What causes confused thinking, reduced ability to concentrate and excessive fear?

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Posted on Mon, 3 Oct 2016 in Mental Health
Question: Seeing following behavioural change(since last 8-9months, here I would like to mention that was a period where he came in contact with one boy towards whom he is very possessive and treat him like a child and control his life like a freak where the boy even can’t resist to his behaviour though he at times gets very irritated for my brother's behaviour towards him; THAT BOY personality is very calm, not opinionated, due to his weak body built he never resist to my brother's action; my brother would like to spend most of his time to the extent that he insisted us about his stay at our home and he is staying together in our flat in one room; my brother never hesitates to talk rudely with my parents infront of that boy; sometimes easily can be figure out that my brother is trying to control that boy life to an extent that at times my brother gets very emotional and weep for long infront of that boy and blaming himself for any act he did and trying hard to convince or seek that boy opinion, HE SEEMS TO BE 100% DEPENDENT ON THAT BOY FOR HIS EMOTIONAL AND PHYSICAL NEED) in my 31yr old younger brother who himself is a doctor (mbbs) junior resident by profession, due to his social withdrawal thing we shifted with him to his workplace (as since his college days 8-9 years we hardly stayed with him for longer period of time though we wre connected on and off when he travels to our place for a couple of days. While staying with him since last 2weeks observed following significant things and are helpless to situations; which worried us in terms maybe he requires psychological evaluation (though convincing him would be very difficult)
1     Confused thinking and reduced ability to concentrate
2     social withdrawal-from friends-activities
3     feeling sad-low-lonely-emptiness
4     Extreme feeling of guilt
5     Blaming himself
6     excessive fear-worries
7     tiredness-low energy and sleep problem
8     detachment from reality-not practical-heavily expending w/o analysing the need or source
9     Trouble understanding and relating to situation and people
10     Major change in eating habit--eating in large quantity and restlessly
11     loud tone-try to convince in loud manner
12     losing focus and control on,life
13     Not organize
14     He didnt response--for hours you may try asking seeking his reponse but you wouldnt get anything
15     Very emotional-cry-beg from his frn for confirmation like he is the bad-silliest child in family or so?
16     emotionaly cold towards other
17     control other by his emotion-loud tone action-logic
18     treat others harshly
19     regardless of family n friends
20     unsafe sex-impulsive behaviour-
21     unstable relationship
22     outburst of anger countering
23     impulsive
24     fear social interaction
25     disregard social rules or obligation
26     feeling of self importance and expect others to behave same of him
27     intolerant-insensitive-selfish-self absorbed
28     lacks empathy
29     naive and child like perspective
30     competent and powerful---rigid control--order--
31     heavily dependent on others for their physical and emotional need
32     usually avoid being alone
33     regularly need reasasurances while making any decision
34     strong opinion
35     too sensitive to crticism or rejection
36     extreme difficulty in do it yourself project always seek a companion
37     excessive spending money

Habits which he inculcated these days:
a)     His words are final words he hates being guide up gets irritated very soon.
b)     His sleeps too late around 2-3am toll 12-1pm noon
c)     His food habits are again changed drastically in terms of quantity and way he eats in very panicky mode.
d)     His life is revolving around that new boy whom he met last8-9 months, since then he is socially withdrawn and emotionally cold towards family.
e)     When he is around he can’t see anything beyond him and control/treat him like a child like gets too worried if he gets late while returning from office, chatting whole day in watsapp, instruct him a lot, don’t allow him to do whatever he feels like, rigidly force him to behave act and do whatever he likes; which irritates sometime that boy out of his possessive behaviour.
f)     He lost all focus in his life towards his studies, career, currently out of a complain of back ache and also a staghorn stone is diagnosed for him so a surgery is planned by month of Oct so he stays at home going not going on job, he is not having any routin just getting up at 1pm..he have his breakfast than watch some videos chat with his friend wait desperately for him till 5-6pm then have his lunch...then that boy as he gets up early 3am works in UK shift he try to take a nap by evening 6-9 my brother too sleeps alongwith him get up around 10 10.30pm have his dinner around 11-12am and then sleep by 1am again gets up by morning 3am along with that boy (WE ARE SO HELPLESS TO THIS SITUATION); when my father try to talk to him he gets very aggressive to his advise and take every thin in very negative light.
g)     He listens to me calmly but DONOT respond, just he kept listening for hours but donot utter a word.
h)     Convincing him for a psychological evaluation is again a challenge to me.

