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psychotic episode

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Hi,

 

 

I posted here before Christmas with respect to my son who was experiencing some serious problems concerning his ability to cope at school. I received some excellent advice, but before we could put plans into action, my son's mental health deteriorated and he was admitted to hospital after a psychotic episode.

 

Please could someone tell me the fundamental differences between the sort of obsessional though patterns experienced by someone on the autism spectrum and a psychotic episode.

 

Thanks

 

 

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I go psychotic on tartaric acid or sodium benzoate. I also experience rage and gluten induced psychosis. when an obsession is hard to prove it can seem psychotic when the problem escalates. what was he being psychotic about? was he on any medication at the time that could have caused this reaction? I know someone who lost his mind on venaflaxine and ended up under section.

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Hi,

 

Thank you Trekster. The situation s a little complex and I am trying to come to terms with it at the moment. My son has attended school on a very reduced timetable since the New Year due to the effects of anxiety and depression. Over the last month, he has been obsessing about his uncle and grandmother who live a quite alternative (but harmless) lifestyle. He has expressed hatred towards them and his hatred seems to be based on the fact that they have chosen to live as they do. Until now, we have taken this obsessive hatred as a symptom of my son's ASD (combined with adolescence). However, on Sunday, we visited my mother and brother (the objects of my son's hatred) and my son stayed in the car, which is a strategy we have agreed upon in consideration of his feelings. However, when we came home, my son had a complete breakdown. He smashed his phone, his bike, the cycle rack and various other objects in the garden shed. My husband rang the emergency services and my son was taken to hospital and held under a police section (not a Section of the Mental health Act). I went with him. My son was interviewed by members of the Mental health Crisis Intervention team. Throughout the interview, he said that he had a 'plan' and the plan was to kill his uncle and grandmother so that he could go to prison and waste his life. He was interviewed by another psychiatrist later and allowed home because he seemed a lot calmer. An appointment was made for him to see the CAMHS team early the next morning. However, the next morning, my son refused to see the CAMHS team and ran out of the house (I was at work). My husband was concerned for my son's safety and rang the emergency services again. A full scale search was undertaken and my mother and brother were taken to a place of safety (which is a bit of an over-reaction in my opinion). My son was found at the local railway station several hours later and he was taken to hospital. I joined him and we stayed overnight. During his stay, my son still talked on his 'plan' but later he said that he realised it would not achieve anything and that he no longer wanted to carry it out. He talked of feeling 'unaware' during the incident and he was discharged again with a discharge diagnosis of 'psychotic episode'.

 

I am a little confused because I cannot distinguish between my son's obsessional behaviour and the possibility of delusional thought and, more significantly, I do not know if the 'psychosis' if, indeed, that is what it was, may return and how we should respond, particularly because I return to work in a few days time.

 

I have also the rather less serious problem of repairing family relationships (bearing in mind Mother's Day is around the corner) when my brother is intent on protecting my 85 year old mother and does not want my son to visit their home again. Our other son has a very good relationship with his uncle and grandmother.

 

I am sorry to include so much detail, but I felt a little context might help explain my query.

Edited by hsmum

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Hi, I'm really sorry but I've tried sending you a private message but for some reason it just won't send, keeps coming up that I need to put more than 3 characters in, so I just don't understand it. Anyway, I will print the message on here instead:-

 

