Tuesday, December 01, 2009

Early stages of treatment

Where are we, and how did we get here?

As I have mentioned, my son was thrown out of two colleges, moved into (and lost) an apartment, and moved in with us. In late September, he was fired from a job at a local fast-food restaurant, and on that evening he got horribly drunk (on nearly a fifth of bourbon) and became belligerent. We eventually called the police, who placed him in protective custody for the night.

His behavior deteriorated since then: more episodes of talking to himself, often in our presence, and not interruptible. An increasing reluctance to go out of the house and be seen in public.

A couple of weeks ago, he found another reason to get drunk again (not a common occurrence), became belligerent again, and again we called the police. This time he (apparently) took a swing at a cop, and instead of protective custody, he was under arrest.

On the advice of court officers, I filed a request for evaluation for substance abuse problems (for which he has a history). It turned out that he was "pink slipped": sent to a local emergency room for a psych evaluation by a local mental health agency. Their findings (unknown to me at this time) resulted in sending him to a psychiatric hospital's "Adult dual diagnosis" unit. "Dual diagnosis" alludes to a combination of substance abuse and additional psychiatric problems; not unreasonable in my son's case.

The doctor's at the hospital applied the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, version 4), and reached a diagnosis of schizophrenia. We were shocked and in denial at the diagnosis, but when we read the diagnostic criteria, we recognized our son in 12 out of 12 criteria.

Our son was prescribed Zyprexa, one of the second generation "atypical anti-psychotic" drugs. He resisted the treatment at first, and has continued to deny that he has a condition that requires treatment, but he has markedly improved. His speech is clearer, he makes eye contact in conversations, and he will acknowledge that the treatment seems to helping, even while denying that he has a condition that requires help.

He will probably have to move out of the dual diagnosis unit (since, thankfully, he doesn't have an active substance abuse problem), but we're on pins and needles wondering where they will decide he belongs next. We don't think he should come home yet; the issues that triggered his belligerence here twice have not been resolved. And he doesn't freely acknowledge that he has a condition that requires continued treatment. But what will be proposed?

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