I was thinking of:

1. I was thinking of calling my brother's friends father and brief him about his son's condition as he too may be not aware about his son's engagement in these activities since last 8-9 months these all came to our knowledge when I visited and stayed with him for couple of days I observed all these things.

[I am having a pity on my brother's friend sometime as his working hour is 3am to 4pm, he reached home by 5-6pm...he gets a time to relax or sleep by 7pm to 10pm and then 12am to 3am; which is largely affected due to my brother's expectation from him and their both lifestyle, sleep and mental health is largely getting affected]

2. I may ask his friends father to take a plea/excuse for his sons higher studies preparation or his ill health issue and take his son back home by this atleast a seperation would happen between my brother and this new friend (further we have shifted here at brothers place with parents to take care of his emotional needs).

3. As long as he continues to stay with his friend at home together or even in the; his tendency of emotional and physical dependency on him will continue; so I guess taking any excuse by his friends father on account of his health or higher studies taking back his son home would be ideal.

4. Is it advisable if my brother is rigid about not meeting phychological help, hidingly Mood stabilizer can be given mixing in food or so, Can you advise any such drug?

5. This kind of people with these behaviour, How do you think they would react incase of separation from a person with whom he is so immensely deeply emotionally engaged? (How to handle it)

6. How serious is his case and what should we do if he didnt agree to visit pshychiatrist, can you refer one at Delhi?

7. Despite my brother didnt going on job due to Back Pain and his kidney stone surgery scheduled, My brother sleeps a lot in a day time like he wakes up by 1-2pm noon (though he gets up early morning around 3 to 3.30am too due to his friends office hour and he need to get ready by 3-4am in morning so my brother too wakes up alongwith him and he is the one who arrange taxi and all for him, keeps eye on him follow him up till the time he reaches home and be so restless and anxious till he reaches back home.

We all in family are confused, patiently observing things going around dont know how to tackle, react to these situation revolving around my brother we can easily see his life has become a mess and he didnt have contolled on his emotion, he have no idea where his life is heading to, Pls..guide how to go ahead and plan it further to get control on the situation?

Pls. guide and bless us with your esteemed insight to this situation.

Live long and prosper,

Thanks

doctor
Answered by Dr. Chintan Solanki 18 hours later
Brief Answer:
this is somewhat difficult to treat

Detailed Answer:
Hello,

Thanks for writing to us. I can understand your concern.

You have narrated very much detail history of your brother.

Possibility of Depression, Bipolar depression, personality disorder, homosexuality are there. Without interviewing him it is difficult to reach to his diagnosis. Detail mental status examination and more detail history are required to reach on final conclusion.

He of course needs evaluation, help and treatment by a psychiatrist.

I have dealt with few of such type cases in which patient is not ready to consult.In that I just manage first home visit by any mean and then convince the patient to provide help with his will.I succeed in almost 60-70% cases.
The first step is visit any local psychiatrist.In XXXXXXX Dr XXXXXXX Mital or Dr. XXXXXXX Parikh have big set up and they have team of psychiatrists. You can search easily their address through internet. Disclose all history to psychiatrist and after that doctor will guide you how he can do home visit and convince your brother for further consultation.

To make him separate from that boy may worsen his situation however it may be the only way to check exactly what is going on in your brother's mind. Decision about this should be made after discussing with local psychiatrist.

He can be given medicine in food for very short duration to just make him ready for consultation. Local doctor can provide further help in this regard.

Do not delay and go ahead.

Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki 7 hours later
Dear Dr. XXXXXXX
Appreciate your insight to my qwery and sorry for putting this case in so long and elaborated manner.
Further I would like to add that and need to be blessed by your astound take on it:

He is the last sibling among four of us; there are two elder sisters married well and settled. I and my parents stayed in different city and my younger brother stayed and working in different city; but due to this situation I took a call of shifting along with him together.

His personality: 8months back

1. He was quite an outspoken and social guy with popular among his circle and quite an active person; his circle includes boys and girls too. He was logical, calm, patient, and joyful wanted to be and stay connected well with family and friends. He was quite an organised/focussed kind of person.

2. In different phases of his life he does met with girls too where there were some connections to certain extent but later didn’t work out as he avoids possessive and obsessive behaviour; still today he is in connected well with one of his female batch mate and can figure out with messages and all that they were seriously engaged but he hesitate to move further due to this new male friend who objects him and taunt him whenever my brother receives a call from her.

