Urgent Guidance Needed for Troubling Teen Mental Health Issues

Urgent! I don't know how to handle this?

Hello Dr.
Zhang,
I have a younger cousin who is going to be a sophomore this year.
He has had sleep issues since middle school, often unable to sleep well at night or sometimes not at all.
After entering high school, he frequently comes home late.
Recently, he has been feeling even more depressed due to a breakup with his girlfriend.
He suggested getting a job, attending classes during the day and working at night.
However, my parents were worried and brought him to live with us.
His family situation is challenging; his mother works, and his father is involved in freight transport, but their relationship is strained.
His father consulted a fortune teller before he was born, who predicted that this son would be a source of conflict.
Due to his lack of interest in academics and his deepening depression, he ran away from home last week and returned three days later.
When asked if he had been working, he said no, he had just been wandering in the park, even sleeping on a bench at night.
When I asked why he didn’t go home to sleep in a bed, he replied that although sleeping on a bench was uncomfortable, it prevented him from overthinking and being unable to sleep.
Last week, I asked my brother to take him to the Taichung Veterans General Hospital for a youth health consultation.
The doctor mentioned it was typical adolescent rebellion and didn’t elaborate much, only advising him to return the following week and prescribed some medication.
That night, he took one dose, and later my mother noticed something odd about his eyes.
The next morning, he took another dose, and unexpectedly, he began experiencing auditory and visual hallucinations and was speaking incoherently.
While taking this medication, he also took painkillers for a headache prescribed by another doctor a few days prior, as he had complained of severe headaches.
By the next evening, after a short nap, he woke up saying he felt very cold, so he took off his underwear and put on long pants, then wore the underwear over the pants.
His eyes were still rolling back, which made my parents very worried, so they hurriedly took him to see a traditional Chinese medicine doctor.
The doctor suggested that he might have a hereditary mental illness.
My mother’s uncle has a son with a mental disorder, but we do not know the specifics of that condition.
Furthermore, this uncle is a half-brother to my grandmother, and there are no known mental health issues in my cousin's father's side of the family.
What should we do?
P.S.
I have researched the medications my cousin is taking online, and they are all anxiolytics used to calm nerves and relieve anxiety.
I am very grateful for your help.

Zhuang Xiaojie, 20~29 year old female. Ask Date: 2004/07/11

Dr. Zhang Zhehong reply Psychiatry

Adolescent mental disorders often present with hallucinations and significant emotional symptoms, which can impact academic performance and social interactions.
A comprehensive medical evaluation and treatment are often necessary.
Pharmacotherapy is important and should be managed by the same physician for ongoing assessment.
It is advisable to trust the same physician for continuous outpatient treatment.
Adults should also maintain emotional stability and sustain their energy levels to support the patient.
Wishing for a smooth treatment process.

Reply Date: 2004/07/11

More Info

It sounds like your cousin is going through a very challenging time, and it's commendable that you're seeking guidance for him. Mental health issues in teenagers can be complex and multifaceted, often requiring a comprehensive approach to treatment and support. Here’s a breakdown of the situation and some recommendations based on the information provided.

Understanding the Situation
Your cousin's symptoms, including sleep disturbances, emotional distress following a breakup, and recent behavioral changes, suggest he may be experiencing significant mental health challenges. The fact that he has been wandering around parks instead of returning home indicates a level of distress and possibly a desire to escape from his current environment. His recent experiences with medication, particularly the adverse reactions like hallucinations and disorientation, are concerning and warrant immediate attention.

The Role of Medication
It’s crucial to recognize that medications prescribed for mental health issues can have varying effects on individuals, especially teenagers whose brains are still developing. The medications he was prescribed, which are intended to alleviate anxiety and stabilize mood, may not have been the right fit for him, particularly if he was also taking other medications simultaneously. This can lead to unpredictable interactions and side effects, as you’ve observed with his hallucinations and erratic behavior.

Family Dynamics and Support
The family dynamics you described—his strained relationship with his father and the pressure from his mother—can significantly impact his mental health. Adolescents often struggle with feelings of isolation and misunderstanding, especially when they feel their home environment is unstable. It’s essential for family members to create a supportive atmosphere where he feels safe to express his feelings and concerns.

Recommendations for Action
1. Seek Professional Help: Given the severity of his symptoms, it’s vital to consult with a mental health professional, preferably a child and adolescent psychiatrist. They can provide a thorough evaluation and adjust his medication if necessary. It may also be beneficial to involve a psychologist or therapist who can offer counseling and coping strategies.

2. Monitor Medication: Ensure that any medications he is prescribed are closely monitored by a healthcare professional. If he experiences side effects like hallucinations, it’s crucial to report these to his doctor immediately. They may need to adjust his treatment plan.

3. Create a Supportive Environment: Encourage open communication within the family. It’s important for your cousin to feel that he can talk about his feelings without judgment. Family therapy might also be beneficial to address underlying issues and improve relationships.

4. Engage in Healthy Activities: Encourage your cousin to participate in activities that promote mental well-being, such as physical exercise, hobbies, or social activities that he enjoys. These can help improve his mood and provide a sense of normalcy.

5. Educate the Family: Understanding mental health issues can help family members provide better support. Consider resources or workshops on adolescent mental health to foster a more supportive environment.

6. Crisis Plan: If his behavior escalates or if there are concerns about self-harm or suicidal thoughts, it’s crucial to have a crisis plan in place. This may involve contacting a mental health crisis line or seeking immediate help from emergency services.

Conclusion
Navigating mental health issues in teenagers can be daunting, but with the right support and intervention, it is possible for your cousin to find relief and improve his situation. Encourage him to be open about his feelings and to seek help, and ensure that the family remains engaged and supportive throughout this process. It’s essential to act promptly, especially given the concerning symptoms he has exhibited.

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