"Hi I've just read your posting regarding your son. My son Glen who has a diagnosis of autism, challenging behaviour and mental health issues. He is nearly 20 and resides in a local care home. How old is your son?, when Glen was around 15 he wouldn't go to school, he became violent and extremely anxious and suffered with depression, he would hit himself and others with extreme force, Glen has always been a very anxious young man.
I am sorry to hear what a bad time you have had recently. In my opinion your son needs to be admitted in hospital for a mental health assessment. Glen was sectioned in December 2012 and it was the best thing that could have happened to him. The hospital was very good, they put him on some new medication which helped him become much less anxious and much happier and settled in himself. Glen stayed there for 5 months and then he went to live in the care home he's currently in as I was unable to manage his needs.
I think you should explain to your family how your son is and that he doesn't mean to say horrible things to them. He can't help it he just needs help. In my opinion if I were you I would really push for a hospital assessment, you have to think of your son and yourself, as a parent all you want is for your son to be happy and you would do all you can to help him.
I cannot believe your son was taken to hospital but discharged. I just don't understand that the professionals did not see that he needed help. You really need to see the CAMHS team, go on your own, I did in the past when I couldn't get Glen to appointments, that way you can explain why your son wouldn't go with you, what I have learnt is you have to fight really hard to get help for your children, and don't give up until you have that help.
As for your family, you need to talk to them, try to explain how your son is and that he doesn't mean what he says he's just crying out for help. You need to think of your son first and not worry so much as to what your family think. I'm sure they understand and want to see your son get better. If I were you I would not take your son to see your Mum on Mother's Day, perhaps your husband could just take your other son round.
Anyway, I hope it's helped what I've said. Please let me know how your son is doing, I will say a little prayer for him and for you. Take care x

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bless you,sounds worrying bet you stressed under pressure ,strain trying pick up emotional turmoil ,upset left in pieces and friction caused by your son's actions when in vulnerable irrational state of mind , is not easy but challenging and difficult task to achieve , have you tried writing a heartfelt letter explaining how situation got out of control filled with emotions I can totally empathise with your son's situation personally as affects so many people around him, not JUST HIM - I think others FORGET that fact! is he on any medication at all right now? has schizophrenia been investigated as this can involve psychosis? Bi-Polar? BPD? all worth looking into? does his anxiety trigger off his psychosis ? do you personally believe he would ACTUALLY carry out his threat of killing family members? or see as harmless threat made? is he remorseful ? does he afterwards what he has said /done? does he remember? does he have any MH support services involved?

 

XKLX

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The obsessional thoughts common in ASD could be fuelling the Psychosis and delusions by thinking about the same subject constantly, pattens join up and you become very illogical thinking wise. I know with me when I become poorly I get very obsessive around certain things mainly paranoia, its hard to switch off.

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Certain foods and meds have caused me to loose it completely and be unaware of what's going on. ive had major meltdowns without threatening to kill anyone I might add. There are a couple of factors at play here 1, hes autistic, 2, hes adolescent and 3, hes severely depressed (wanting to waste his life sounds like severe depression to me). ive heard of angry depression in autism before but not any threats to kill.

 

I am off all tartaric acid and sodium benzoate as it causes me to become severely dissociative which is how your son seemed. Would explaining how his uncle and grandmothers lifestyle are 'OK for them' help your son to understand? Your son accepts carrying out his actions would be a bad idea? To me that sounds like a severe autistic meltdown. There are a few books aimed at adolescents about Asperger syndrome/autism. I hated being a teenager. There are books about managing meltdowns and Aspergers/autism around. What sort of things calm him? Can he be distracted with these interests when he's starting to get wound up.

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Hi hsmum how horrible for you. Teenage years seem to be so tough for our kids. My son had a psychotic episode around 10 years ago, ( in my opinion,brought on by his retina detachment that literally drove him nuts). If you decide on a treatment and assessment unit It will depend where you live but please read and avoid this outfit http://mydaftlife.wordpress.com/about/

Edited by lisac

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I'm diagnosed Schizoaffective disorder as well as ASD, when I was unwell I had this delusion around my bother being an alien and I threatened to harm him, I didn't know then but mental health professionals take that sort of thing very serious indeed, they will be making a very thorough risk assessment of your son and his needs which could possible get him moved into locked rehab or a low secure unit if he attempts harm towards any individual, They're are specialist units that cater for vulnerable people with ASD....

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If you mean the Hayes Unit that shut down a few years ago.

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The obsessional thoughts common in ASD could be fuelling the Psychosis and delusions by thinking about the same subject constantly, pattens join up and you become very illogical thinking wise. I know with me when I become poorly I get very obsessive around certain things mainly paranoia, its hard to switch off.