3. after +2, mostly he stayed outside but still we have been connected well with family and friends.

4. Since XXXXXXX 2015 when he starts working he use to occupy a single room where he stays alone (as it’s his nature of not being comfortable with unknown persons so he preferred living alone) later September 2015 he met with a person who is B.Tech with whom he met thru some common friend; so it was just 8-9 months old friendship.

5. 10 days back I came here to his place to see what exactly is the reason for his sudden changed behaviour and found his total room is a mess nothing is there on its place AND that my brother is emotionally-extremely deeply attached to this person/new friend to the extent that he cares him like a child in the sense the way he communicates his gestures tone all are changed when he is around else while talking to me I can see his tone and gesture is normal.

6. I found him one day engaged with sexual activity with this new friend and I purposefully realised them that I saw them engaged. Later very patiently and like a friend I counsel/talk to them one-by-one and my brother disclosed which is thoroughly unnatural and illogical on his part he says ‘he is more attracted towards male since his early age’ ‘I want to lead my life with that new friend and can’t see my life without him’ which is thoroughly wrong ON THE OTHER HAND HE HAS THE GIRL FRIEND we saw him having girl friends and responding to all those younger age attractions towards female and later in his college too he got girl friends where till XXXXXXX 2016 he was in connected with whom he seems to be serious too as he discuss/share most of the things of his life from me too since early days. He also tried justifying his stands by saying ‘there is no guarantee in any relationship AND QUESTIONED ME “you got married to a gal but got divorce so what is a problem in my relation atleast I know that girl”; despite knowing the fact that my wife is a suffering from multiple personality disorder and this fact was hided by their family and this was the reason for the my divorce.

7. His new friend personality is weak body-mind emotionally 100% dependent on my younger brother he working hour is 4am to 3pm; its my brother who wakes him up early morning make tea prepare him for office which affect my brother’s sleep at large. New friend is very inert in the sense he doesn’t share things a lot but he carry all the gestures and tone of a person like a XXXXXXX He controls my brother emotionally by withdrawing sudden contact with my brother where my brother goes unrest/anxiety and when they meet my brother use to have a discussion about it which his friend enjoys.
I spoken with him (my brother’s friend) as well one to one trying to know his stand on it; he respond like he got an orientation towards male sex since his early days and continued to have so his family doesn’t know about it BUT he accept the fact THAT MY BROTHER IS NOT LIKE THAT IN THE SENSE HE SAYS STILL THEY WERE IN RELATION MY BROTHER IS HAVING A RECURRENT CALLS WITH HER FEMALE FRIEND and all, BUT ON THE OTHER HAND HE confessed that he may not be having any problem leaving my brother BUT my brother’s life would be a mess because he is very obsessed and emotionally dependent on him like emotionally very close/over caring to him and always want to guide –direct-control preach things and try to convince him all the time on various topics. But as new friends personality is of not responding strongly and putting his opinion on anything he accepts all and everything what my brother says or does. He accepted the fact that he since his childhood attracted towards male and not feeling comfortable the company of females when he came in contact of my brother he get close to him day by day and starts putting restrictions on his phone calls to his friends and family and also objected whenever my brother talks to his girlfriends as this new friend doesn’t feel OK and gets irritated with my brother’s social life; he wanted just to be with him all the time. Lastly he mentioned my brother is not like that but he tends and tried to be someone who actually he is not.

10. Today I am still here with my brother and this new friend in his room and saw some watsapp messages where this new friend disclosed our discussion to my younger brother and constantly trying to put my brother in that zone.
Now Sir, I being the elder brother; after my all counselling to both they are continuing the same gesture behaviour infront of me and trying to be normal which they are not; my brother is insecure/ he is loud and trying to enact to be happy with his friend but has lot of differences within, in public places too he is very caring and controlling towards his friend though out day and night he chats with him and gets uneasy when his friend is not around. I have seen a sign of rebel as well if things are not shaping up as per his expectation this all are taking his focus away from his PG preparation, social life family and all. His life is confined to new friend only.

Engaging his new friends father and talk to him regarding his sons behaviour and slowly try to dis-associate with his friend WHICH I KNOW WONT BE SO EASY AS ON TODAY but separation is very important at this very level and call up her female friend to spend some time off with him and to rejuvenate his old social circle which I have already started calling his OLD FRIENDS and planning an evening for him together, mother is spending time with him evening with him, though he is little hesitant in beginning but agreed to be part of later.
Until and unless his friends father get engaged who is about to retired this year and having only son and other 2 sisters...whose marriage is yet to be happen I guess this would be a big blow to their family too, so having all this event to take place he can request his son that he require him at his native to manage the marriage of his daughter and his home he requires him to make a shift to native and LETS SEE THE REACTION...like my brother will not going to held us responsible for his shift and he may take it as a natural relocation for his friend..

