Chapter 1047 - 795: Amitabha Buddha (2)
But if the tics are frequent enough to affect vision, writing, walking, or social interaction, intervention is necessary.
The first choice is psychological and behavioral therapy, such as habit reversal training, with medication control for moderate to severe cases.
The overall prognosis is good, with about two-thirds of children experiencing significant symptom reduction or disappearance by adolescence, and only a few continuing into adulthood.
But the boy in front of us...
Nan Zhubin’s eyelids drooped, clearly not the optimistic type.
...
"The tics are still very frequent."
Facing Director He’s question, the mother’s tone carried a weary calmness: "He has completely stopped going to school for now."
Director He also maintained a calm tone: "Is this change since the last medication adjustment?"
"Yes." The mother replied, "The whole body feels uncomfortable, and the child’s mood is always excited."
"When he’s excited." Director He asked, "Does the child’s mood improve?"
"No, when I’m excited, I feel uncomfortable." The boy interjected.
Director He turned to the boy.
"—Amitabha Buddha."
Director He nodded at the boy, entering everything the boy said except "Amitabha Buddha" into the system.
"Yes, when he told me, he was very excited but uncomfortably so." The mother added.
As she spoke, her calm demeanor was broken, and her tone started becoming mournful: "Seeing him uncomfortable makes me uncomfortable too, so I thought about increasing the medication..."
"You can’t increase the medication!" Director He suddenly raised her voice.
Her calm expression also broke, her eyes becoming stern.
"When you said you couldn’t increase the medication, were you saying you medicated according to doctor’s orders, or did you add medication on top of that?"
The mother was stunned.
"Did you increase the medication yourself?" Director He leaned forward, raising her volume a notch.
"I just wanted to make him a bit more comfortable when he was suffering..."
"Did you increase the medication yourself?!" Director He’s voice was almost scolding.
Faced with this scolding, the mother still didn’t give a definite answer: "I felt heartbroken seeing him suffer, so..."
"You increased the medication." Director He said.
She leaned back, shook her head, adjusted the computer back to the initial screen, deleted what she had previously written, and started re-entering data.
"You can’t increase the medication on your own." Director He’s voice was calm, "The medication we prescribe is carefully adjusted to work together gradually. It takes time to assess the effect and efficacy of the medication, and if you increase the dose, even if nothing seems to happen, the adaptation period will have been wasted."
"I can’t reduce your medication now; we need to return to the prescribed dosage and monitor the child again."
The mother’s body shrank slightly, now acting like a child.
"I saw he was really suffering, and wanted him to feel a bit better. Seeing him suffer makes me suffer too..."
"Psychiatric medications are not sedatives or anything... that can necessarily make someone feel better." Director He looked at the mother, then turned to the boy.
She seemed to be speaking to both: "Some medications might feel uncomfortable when taken, but over the long term, there are benefits. We are dealing with a psychiatric condition and developmental issue, something that requires fighting against."
"I... I just saw him suffering, and I felt bad too, I just wanted to make him feel a little better..." The mother’s voice grew softer and softer.
Director He sighed: "The subjective level of distress in tic disorders is indeed very high."
"As I said before... this is a process that requires fighting."
The mother couldn’t find words and just lowered her head.
The boy looked at Director He, then at his mother, frowning as if wanting to say something.
"Mom..."
The next moment, he cut himself off: "—Amitabha Buddha."
He clasped his hands together, his expression pained yet compassionate.
Director He sighed, adjusting the medication page again, then reopening the previous screen.
"Does the child often feel agitated or restless?" Director He continued with her procedure, treating the previous moment as just a small episode.
The mother couldn’t answer immediately.
"This kind of situation happens a lot." The boy said himself.
"Any other symptoms? How frequent is the physical tic at present?"
The mother’s emotions adjusted slightly: "The tic frequency has increased. We’ve been advising the child that health is more important than studies; once he relaxed about school pressure, the school-related tics reduced. But when the child becomes unusually excited, the tics become very frequent."
The boy nodded: "I don’t tic much during class, mostly at home or during break periods."
Director He nodded, typing on the keyboard twice, then asking: "How about self-talk?"
The mother glanced at her son: "Compared to before, it’s relatively normal, not excessively frequent, and his appetite is normal."
The boy added: "Sleeping is bad, waking up many times at night, waking up early feeling very hyperactive, unable to go back to sleep."
The mother softly asked: "Does this... have much to do with increasing medication?"
Director He was clearly considering the same question.
"Can’t rule it out."
She was silent for two seconds, then said something that left the mother stunned.
"I suspect the child has comorbid tic symptoms and bipolar disorder."
This term needed no further explanation, just hearing the name was enough.
The mother was momentarily stunned: "Bipolar... is it just that he finds it hard to control his emotions, kids are like this..."
Nan Zhubin looked at the mother’s expression, sensing she now hoped it was just due to her increasing medication.
"We’ll need further observation, let’s wait until he finishes this cycle of medication stably before deciding." Director He shook her head, "Based on the medication I prescribed... this excitement is unlikely due to medication side effects, you need to be mentally prepared."
This statement was very direct. Nan Zhubin thought.
This is another difference between a psychiatric consultation and psychological consultation; psychological consultation usually wouldn’t speak so directly.
The mother was stunned.
"—Amitabha Buddha." The boy clasped his hands together, his tone calm.
The mother seemed to be remembering something and suddenly began speaking to herself: "Since he was very young, the child has been talking to himself for no reason, this situation has lasted a long time."
"Since childhood, he frequently had bouts of unexplained laughter and soliloquy." The mother continued, "It has lasted a long time."
Director He suddenly added: "It could be bipolar, but it could also be bipolar disorder."
The mother suddenly seemed startled and asked: "Bipolar affective disorder, is that alternating states of mania and depression?"
Evidently, she had done some homework in advance.
Director He nodded and shook her head: "It’s alternating, but also has a focus. Some people have more manic episodes, some have more depressive episodes."
She typed on the keyboard twice, and the printer beside her began to work, producing a sheet amidst a humming sound.
"Why don’t you go for an ECG first, and return after it’s done."
The mother stood up but didn’t move. She stood in the middle of the consultation room, looking down at her son sitting on the chair.
"Amitabha Buddha."
After a moment of silence, the mother’s voice suddenly lowered: "I just feel the child’s condition is very difficult to treat."
Director He did not deny: "It is indeed difficult to treat, as it falls under neurodevelopmental disorders, which are inherently challenging to treat. Moreover, the child currently has compulsive traits, with extremely unstable emotions."
Many psychiatric disorders often involve comorbidity, and textbook cases of just an "individual" disorder are rare and fortunate. Because when there’s comorbidity, whether psychological or pharmacological intervention, treatment difficulty doubles.
Director He glanced at the mother, then suddenly asked: "Would you like to have a psychological consultation?"