Friday, December 19, 2014

Contract, housing applications & symptoms

My son's case worker was here yesterday. Several things about that meeting are bothering me. As I stated in my last post I had spent some time looking up, printing and filling out housing applications for my son as he wanted me to do. When his case worker arrived and we started going over the applications she asked me if he was officially diagnosed with ADHD as I noted it as a secondary diagnoses along with addiction. Official? I don't know. Obvious? Yes. Why try him on Adderall, an ADHD medication, if one didn't believe that he had it? I guess if the medication worked then his psychiatrist could say: Yes he has ADHD. It triggered psychosis instead. Hmmm... So all the people diagnosed with schizophrenia who's medications are NOT working are not schizophrenic? It's diagnosed by symptoms not the success rate of medications. Wouldn't the same mindset apply to ADHD? Apparently not. Watch my son's leg go a mile a minute and tell me he is not ADHD... Another item was self-harm. Yes my son has superficially self-harmed in 2011. Apparently it's not schizophrenics but people with personality disorders that self-harm. Ahem... Please read some forums. It may not be common but it does happen. I have personal experience with someone who self-harmed. I didn't know about it, at all, and I saw this person daily. Like someone who self-harms is going to do it in obvious spots that show or tell someone that they are doing it? No, it's done in hidden places like inner thighs, under the arm and even on the torso and they certainly don't voluntarily show it to their treatment team as the shame is too great. When it's done in more obvious places then it's long sleeved shirts and no shorts in the middle of the summer or lots and lots of bracelets that cover up the wrists. Unless looking for the signs is someone going to spot this seeing someone once a week or once a month for 10-30 minutes? If not aware it's even possible will someone even think to look for the signs?

Honestly I sometimes feel so mad at professionals who have their blinders on and refuse to see or do the appropriate research into the conditions they are treating and medications they are prescribing. I don't blame my son's treatment team (maybe I do) however I think they need to be more responsible. My son was prescribed Adderall despite the warnings regarding previous psychosis and addiction. Sometimes they will only prescribe small amounts at a time due to addiction. Does anyone know the mindset of an addict? Unfortunately I do. Some will abuse the medication for a week then go the three weeks without, because they know that in three weeks they can have that high again. They have something to look forward to. Really what are weekend warriors? They are users that work all week just to let lose and use on the weekend. The week of suffering and withdrawal is worth it knowing that the weekend is coming. When I discuss drug seeking characteristics with respect to Neurontin/Gabapentin then it's no, that medication doesn't do that. Again read the forums, there are lots of them, with statements like: Taking Gaba and smoking a joint will get you super high...  It amplifies the affect of the alcohol or drug. Honestly forget what the manufacturer says... They aren't the ones abusing it (hopefully ;)). Gaba has the same addiction risk as Aspirin... Right, because no one has ever gotten addicted to Aspirin! (sarcasm) I was actually reading an article the other day on a new concurrent disorder treatment facility in a neighboring district, that treats mental illness and addiction concurrently or at the same time. They had to get rid of un-monitored hand sanitizer because alcoholics were drinking it. Cough syrup! I learned in a recovery class how common it is for alcoholics to relapse because they got sick and drank cough syrup which triggered them. Apparently some forms of NyQuil is 25% alcohol! That's alcohol. What about drug addiction? We are prescribing medications that are triggering drug seeking behavior, because the manufacturer doesn't say it can do this, and dealing with the consequences. Consequences however that professionals, in my not so humble opinion, are ignoring or lack the knowledge or insight to see. Another article I read yesterday was discussing the fact that even though the risk for prescribing benzodiazepines increases with age that seniors are STILL being prescribed them at a higher rate. Sad isn't it?

They want to keep him on the Invega injection which I understand but it's not working. That's another rant ;) I did just call PACT and left a message stating that it looks like the Invega may be wearing off again and it hasn't even been two weeks. He has been doing a lot of just lying around, doing nothing. Never a good sign with my son. I'm also noticing that him laughing, for no apparent reason, seems to be getting more frequent again. I want to be pro-active instead of waiting another week, when he sees his case worker again, and preferable before the weekend. Catch 22 on this one is that we still don't have his disability or drug card straightened out and considering how much the Invega shot is, the oral form is probably just as expensive. *sigh*

Back to his case workers visit that certainly didn't go according to plan. He ended up having attitude about signing the housing applications which started because he didn't think that the level of support that he needs from these agencies is high but should be low. Tried to explain this meant that he would get more help but no... He doesn't want more help. He refused to sign the group home application as he wants his own room. The group home gives him his own room. He doesn't want someone monitoring his medications, a memory of us discussing group homes in August I guess, so it's to late and he is already in defiant mode. When I pointed this out he tells me not to use that word anymore. He gets mad and tries to put of walls to what I'm saying since he can't defend against it any other way. He decides not to sign anything, that he will do it on his own by contacting the government on his own. We explained that these forms (not the group home one but the other two) are him contacting the government asking for assistance for low income housing. He finally relented and signed one of the forms that is applying for housing where 3-7 people share a townhouse. Still refused to sign the other application through another agency for the same type of housing. He can certainly be a conundrum as he is putting up roadblocks to getting what he says he wants. His case worker also tried to talk to him about that fact that he needs to show that he is capable of living on his own before PACT will put him into a living environment that he can't handle. Forms are being filled out that quit frankly state that he is not even capable of taking care of his hygiene without assistance not alone do grocery shopping, cook or clean. A group home is a stepping stone in this goal of his to be independent. Honestly what am I saying... He doesn't want to be independent, he wants no rules and the freedom to get high and drunk whenever he wants.

