Good evening sir/madam am an occupational therapist by profession. I need guidance for my my personal family issue. My elder brother (29 years old) has aggressive behaviour that is self harm like hitting his face by his hand, slapping continuously whenever he feel uncomfortable. He frequently ordered family members to do (come here, sit here, go there stand there) if we don't followed his command he increased his self harm activities. This is happening since 4-5 months. Shown in kem hospital mumbai, psychiatrist trying to figure out diagnosis. Differential diagnosis intellectual disability with self harm with ocd. Was advised to continue antipsychotic drug with t. Pacitane. But he didn't complete 2 weeks medication because he was complaining severe headache. Now he became so uncomfortable, violence towards us when we stop him.

Hello, diagnosis seems to be right provided the patient has decreased overall general understanding since childhood. I would advise to continue treatment with the psychiatrist. Tell him about the headache. If he feel he would change the antipsychotic. Within 20 days of treatment you will start to see positive effects on his behaviour.  

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Mr. Saul PereiraPsychologist50yrs exp

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It looks like he can be uncooperative in therapy. This could be a severe handicap in treatment. Any way you look at it he needs medication and therapy but without cooperation, it may all go to naught. If you have any relative/friend/nurse who can make him comply with the medication and therapeutic requirements, it will go a long way to get some submission. If you get him to follow these requirements even for a period of three weeks, you can get some more out of him gradually. Apart from getting a diagnosis, his behavior itself shows signs of extreme fear and anger. These may have roots from early childhood including prenatal influences. He is still young and the prognosis can be good, subject to his liking the therapy, the therapist, and complete compliance with the methodology. A healthy routine of vigorous exercise, occupying daily programs of activities, cbt, and employment (when he gets better) will help him to rehabilitate. This condition will get worse if you did nothing about it: something done (even if it is wrong) is better than nothing done. As a last resort, you may even get some ect done, after consulting with your psychiatrist.  

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Dr. Shashank RaikwarPsychiatrist5yrs exp

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Madam, with the limited history available there can be multiple diagnosis. Intellectual disability presentation is complicated by presence of psychiatric illnesses like bipolar and ocd, which are difficult to treat. A fine balance of medication is required for him. I would request you to kindly consult your psychiatrist often alongwith patient for finetuning of medication. For those who refuse to consume oral medications, their is option of long acting injections for few psychotropic medications. In nutshell, kindly be regular with psychiatrist visit so that optimum treatment outcome can be achieved. Thank you. 

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Dr. Saranya DevanathanPsychiatrist50yrs exp

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Dear Sharada, Please continue KEM medication and go back for follow up. Many medications act only after 2-3 weeks. They act in certain dose. Doctors usually start with low dose and build up after 2-3 weeks. Severe headache can be due to several causes. It can be managed separately along with his behavioural problems. 

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Dr. Prof. Jagadeesan M.S.Psychiatrist17yrs exp

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Then you need to admit him a registered psychiatric facility, since he is a harm to himself and others. They will administer medications in a controlled environment to bring his aggression under control and work out the diagnosis as well. Good luck. 

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