 

I was going to say the same thing. The obsessive thought patterns and the 'psychoses' are the same, to me they are anyway.

 

Nt's tend to have common thoughts/ personal opinions that are very similar to your son's, in having the thoughts he does about his uncle and grandmother, only he seems to have taken some thoughts and feelings that he has and has latched onto them, repeating them within himself in an obsessive manner and blowing them up in the process.

Edited by cookiemonster

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Certain foods and meds have caused me to loose it completely and be unaware of what's going on. ive had major meltdowns without threatening to kill anyone I might add. There are a couple of factors at play here 1, hes autistic, 2, hes adolescent and 3, hes severely depressed (wanting to waste his life sounds like severe depression to me). ive heard of angry depression in autism before but not any threats to kill.

 

I am off all tartaric acid and sodium benzoate as it causes me to become severely dissociative which is how your son seemed. Would explaining how his uncle and grandmothers lifestyle are 'OK for them' help your son to understand? Your son accepts carrying out his actions would be a bad idea? To me that sounds like a severe autistic meltdown. There are a few books aimed at adolescents about Asperger syndrome/autism. I hated being a teenager. There are books about managing meltdowns and Aspergers/autism around. What sort of things calm him? Can he be distracted with these interests when he's starting to get wound up.

 

Yes, perhaps try talking to him. Understandably, you may think that talking to someone who is psychotic may be a hard thing to do but he may understand if you have a discussion about his uncle and grandmother and really get into the technicalities surrounding his feelings towards them and your differing feelings on the matter. Perhaps he just needs to see everything from a different perspective.

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http://www.mind.org.uk/information-support/types-of-mental-health-problems/psychosis/what-can-friends-and-family-do-to-help/

 

This is an excellent website aimed at friends and family who support folk going through a psychotic experience.

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How old is your son.

 

Is he on any medication?

 

I think your question is hard to answer, other than you knowing your son and what is 'typical' of his usual behaviour.

 

What is it about your mother and brother's lifestyle that he does not like?

 

For example, my son has ASD and OCD, and he would struggle with anyone who he felt was likely to contaminate him or his house or his family with germs etc. And if put in a situation where he had to meet or be near such people he would get very upset.

 

Regarding the language he used, it is hard to know whether he actually meant it. My son and children with an ASD can say some very literal things and not have any intention of doing them. Again, it would need you to know your son's understanding and use of language.

 

And why is he running away? Is his depression being treated? Is school just too much for him at the moment? Is there anything else in his life that could be causing additional anxiety?

 

Involving the organisations you have means that they are going to follow their procedures, and does not mean that they will necessarily understand or take into account his ASD. Basically they don't know him. So would have to respond to threats he has made. But the main point is what happens from here onwards?

 

I agree with Jeanne that he needs a proper psychiatric assessment, whilst in a mental health hospital setting, by a professional [psychiatrist and clinical psychologist] that does have knowledge and experience of working with children or adults with an ASD and Anxiety.

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Hi,

 

Thank you for your advice. My son is 15 (just). Since my last posting, he has been admitted as an inpatient to the local CAMHS unit where he has settled quite well. The episode seems to be treated more as a mixture of autistic obsession, depression and anxiety than psychosis, although the boundaries between the two are, as mentioned above, unclear. For example, my son mentioned hearing voices, but the psychiatrist told me that because the voices came from within his own head and he was not distracted by them in conversation, they seemed to be part of his own internal dialogue rather than hallucination. My mother and brother have a few issues with keeping things clean and tidy and this is something my son has been focusing on. It is still early days, but my son does seem a lot calmer now.

