Hell Week Part I

Hello [therapist],

Unfortunately, we have had a very bad week so far. On Monday, [Sunny]'s behavior in school was bad and we got a note from his teacher. Tuesday, [Guy] had to pick him up from school early because he was pushing other kids in line, and then had a tantrum and threw things when the teacher confronted him. They told [Guy] he was "out of control". They are having a meeting Thursday morning.

Yesterday, his gym teacher also said he behaved badly and was almost asked to leave the class. I also had to restrain [Sunny] numerous times yesterday. Once in the morning and once after school and twice after gym class. He would get very, very oppositional and when he was asked to do something say "I don't have to!" or "I hate you!" or "you're ruining my life by not letting me (watch TV/do XYZ)". We eventually got the routine done: dinner and reading and bedtime. [Guy] is especially stressed out.

[Sunny] is grounded (he can play outside but not go into anyone's house) and also has no TV privilege until he can have at least one good day at school.

One thing I have been worried about is that in the last week or so [Sunny] has seemed to hear voices when no one is talking. Sometimes I won't say anything, but he will ask "what?". This seems to have increased. I talked with him about it last week, and asked him if he was hearing voices that weren't really there. I didn't make a big deal out of it (he's kind of a hypochondriac so that would encourage him to get carried away). He said he does hear those voices sometimes and they say things like "I hate you".

He told me in the car yesterday that he was hearing those voices, that they were bothering him, and that "maybe he should see a doctor". Again, I didn't make a big deal out of it, I just asked him some questions about them. He knows they are not real. They don't come from the front or the back, they come from the inside of his head. I'm very concerned because I don't think he would say he wants to see a doctor unless he was really hearing them. He's not a big fan of going to the doctor, because that almost always involves getting a shot (though he loves going to the dentist because they have video games in the waiting room).

With all of this going on, I made the decision to put him back on medication. I just read that [the atypical antipsychotic] takes a long time to fully clear out of the system. So his good behavior last week, off the med, was not really indicative. He had a pill last night. This morning he did OK.

Response:

I am sorry to hear it has been such a rough week. I would agree with your decision to put [Sunny] back on the medication. I would also speak with his psychiatrist about this. You are correct that it takes time to clear the system of [med] which is likely why he did so well when he was initially taken off of it. In terms of the voices, auditory hallucinations actually seem as if they are coming from outside the body. In other words, it seems as if someone who is not present is talking to you. More than likely, [Sunny] is experiencing self-deprecating thoughts he is unable to control which translates (in his mind) to a voice of another. This is likely to abate once the medication becomes effective in his system. I would encourage you to monitor it to see if it changes over the next few days. Thanks again for the update. Don't hesitate to contact me with any additional questions or concerns.