April 02, 2004

Executive functioning

I think the thing I hate most about this illness is the residual symptoms. Paranoia is horrid. Delusions of persecution, harrassment, and being in danger from loved ones is awful. However, now that those symptoms are better, if not gone, the worst thing about this illness is the decline in cognitive skills and executive functioning.

Over the past 3-4 years I have watched a steady decline in David's grades. He has horrible difficulty thinking clearly, problem solving, thinking abstractly, initiating, planning, decision making, and just living. Math, which used to come easily, he could earn A's and B's without much effort, is now his worst subject. He failed one class this year already, and is fighting just to pass, now, with a D. English is also awful. He cannot handle the decision making and abstraction of research, outlining, deciding how to cover a topic, put thoughts together in a logical manner to write a paper. When looking up something on the internet, he will type in one option for a search, then check the first couple sites. If he cannot find what he is looking for, he seems unable of changing the search criteria. Change and flexibility simply seem beyond his capability to consider! David's grades were 3.459 GPA first semester freshman. Last semester, first semester junior year, was 1.446 GPA.

David gets stuck on a thought. If he cannot figure out an answer, he cannot move on. He would rather take a zero, than complete the assignment incorrectly or partially. He focuses on the overwhelming amount of homework and cannot get anything done for the anxiety and paranoia. even on positive things, David cannot make decisions and plans well. EG... Activities with friends. David can rarely initiate interaction. Sometimes an invitation from a friend, or their asking to come here is enough to get things started. Usually, it takes his father or me asking if he would call a friend to make plans, then ask if he has made transportation arrangements, Ask if he has money for said activity, and often make sure he gets there and is picked up.

With medication, David's negative symptoms of social withdrawl have greatly improved. He has more friends now than he ever has, but executive function and cognitive dulling is not improving much. We are to the point that, should he fail another class this semester, he will likely withdraw from High School and get his GED. I believe he could test and pass it now. The stress and overwhelming stimulation and load of school is his biggest trigger for explosions and paranoia. Although, up till now, he does not usually have overt symptoms at school, he unloads all the stress at home. Simply a mention of the word, homework, is enough to elicit a full blown paranoid explosion which, if we are unable to halt, will escalate into an hours log rant about being hated, harrassed, persecuted, unwanted, a target, a victim.......

David began Risperdal approx. two weeks ago. It is hard to say if it is helping to clear his thought processes. David has read half a book for pleasure during this time. This is a first in over a year or more. Yesterday, he was able to complete a History assignment. He even was able to skip a question he could not answer, and go to the next one, to come back to the unanswered one when all others were done. This was at my instruction when he got frustrated and fixated. This is something he has been unable to do for a long time. Wednesday evening, I finally got him to the "Lightbulb" moment of concluding: "Oh, you mean I should ignore my research paper assignment until all my other homework is caught up?" This is a huge improvement for him. He has been unable to do hardly any homework in over two weeks, for his fixation on being overwhelmed by the english paper.

Is this enough? Is this as far as he can go? Will he ever be able to hold a job requiring critical thinking, and planning? Risperdal is the last of the atypical antipsychotic meds. He has tried all the others. It is so sad to watch your child struggle with being unable to do things which he once could.

David described his thoughts when confused as multiple trains of thought, all different, all at the same time, and being unable to decide which is correct. If we try to help him with the "correct" choice, we are confusing him worse. If we don't try to help, we are "refusing" to help and hate him.

I hate this part of this illness.


She sighed.

Looking out into the greying mist
unable to discern, the shape of
angry cliffs piercing the night,
before her eyes,

which wept.

Waves crashing on the rocky shore,
the spray disguised apparent weakness.
Lightning broke the darkness
to reveal, only fog, blanketing the seas,
which churned.

She prayed,

for sailors caught helpless in the storm,
with no control of forces buffeting
impassioned seas. For restless souls,
who, in spite of danger, continue to face
a merciless world

with dreams.

Betty Jo Hilger

Copyright �2004 Betty Jo Hilger

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