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hs mum - I have also had personal 1st experience of ''inner self voices' where hear own thoughts on over drive and can't get rid of them so overlap each other caused by either excess anxiety or depression or even both mine at time seemed sit with more anxiety ,panic attacks but could be mixed together can be so scary when experience this as so sudden,unpredictive and difficult to know how manage them more effectively! glad your son seems more calmer and settled now receiving right kind of treatment package for him! and take slow steps move in right direction to make himself 'well' can become fuzzy within mental health difficulties when ASD whatever form or level also involved within situation can complicate and confuse issues and difficulties further! making more of mystery struggling unravel of what causes what! can totally empathise with your son's experiences ,difficulties and issues! x

 

XKLX

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Autism in many individuals will come with co-morbid mental health problems, such as bi-polar, depression, schizophrenia etc, as such psychosis as a sign of illness is often compared to fever since it can have multiple causes that are not readily apparent. The psychosis can be brought on by medication, foods and other environmental effects

and it might not re-occur. IT is a good idea to talk to your GP about possible co-morbid mental health problems that might arise, the possibility that Autism can trigger mental health problems

is very real, that's why it is important that the doctors you see are experienced in autism, many people with autism are wrongly diagnosed as schizophrenic, when a good doctor with knowledge will realise that the autistic person is not able to regulate their anger and use in appropriate language such as I will kill you, when asked how they would do that they will give a well planned out reason, not realising that words effect NT's (neurotypical people) , but there is no intent at all, the crisis team most likely are not trained to understand autism and gave the general term psychosis.

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My son had a mental health breakdown last weekend at the care home, he hasn't been settled lately so it wasn't a complete surprise. This breakdown was very bad, he was hitting himself, hitting staff, and distroying his room, breaking everything he could and broke the t.v. in the lounge. This was the worst he'd probably ever been. As it was the weekend, there was no psychiatrist on call, a doctor came and did prescribe diazepam, but the situation was so out of control the police had to be called. Glen did calm down very late that Saturday night. The doctor said it did look like a breakdown, there seemed to be no triggers at all, it just happened so quickly and escalated. There was an emergency meeting held on Tuesday which I attended with the care home manager Mel. They asked her if she wanted Glen to be admitted into hospital, but Mel said no, we want to keep him. They are such a dedicated team at Glen's home he is very lucky to be around such wonderful, supportive, caring ladies. Mel also knows that the 2 possible hospitals that Glen could go into in the area where he is don't have the best reputation and she was concerned with who Glen could be put with. So I'm thankful that he is still at the home. Glen has been very quiet, in a low mood all this week and has appeared quited exhausted which isn't surprising due to last weekend. His appetite has returned which is good, but he remains in his room a lot of the time. I'm hoping he will soon feel better in himself. I have complete confidence in the staff to help Glen through this very difficult time. I am though very concerned that this could happen all over again.

Edited by JeanneA

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Hi Jeanne I am very sorry to hear this It makes me want to cry. My son had an episode like this about ten years ago, I stupidly tried to intervene and was bitten badly and I was petrified he could kill himself. He attacked himself violently. He was put on high dose meds after that. I am always wary but It didn't happen again thank god. I am sure it had everything to do with his eye problem that he just could not cope with the discomfort. I really feel for you and hope this was a one off. Glens care home sound excellent. x

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Hi Lisa, lovely to hear from you. Yes I am lucky that Glen is in an excellent care home, whatever happens to them or anything around, i.e. furniture etc all they care about is the young people that live there. Also they know what the hospitals are like in that area and wouldn't wish to see Glen be admitted, whereas Glen's previous care home admitted him as soon as he became aggressive. Like your son, Glen's had eye problems with the detached retina and unfortunately through him constantly hitting it he now has virtually any eye sight out of his right eye. I'm hoping the diazepam gets him over this difficult period. I know from past experience the diazepam was the only meds that really helped him in the short term. Yes, I to hope this was a one off.

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Im sad to hear about Glens eye sight, the same happened to my lad. The eye specialist said not to repair it because it had been like that for a while and other problems can occur later on with reattached retinas, like cataracts. I wonder if Glens eye could have been been bothering him for a while. It must be as irritating as hell and unbearable to live with. Our poor sons they really really don't deserve any of it. x

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Hi Lisa, yes I quite agree our sons don't deserve it at all. The eye doctor thought Glen probably had been suffering for a while with his eye and didn't recommend another op, he felt it would probably not give him back much site and it would be too much for him to go through. I feel so sad for Glen, I talk to my husband (Glen's step-dad) about how I'm feeling but he doesn't like me to keep going on about it so I haven't really got anyone to confide in, my daughter helps in her way but just keeps telling me not to worry, but the problem is I do worry, I always have, about all my kids. My Mum bless her was just the same so I definitely take after her :-) Julie takes after her dad, (my ex), she never worries or gets stressed about anything, I wish I was like that. Anyway, lets hope as our sons get older they will be more settled and aggressive outbursts are no more, well we can but hope, can't we?

