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Behavior: OCD, withdrawal, anger, sleeping

My teenage son over the last year has been experiencing more withdrawal from family activities, sleeping more, having explosive outbursts at home, picking, obsessing about peers, and has an increasing awareness of his differences from peers. He began seeing a psychiatrist and is on a low dose of Prozac. Are any specific drug recommendations for the different behaviors he is exhibiting?

A trial of increased Prozac is warranted since the doses for obsessive symptoms usually are higher.  The patient's CdLS complicates the picture because of the characteristic neuropsychiatric syndrome of CdLS-- but I must point out that these symptoms vary over an entire spectrum and I have seen many patients who do not have any of the "typical" responses. In general, individuals with CdLS seem to have more obsessive compulsive symptoms of as well as some autistic features which do respond to the usual meds. They seem to not do well with first generation anti-psychotics nor do they tolerate sedation as well as some other patients.I would be concerned about GI tolerance if this patient hadn't already done well on Prozac at the lower dose. Supportive therapies as well as other psycho-social interventions within the family are very useful. My constant message is that individuals with CdLS may have acute social awareness, in distinction with the apparent behaviors of autistic individuals.  Anxiety can be the driver behind OCD. The role of anxiolytics is questionable however because of problems with sedation and disinhibition. The behavior you describe can more common in the later teenage years and early 20's. Sometimes giving him slowly more responsibility and/or independence, as you would for any growing teenager, can help with some of these behaviors.It might help if he can join some kind of teen group (especially without parents present. DS - TK 3/25/11



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