Since this visit didn't go to well I decided to do something else. I did up a Room & Board Contract between my son and I (and hubby). I think I covered anything that I could think of that has been or could be an issue between us regarding expectations. It outlines what his room and board payments cover and what he is responsible for. Respect, Privacy, Noise, Cooking, Cleaning, Drugs & Alcohol among other things have been spelled out in the contract. One day a week he has to cook dinner, do the dishes and help clean the bathroom (toilet). I let him pick which day he wanted to do these things. He picked Monday for cooking a meal, Wednesday or Thursday for doing the dishes and Friday for cleaning the toilet. He wanted to pick an 'or day' for cleaning the toilet and I said no, it's a 3 minute job. We both signed it and I gave him his own copy. Today he is supposed to clean the toilet... I didn't stipulate by what time... my bad. Haha! Sometimes I get lucky... I asked him what time and he picked 3... then picked 4... I asked why the change? He is going to be thinking about it until then anyways so 4 would be the latest that he could think about it. I'm pretty sure this is an ADHD type of thinking as it's like over-thinking yet without the action because his thoughts and nervous system are not on the same level of stimulation. I said that I didn't get it, why spend hours thinking about something when he could just get up and do it and then it is done and over with... I didn't faint... He said ok I'll do it now. I told him what to do and he did it! Score one for mom! I'm curious to see how many of these things he will do before he starts asking to be paid for doing chores. I did put stipulations in the contract stating that room & board doesn't cover candies, goodies, energy drinks etc unless previously approved. Not because I won't ever get him any but because if I let him he makes it a daily thing and he does need to start learning limits. Once he does take that step out into the real world there will be limits, expectation and rules that he will have to learn to manage and deal with. Poor kid has been getting a lot of no's lately however I can't do it all.

Maybe I will go into my rant/concerns about Invega considering the conversation I just had with my son. I asked him what is happening with his schizophrenia or thoughts considering what I have been seeing for the past two days. He says he doesn't have the want to do things like play his games. He doesn't have the want because his schizophrenia is getting in the way of him doing the things in this reality that bring him enjoyment. He told me that he has an entity standing in front of him and he wants to be able to tell me about him. We ended up discussing words like sacrament and sacrilege that I had to look up the definition for and explain to him that he is misusing words or making up meanings for them which is his schizophrenia. He shouldn't be sacrementing or killing entities. He shouldn't be dealing with them at all if he can't understand that they are not real and a manifestation of his brain producing too much dopamine. He wants to smoke marijuana and get high. I can understand that since his symptoms are acting up and getting high will ease them and give him a break from his voices or audio/visual hallucinations. If he is seeing entities than he is experiencing visual hallucinations. He seems surprisingly accepting of my explanations at the moment that it is his schizophrenia, not real and that we may need to up his antipsychotics to get rid of them before they start to irritate him. Preferable today before it gets bad enough that he may need to be admitted again. If he is admitted again then chances are he will be inpatient for at least 3 weeks which we don't want happening. It's different to have this type of conversation with my son and to have him be open and not deny that what he is experiencing could be schizophrenia. Hopefully we can get this under control before he loses this insight to symptoms. I have left another message with PACT stating this conversation and that regardless of drug benefits, I will pay for a weeks supply of medications, today, as they are needed. On a side note he did drink vodka last night :( Yah, I know. The vodka that he told me he was throwing out early last week... I guess not. I really should have gone looking for it but I have looked before and couldn't find it. I think he only had one or two shots then threw it out. This time I found the bottle in the garbage so I know he did. Side affect to this... He missed taking his Lithium and Trazodone last night and was resistant to going to bed in his own bed. I think he is learning or finding out that vodka is not helping him but making things worse, at least I hope he is. How many times he will have to test that theory? I don't want to know the answer to that. He did take his Lithium when he got up this morning so we are good for getting his medications into him. My concerns with the Invega shot... I like the Invega. He is not getting enough of it which will translate into break through symptoms which will further non-compliance as once insight goes it is gone and takes a lot of work to get it back. Having break through symptoms that can be avoided will only make keeping his dopamine under control all the more difficult.

I think talking about it may have helped my son, for now anyways, as he is now playing the Wii u!


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