Q. My husband and I have a 20-year-old son who was diagnosed with Tourette's syndrome at age 13 and put on Orap, a very strong antipsychotic drug, which worked very well in controlling motor tics, his only TS symptom. He is an accomplished classical musician and straight A student. A month ago, while attending college in California (we're in Chicago), a neurologist weaned our son rather rapidly off the Orap, warning of tardive dyskinesia. Our son was thrilled that his motor tics were practically non-existent post-adolescence, but suddenly he suffered a tremendous manic episode causing hospitalization. My husband brought him home. (To top it all off, he also caught mononucleosis, which explains why the psychiatrists in CA had never seen a manic person sleep as much as our son did.) Now a psychiatrist in Chicago has him on 10 mg. of Zyprexa and 1,000 mg daily of Depakote. We don't think the meds are working well, but because our son is 20, no doctor will deal directly with us. Our son is definitely not himself, and we are frightened. It is incredibly frustrating to see our until recently healthy, successful child spiraling downward. He wants to go back to school, but he is exhausted and I would say hypomanic and quite irritable. He has no focus for studying or music practice, and we are all at our wits' end. Might the mania have been brought on solely by the discontinuing of the Orap? When a person is impaired, can't the doctor at least receive information from the parents without breaking doctor-patient confidentiality? The psychiatrist will not even return phone calls we have made reporting that we suspect our son is not taking the Zyprexa.

 

  A. Very good questions. I will answer the easy ones first. You can give any information you want to a psychiatrist. It is only breaking confidentiality if the psychiatrist gives you privileged information about your son without your son's permission. I am sure the psychiatrist is busy (or at least will say he is), so you may want to pay for the time. Your insurance will cover this, so you and your husband can talk to the psychiatrist with or without your son present. Perhaps your son wants you to be at one of his medication management sessions. That makes everything easy. If no one is happy with the results, discuss it with the doctor. If there is no satisfaction, get a second opinion.