PLs. GUIDE n HELP.

doctor
Answered by Dr. Chintan Solanki 19 hours later
Brief Answer:
yes separation of them is the first step

Detailed Answer:
Hi,

Thanks for other information.

From history it is possible that your brother is bisexual and that friend is a XXXXXXX If life of your brother was ok before that boy came in to his life, separation of them is the first step to bring your brother back to normal. Your idea about sending that boy to his home by giving reason of marriage at his home is good. However after that your brother may go in to more depression so you should consult local psychiatrist before to tackle the situation.

How to move in life further that may be likely a big confusion for your brother (either as a XXXXXXX or bisexual or normal sex orientation). This can be resolved only after detail psycho-dynamic evaluation and counseling.

Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki 37 minutes later
I got one more psychiatrist discussed his case online and got the following reply pls..refer
QUOTE:
“Hello
Thanks for giving here the detailed description.
In my opinion, there are few diagnostic possibilities in this case. It could be a personality disorder or a mood disorder.
I would suggest symptomatic management here. I think the mood stabilizers would be the appropriate drugs for him.
A psychologist/psychiatrist who can provide counselling sessions for his behavior change is also needed for him.
You need to respect his sexual orientation but take care that he does not gets involved in risky sexual behaviour.
Also, keep an eye over him for homicidal or suicidal attempt.
Hope this helps.


• Differential diagnosis:

Cluster B Personality disorder, Mood disorder, schizotypal personality disorder
• Treatment plan:

Mood stabilizers, antipsychotics”
UNQUOTE
QUOTE:
“Yes, mood stabilizers can be given in food.
Divalproex is available in liquid form under the brand name valance. It can be given in juices or food. These are largely safe drugs but common side effects like gastritis, nausea, sedation, weight gain must be looked for. (It is always better to give any drug in medical supervision).

If there is a separation, there would be mood swings, anger outbreaks or aloofness and depression. You must take care that he does not tries to harm himself or others. Otherwise, he will take time to normalise after this separation. You must take him in confidence before doing this and prepare him for this indirectly. Motivate him to look towards his career, his personal life, life goals etc.

I feel the case is a serious one and needs urgent psychiatric care. You can consult at XXXXXXX institute of medical sciences for opinion.
He is in urgent need of drug as well as psychological treatment. If possible, consider an inpatient treatment for him at the institute.”
UNQUOTE
NOTE:
Note:
1.     What to do for changing his daily routine like getting up so late and use of XXXXXXX all the time, any advise he take in negative light
2.     How to convince him for making a visit to psychiatrist.
3.     What is meant by risky sexual behaviour?
4.     “Keep an eye over him for homicidal or suicidal attempt”, do his case seems for the above apprehensions?
5.     Appreciate if you could share your views/take on above prognosis/diagnosis.
Thanks
doctor
Answered by Dr. Chintan Solanki 13 hours later
Brief Answer:
I agree partially

Detailed Answer:
Hi,

I read other doctor's recommendations.

I agree that he might have bipolar disorder or some kind of personality disorder from initial history you told. But later on when you elaborated his relation with that boy I guess more possibility of depression due to crisis of sex orientation. In our society still homosexuals are not respected normal. That is why he may be confused that what he should do further.

1. The person to whom he obeys or believes (may be that boy for a while) can convince him to reschedule his routine or if he is ready to consult psychiatrist doctor can help.

2. I already mention that you ask doctor to take home visit if he is not ready to consult psychiatrist on your request. Or ask that boy to do so.

3.Risky sexual behavior means engagement in sex with multiple other persons without condoms which may possess risk of transmission of sexual transmitted diseases.

4.If he has mentioned death wishes or suicidal thoughts ever to anyone you should keep eye.

Diagnosis is only possible after much detail history and mental status examination in person. Prognosis only can be commented after diagnosis.

If still any query there, I will be happy to answer. If not, you can close the discussion and give your feedback and rating so I can improve my service.

In future if you wish you can contact me directly with following link:
http://bit.ly/drchintansolanki

by clicking on 'Ask me a question' on same page with three follow up questions.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

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