...we were gone for almost three hours.  

It seems like you have alot of experience with mental illness with your two siblings...and I really appreciate you taking your time to advise me on this issue.  Thank you!!!!

I have been doing my ancestry on ancestry.com and although I have never been to the UK...I would love too...apparently I have ancestors all over England, Wales and Ireland...maybe a trip in a couple of years...that would be exciting.

Sincerely,
Pearl166

[Sally44]

Glad it was of some help.  Regarding team meetings.  That is why a diagnosis of Aspergers, if relevant, would be useful because in the UK they do tend to have 'team meetings' with everyone present.  There is usually someone to be an advocate for the 'client' if requested, but it is still a very daunting task and, as you rightly say, would be difficult for your son to sit through such a meeting.  He probably wouldn't be able to take in much of what was being said or be able to contribute if his anxiety is going through the roof. We as a family are in the same position.  We are trying to find ways of getting people/organisations involved so that there is a 'safety net' of people who all have contact with them on a regular basis.  But we are finding it hard to break current routines.
As you know, they can take a turn for the worse suddenly, and if it is left to them to take themselves to the doctor then it just doesn't happen.  
My sibling also has periods of paranoia and delusions which are never fully resolved because he believes they are true and not part of his illness although he does admit that certain things (including alcohol) tend to make him more paranoid.
It might be worthwhile getting an Occupational Therapist involved to look at ways of 'self monitoring', if you think that is an achievable goal.  This would help your son identify when he is beginning to become unwell so that he can take action.  This might involve completing a daily questionnaire that will give a 'wellness' total and if it drops below a certain number then he knows he should contact someone.  They can also look at issues such as anxiety/phobias, and can help your son find ways to get a more balanced life eg. ways to improve social life etc.
There are also many people who prefer not to use medication and see their periods of depression and mania as productive and even creative.  But it is a bit scary for family members to watch this.
I have been involved with Occupational Therapists before and have found them useful because they can take a broad view of the situation.  Some professionals seem to only work in a narrow field, but OTs can cover just about anything.  But it is worth finding one that works in mental health.
But any change that your son is able to take on board is going to be a positive one.  So work with what are his priorities (not anyone elses) because he will be more motivated to do things he himself wants to achieve.
Wishing you all the best.

[Pearl166]

I will ask my friend who is an Occupational Therapist for her ideas...she works mainly with the elderly at nursing homes and in the hospitals.
The medication was really a last resort for us because of our past experiences with meds....and we resorted to it because we simply did not know what else to do...he had a pychotic episode that was very scary that led us to that decision.  Now is a wait and see with no meds.  I didn't know how broad the spectrum was for Autism...I have alot to learn and who knows maybe he has something else....My husband said he doesn't do all of the things that Jerry does on Boston Legal...so maybe that's not what he has...All I know is he has alot of those symptoms.  
Thanks again