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Thanks Lisa, I've rung tonight and Glen's had a fairly calm day, came down a couple of times for meals but otherwise stayed in his room. I hope he gets over this difficult period soon. I feel so sad for him, it's really difficult not seeing him as well but I don't want to do the wrong thing by visiting at this time as staff have enough to deal with. He hasn't been out since last weekend, they are not pushing it until he is more stable, which is for the best. tc Lisa.hope all is going ok with your son :-)

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Sorry to hear about Glen. It is horrible being a parent and knowing there is nothing you can do to make it better or easier. I'm glad he's somewhere you have such confidence in. Mental health services for children/young adults is scare.

 

I've been trying to find some organisation that can advocate for my son and the family regarding mental health issues, and there is nothing for children at all. We are having problems with childrens services who just have no understanding of ASD and OCD. I just get so fed up of going round and round in circles. And we've had very unhelpful and damaging 'advice' from the school psychotherapist who is of the opinion that his anxiety, OCD and even some ASD behaviours are due to some emotional 'trauma', and is pointing the finger at the home environment! Beggers belief. Especially as he does not even talk to my son and my son does not talk to him. He sits and watches him play with plastercine! He is from the Freud school of thinking. I've told school I am not happy for my son to see this person anymore.

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Hi Sally, sorry to hear what you are going through. i know all about emotional trauma and pointing the finger at the home environment I had that when Glen was at School so I do sympethesise. Some schools will do anything to point the blame within the home and not within the School.

 

I am concerned that Glen is very isolated at the home, he spends all his time in his room apart from coming down 2 eat. Don't get me wrong the carers do go up and see him, but I'm just so worried about what happens if he doesn't get better. I'm sure he's in a deep depression. I don't know if I should have insisted on Glen going into hospital or not. The home is good but they are just carers, whereas in hospital he would get treatment. Unfortunately the hospitals have not got a great reputation, which is why the care home manager wanted to keep Glen at the home and the last thing I would want is for Glen to go somewhere that he is not treated very well. I know the carers at his home and they are lovely people, and another 'move' doesn't seem fair on Glen, he's had so many moves in his life. I really don't know what the answer is, I just hope and pray Glen gets better in his own time.

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How does or can the home access psychiatric input [advice and not just medication]?

And I know you will also be thinking that hospitalisation will be yet another change for Glen.

Can you go and see the hospitals that might take Glen. Or is there any other hospital elsewhere that is more appropriate?

 

Is there anything you can think of that might have started this downward spiral?

And how does Glen respond to medication, and is he on medication for depression?

 

Has Glen been hospitalised before?

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The home manager Mel keeps trying to contact the hospital psychiatrist, but he isn't the most helpful of people, Mel doesn't like him at all. I went to the crisis meeting last Tuesday with her at the hospital where the psychiatrist works. I didn't take to him either he wasn't willing to review Glen's medications unless Glen was admitted into hospital and he even walked out of the meeting before it had finished with no explanation! There are 2 hospitals Glen could go in, in the area where he is, the one where the meeting was held at and the other one which definitely would not be suitable which is why Mel fought for Glen to be kept at her care home to be given the chance of getting better without being hospitalised.

 

Glen has been in hospital twice before, once in December 2010 in Northumberland for a mental health assessment and the next was in December 2012 in Birmingham (Glen was in a care home in Coventry at the time). I dont really think either assessment resulted in any answers which is why I don't know whether having yet another assessment in another hospital would make any difference or would just cause more distress to Glen who is in a very fragile state at the moment.

