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Suggest Treatment For Impulsive Behaviour In A Person With ADHD While On Ritalin
Question: Dear Doctor
I am from XXXXXXX Lanka (Colombo) and my son is 24 years. He was diagnosed with ADHD from the age of 8 and was been given Ritalin at that age. But right now he is taking Valparin and Risperidone on the need prescribed by his doctor. Also the dosages are as follows.
1000mg of Valporine (600 in the morning and 400 in the afternoon)
1mg Resperidone( in the evening) if the need arises we give him 2mgs.
The main problem we are facing right now is his impulsive behavior. For example: he gets the urge to kick parked vehicles when we take him out and tries to hit women , he does not touch women, he only wants to hit them two shots on the chest with that he stops, but not all the time. Suddenly he does this without any prior indication. He tells that its coming to him to behave that way. Is this true or is it a planned action? However he doesn't want to hit our own vehicle. He is not worried about this action. He is also happy at times after doing this. As a father I have told him several times of the consequences, but he is not bothered. Why is he doing this? Is there any problem for his erratic behavior? As a parent we are very worried about his future.
On the positive side he can read, write and he has completed his school education (Ordinary Level). And he can play the piano and guitar well, does swimming and cycling well. He also has a very good memory. He is very conscious of his figure and his belongings. He prays every day and does his other work in a satisfactory manner. He helps the mother in the kitchen and also helps in the house chores.
Now he is following a basic computer course at an institute.
The main problem he has is that he kicks parked vehicles (this habit started recently- 3 months) and having a tenancy to hit women occasionally.
This happens when he has a mood swing I believe. That is why he is under Valparin and Risperidone for his aggressiveness. Please advise us how we can overcome this problem so that he can lead a normal life. Also please tell us whether this happens because of his mood swings. If so how we could manage this problem.
Your kind co operation regarding this matter is greatly appreciated.
Thank you
Regards,
Kingsley
I am from XXXXXXX Lanka (Colombo) and my son is 24 years. He was diagnosed with ADHD from the age of 8 and was been given Ritalin at that age. But right now he is taking Valparin and Risperidone on the need prescribed by his doctor. Also the dosages are as follows.
1000mg of Valporine (600 in the morning and 400 in the afternoon)
1mg Resperidone( in the evening) if the need arises we give him 2mgs.
The main problem we are facing right now is his impulsive behavior. For example: he gets the urge to kick parked vehicles when we take him out and tries to hit women , he does not touch women, he only wants to hit them two shots on the chest with that he stops, but not all the time. Suddenly he does this without any prior indication. He tells that its coming to him to behave that way. Is this true or is it a planned action? However he doesn't want to hit our own vehicle. He is not worried about this action. He is also happy at times after doing this. As a father I have told him several times of the consequences, but he is not bothered. Why is he doing this? Is there any problem for his erratic behavior? As a parent we are very worried about his future.
On the positive side he can read, write and he has completed his school education (Ordinary Level). And he can play the piano and guitar well, does swimming and cycling well. He also has a very good memory. He is very conscious of his figure and his belongings. He prays every day and does his other work in a satisfactory manner. He helps the mother in the kitchen and also helps in the house chores.
Now he is following a basic computer course at an institute.
The main problem he has is that he kicks parked vehicles (this habit started recently- 3 months) and having a tenancy to hit women occasionally.
This happens when he has a mood swing I believe. That is why he is under Valparin and Risperidone for his aggressiveness. Please advise us how we can overcome this problem so that he can lead a normal life. Also please tell us whether this happens because of his mood swings. If so how we could manage this problem.
Your kind co operation regarding this matter is greatly appreciated.
Thank you
Regards,
Kingsley
Brief Answer:
Consultation
Detailed Answer:
Hello, thanks for your question to Health Care Magic.
The additional detail in this question is very helpful. Let me add more detail here accordingly.
First, this behavior of hitting women is very concerning. It could get him arrested.
We need to understand this behavior more :
Is it an impulsive behavior, or is it a desire?
Why does he want to hit women?
Does he dislike them?
Does he understand the consequences?
I would recommend increasing his dose of Risperdal to at least 2mg twice a day. Risperdal is excellent at decreasing impulsivity, and I think this is one of the first things we can do to help.
His dose of Depakote may also be too low.
What is his most recent blood level?
