Motivated by desperation, we sought out additional opinions. First let me just say that doctors are quite similar to building contractors or software engineers. Show them someone else's work and they'll say, "Well, I suppose that's one way to do it...but I would do it this other way..."
We visited another psychiatrist. That's pretty much what we got from him. I would have used this other anti-depressant; I would have used this other anti-psychotic. He seemed to want to emphasize the use of an anti-psychotic. Further he suggested that the dosages used thus far were not high enough. He suggested that we switch from Abilify to Seroquel. The choice was driven mostly because of the sedating effect of Seroquel as my son wasn't sleeping all that well. He suggested starting at 50mg and ramping up by 50mg every 3-5 days and reporting progress. It all seemed reasonable seeing as the Abilify seemed to produce little except alarming muscle spasms. So we started off on the Seroquel path. The sedating effect was a helpful respite certainly to us and, I believe, to my son, as well. He slept a few consecutive hours a night rather than in fits and starts. I wasn't yet sure if there was any behavioral differences.
During the Seroquel ramp-up, we also visited a pediatric neurologist. This was driven by a well-meaning remark by a psychologist that our son may have "brain lesions". Certainly a frightening sounding possibility. It turns out to mean very little and suggest nothing in terms of treatment. The neurologist listened to our story and watched my son and mostly suggested that he could prescribe medication - like a psychiatrist. He said any of the three tests he could perform would likely yield little useful information. We got the same message regarding the medication as we did from the second psychiatrist - I would have used this other anti-depressant; I would have used this other anti-psychotic. But he also believed the dosages used thus far were not high enough.
So we kept along the Seroquel path. Apparently, it is usual to reach a level where the sedating effect is overwhelming and that's how you know to back off. In our case, after a couple of weeks, long before seeing our son sleep away his days, we reached a level where my son started behaving psychotically - much as he did with Risperdal. So we backed off. It took a few weeks to get back to where my son was not behaving psychotically. This seems to go back to the slow metabolism where my son's system seems to extend all drugs' half-lives to the maximum.
Three anti-psychotics and three psychotic reactions. We decided to drop anti-psychotics. I began to wonder if this meant that my son wasn't actually psychotic. Our first psychiatrist suggested that this might be the case. In the meantime, we added a new collection of bottles of drugs to ever increasing cache of pysho-pharmacology.
His thesis, which I stated once before, was that my son's obsessive tendencies had been amplified by the shock and finality of death and also focused the obsession on death itself. He thought we ought to treat this more as a problem of OCD than a psychosis.
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