Starting testing for an older child

Due to various circumstances, I’ve been raising my nephew alone for the past year, and I got legal custody more recently. I don’t have biological children myself, so I don’t have a good sense of norms for different ages. My nephew is in his late teens. I’m keeping details vague, but one side of his birth family has several generations affected by schizophrenia. Unfortunately, the parent with schizophrenia has never consented to any treatment and is in a pretty bad state right now, but (not related to schizophrenia) also was a seriously emotionally abusive parent which makes communications about mental illness fraught because he has had a long association of mental illness with being an abusive person.

This child has major trauma. Lately, he has developed more suspicion than usual, accusing relatives and friends of things that haven’t happened. Not seriously bad things, but things he views as a betrayal, such as talking about him. He says some strange things such as that other people than him don’t actually have any feelings. He’s doing great in school but overreacting emotionally and looking to pick arguments (which I hear is normal for teenagers? but it’s a lot and he gets mean!). I’ve been assuming he might have PTSD or something similar and, after a long wait due to the legal situation, have him an appointment with a psychiatrist in a few weeks. He’s had difficulty focusing the last year or so. He keeps a baseball bat in his room for “safety” (but on the other hand one of his parents would talk about wanting to kill him). He can go from the kind, good-humored kid who looks out for stray puppies to someone who is full of rage (not violent) in a few minutes.

The psychiatrist said she would want to mostly talk with him, other than to hear my concerns, which I understand. The suspicion and beliefs about others not being real are new since we did intake a couple months ago. I’m not sure how much of this is teenage acting out stuff or trauma stuff, but I’m aware that catching a psychotic episode early can change mental health outcomes, also. I’m going to share with the psychiatrist the new stuff but am guessing my nephew will deny both. Can those who have been through testing of their older kid share a little? Will the tests be able to rule out psychosis? Do I need to discretely ask for a particular kind of test? And is believing others don’t have feelings a delusion, or is it just standard-issue teenage lack of empathy? Is there anything else you would have wanted to know at the beginning of getting your child tested? He definitely is suffering, and I want to make sure I help set him up for the best possible treatment outcomes whatever is going on!

Thanks for any help!

Late teens might be a bit early for SZ. Early to mid-20s is more typical. My son, however, was diagnosed as having bipolar disorder around 19 or so. Later it became SZ or SZA (schizoaffective), and I’ve been told that it’s not unusual for SZA to start out as bipolar.

The mood swings you describe might be more indicative of bipolar. The keeping of the bat in the room is concerning for me, so it’s good that you have an appt. set up with a psychiatrist.

In the meanwhile, you might want to read I Am Not Sick, I Don’t Need Help! How to Help Someone Accept Treatment, which is standard-issue reading on this group.

Thanks very much, caregiver1! I just ordered that book. It looks very helpful! And thank you for the information. I hope things are going well for you and your son.

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Yes, age of onset is typically older, but my daughter became psychotic at age 14.

My daughter first presented with depression and anxiety (age 12-13). We put her on an SSRI antidepressant. I wish i had known that she should never have been given those. Mood swings and unsual ideas followed and then, at 14, psychosis. Her psychiatrist says that she would have developed SZA later anyway.

Also, genetic testing is available to determine which meds will work better than others. It would have saved years of trial and error with meds if we had done it sooner. The company that did my daughter’s was called Genesight. The psychiatrist’s office handled it all.

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Be informed if nephew is using any kind of street drugs - pot included. They can be detrimental to their mental health and make everything worse. It’s common for SMI to use alcohol and drugs to self medicate. Stay positive, help him set goals so he has something to look forward to and focus on beside the negative things. Wishing the best for both of you. You are not alone.

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My approach would be entirely different. Your son is finding it difficult to articulate to those close to him, how he feels. He is sensitive, easily upset. He needs empathy, an understanding, security and re-assurance in a world that is challenging. This is fairly typical of teenagers approaching adulthood. You need to talk about issues that matter to him, not to give advice, but to reflect back to him the power he has to take control of his issues/dilemmas/problems. He will gain self-confidence, self-esteem, through finding his own solutions. He will develop personality/identity.

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Thank you for sharing this. I hope your daughter is doing well. That had to be scary going through that, especially with one so young. I’m going to mention Genesight to the psychiatrist working with my nephew.

Thanks, TXm0m. He says he isn’t using and I’ve shared literature about how even pot can increase risk of developing schizophrenia for people with parents with it. However, I don’t know for sure what he does when he’s not home. I’ll try to keep an eye out! I really like the idea of staying positive. This is challenging sometimes when it feels like he rejects positivity. I’ve started parenting counseling myself this week and feel like it may help me find ways to share positivity without making him feel it’s false or not realistic.

Thanks, Rainforest. I really like these ideas and trying to help him gain self-confidence. I think sometimes he gets in the mindset that he is a victim of his parents but doesn’t also easily see that he has power to make choices going forward.

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You are doing a great job so far by being so proactive. The fact that you recognize he has trauma that’s needs to be addressed is very important as trauma is linked to mental illness. One thing that I missed was all the programs available for first episode psychosis and early intervention programs. Look into those if it’s determined that he is having psychosis. I went straight into meditations. Please do a lot of research on these meditations if prescribed any. They work on the brain and some side effects can be permanent. I have seen in other countries that meditators are the last line and therapy is first. I’m glad this young man has someone like you trying to understand and help him. Wishing you all the best. God bless…