In the future, for continuity of care, I encourage you to contact me at my private link below. After you ask a direct question it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Consultation
Detailed Answer:
Hello, thanks for your question to Health Care Magic.
The additional detail in this question is very helpful. Let me add more detail here accordingly.
First, this behavior of hitting women is very concerning. It could get him arrested.
We need to understand this behavior more :
Is it an impulsive behavior, or is it a desire?
Why does he want to hit women?
Does he dislike them?
Does he understand the consequences?
I would recommend increasing his dose of Risperdal to at least 2mg twice a day. Risperdal is excellent at decreasing impulsivity, and I think this is one of the first things we can do to help.
His dose of Depakote may also be too low.
What is his most recent blood level?
In the future, for continuity of care, I encourage you to contact me at my private link below. After you ask a direct question it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Dear Doctor
We also don't know why he want to hit women and kick vehicles . The habit of kicking vehicles started recently. If we increase his medicine what he is taking can we over come these two problems. Can he over come this through therapy? If so is it possible for you to help us.
How long does the effect of 1 mg Risperdal last?
He is also taking Vegepa health care nutrition one a day in the morning.
His blood report description are as follows
S.G.O.T. Result - 19 U/L
S.G.P.T. Result - 23 U/L
Thank you.
Regards
xxxxxxxxxxxx
We also don't know why he want to hit women and kick vehicles . The habit of kicking vehicles started recently. If we increase his medicine what he is taking can we over come these two problems. Can he over come this through therapy? If so is it possible for you to help us.
How long does the effect of 1 mg Risperdal last?
He is also taking Vegepa health care nutrition one a day in the morning.
His blood report description are as follows
S.G.O.T. Result - 19 U/L
S.G.P.T. Result - 23 U/L
Thank you.
Regards
xxxxxxxxxxxx
Brief Answer:
Followup
Detailed Answer:
I believe increasing his Risperdal would indeed very much help this problem of kicking vehicles and hitting women, and might even solve it. A combination of this medication adjustment and therapy is almost guaranteed to fix the problem entirely. I can provide text-based therapy to your son via my private direct link on this site:
tinyurl.com/DrSheppeAnswers
OR
https://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70684
Those blood tests are reassuring and normal. The effect of Risperdal lasts for as long as you take it. An increase in dose would take about a week to take full effect. The nutritional supplement he is taking should not affect anything.
I look forward to hearing from you on my direct link.
Dr. Sheppe
Followup
Detailed Answer:
I believe increasing his Risperdal would indeed very much help this problem of kicking vehicles and hitting women, and might even solve it. A combination of this medication adjustment and therapy is almost guaranteed to fix the problem entirely. I can provide text-based therapy to your son via my private direct link on this site:
tinyurl.com/DrSheppeAnswers
OR
https://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70684
Those blood tests are reassuring and normal. The effect of Risperdal lasts for as long as you take it. An increase in dose would take about a week to take full effect. The nutritional supplement he is taking should not affect anything.
I look forward to hearing from you on my direct link.
Dr. Sheppe
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear Doctor
Thank you for all your advise. at present we give him 1mg of Risperdal everyday at 4 p.m. How ever when he has classes in the morning we give him an additional of 1 mg in the morning as well. Is this practice in order?
Further, eating chocolates and ice creams often is there a tenancy for him to get more activated? now we don't give him much.
Thank you
Kind Regards
xxxxxx
Thank you for all your advise. at present we give him 1mg of Risperdal everyday at 4 p.m. How ever when he has classes in the morning we give him an additional of 1 mg in the morning as well. Is this practice in order?
Further, eating chocolates and ice creams often is there a tenancy for him to get more activated? now we don't give him much.
Thank you
Kind Regards
xxxxxx
Brief Answer:
Followup
Detailed Answer:
Risperdal is usually dosed twice daily, once in the morning and once in the evening. He may be tired for the first couple of weeks with the morning dose, but his body will get used to it. 1mg in the morning and in the evening is good practice.
I would avoid sugary foods as this can contribute to high energy and weight gain.
Dr. Sheppe
Followup
Detailed Answer:
Risperdal is usually dosed twice daily, once in the morning and once in the evening. He may be tired for the first couple of weeks with the morning dose, but his body will get used to it. 1mg in the morning and in the evening is good practice.
I would avoid sugary foods as this can contribute to high energy and weight gain.
Dr. Sheppe
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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