 

Glen is on medication for depression, but has been on the same one since 2011 and I feel a change could be needed. The psychiatrist did try Glen on something not long ago which didn't suit him and could have led to Glen's behaviour last weekend, so that was stopped and diazepam was prescribed instead, which is definitely helping to keep him calm. He has been much better since being on this. At the moment Mel and her team are taking each day at a time hoping Glen will start to get back to his happier self, they are not putting any pressure on his whatsoever. Since the crisis meeting the care home are getting phone calls twice daily checking on Glen, so if anything should occur again hopefully they will act straight away before Glen's behaviour escalates out of control.

 

I don't know about looking at hospitals outside the area Glen is in, I would have to find out if that was possible. Like the staff I have to give Glen the chance to recover in his own time, he has great carers around him. Although of course I am worried, am on edge all the time, hoping the phone doesn't ring with bad news :-(

 

Glen had been hitting his right eye for some time which has probably been hurting him, he had an operation for a detatched retina in 2012 which was a success, but gradually Glen's eye became worse again through Glen hitting it and now he has virtually no eye sight in that eye, the eye doctor said it wouldn't be worth operating again as he didn't think it would make a lot of difference to his vision so it wouldn't be fair to put Glen through another operation. Glen has eye drops which he has to have for the rest of his life.

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Although another operation might not help his sight, could Glen be hitting his eye because it is irritating or hurting him? Can he communicate that using PECS?

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Hi,

 

Thank you for your advice. My son is 15 (just). Since my last posting, he has been admitted as an inpatient to the local CAMHS unit where he has settled quite well. The episode seems to be treated more as a mixture of autistic obsession, depression and anxiety than psychosis, although the boundaries between the two are, as mentioned above, unclear. For example, my son mentioned hearing voices, but the psychiatrist told me that because the voices came from within his own head and he was not distracted by them in conversation, they seemed to be part of his own internal dialogue rather than hallucination. My mother and brother have a few issues with keeping things clean and tidy and this is something my son has been focusing on. It is still early days, but my son does seem a lot calmer now.

 

Do you mean your mum and brother have an untidy house? Could these be OCD obsessions? Is he worried about germs and contamination?

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Hi sally I've just heard from the care home manager and Glen has an appointment on Thursday, I have just mentioned that Glen's eye could be irritating him. Glen remains calm but quite unsettled. I don't know how they will get Glen there as he still won't go out. I will let you know what happens.

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Can Glen communicate discomfort or if he is in pain?

My son often does not say anything unless you ask him the direct question "is your ear hurting you", then he might say "Yes, I've not been able to sleep for days!" But he never gives up that information unless he is asked. Could Glen be the same and he needs to be asked the question? And can he give a response verbally or using PECS or similar?

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They have asked Glen outright if something hurts and he has nodded at times, the problem is Glen is known to nod at anything, so you never know if he is in pain or not. What works best for the home is when they point to various parts of Glen's body and Glen has nodded to what hurts, but it is hit and miss I'm afraid. I've also found out from the home manager a short while ago that Glen over the past couple of days has become very active in the home and is searching for food again everywhere, now this is what Glen did when he moved into the home a year ago this week. So, it does show you Glen has these cycles, he was the same when he lived at home. I remember Glen going through all the cupboards for food, it seems Glen goes from one thing to another. I remember I kept him busy doing household chores to keep his mind off of going through the cupboards.

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Hi things are still not great with Glen. The home manager went to see the psychiatrist on her own last week, as Glen wouldn't go with her. He did increase the diazepam to keep Glen calm that was about it, but there is another appointment this Thursday for Glen to see the psychiatrist again with another professional, but it's highly unlikely that Glen will go, he still will not go out (hasn't been out for nearly 2.1/2 weeks now) and is hitting himself frequently but is very happy and smiley afterwards, I think he is hitting himself to force the brain to release the endorphines to give him a good feeling. I have been looking this up on the internet and it is quite common apparently. Glen should have gone to the dentist this afternoon, I'm waiting to hear if he went, but I very much doubt it.

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