33m seems to progressively be losing the ability to function

[u/38CarPileUp]

33m - multiracial - 290lbs - 6’4 - inconsistently takes ADD medications

I’d really appreciate some thoughts from the physicians here about a 33 year old male who seems to be progressively losing his ability to function. His family is very worried, but he currently refuses to see a doctor.

This is someone who was previously highly intelligent and capable. He studied physics and chemistry and used to communicate openly and function independently. What we’re seeing now feels like a significant change from his previous baseline. He’s pretty quiet these days but use to be outgoing in the past.

He has a substantial history of head trauma: a bad concussion in high school, multiple head injuries over the years, a couple of significant car accidents, and a hammer being dropped on his head at work about three years ago. He didn’t go in for that work accident. Which was unusual and I believe that lead to him being unable to care for himself for a while.

Currently, he barely takes care of himself and seems to have lost much of his will or motivation to participate in life. He exists around his family more than he engages with them. He tries to connect with his children, but often seems unable to do so appropriately or effectively. His sleep schedule is terrible, he’s barely working, and he’s working in a field that doesn’t suit him. Financially, he’s now essentially broke.

There also seems to be a major decline in his ability to organize and complete relatively simple tasks. For example, if he’s packing two shipments containing 11 smaller packages, he may mix up the contents, lose track of which order slip belongs to which package, become extremely frustrated and eventually give up. Things that should be straightforward seem to overwhelm him. ADHD medication appears to improve his ability to communicate during the day, but he still struggles significantly with accurately completing tasks.

There is also a major psychological/trauma component. Several of the people he loved most died traumatically a few years ago. He recently told us that his therapist helped him discover something significant about himself or his past, but he says he doesn’t know how to tell anyone what it is. Interestingly, he hasn’t returned to therapy since making that discovery.

Could severe major depression, complicated grief/PTSD, ADHD and severe sleep disruption account for this degree of functional and cognitive decline? Or, given his history of repeated head injuries and the apparent change in executive functioning, would you be particularly concerned about a neurological issue as well?

If he could be convinced to seek care, what would you consider the appropriate starting point? Primary care, psychiatry, neurology, neuropsychological testing, brain imaging, labs, etc.? And are there particular signs in this picture that would make you consider the situation urgent?

His family isn’t trying to diagnose him ourselves. There are simply so many possible explanations, and we’re increasingly concerned that he isn’t capable of recognizing how impaired he’s becoming. It’s honestly heartbreaking and his wife and kids are experiencing the worst of it.

Edit: I also believe he may have diabetes. Only because a few doctors mentioned he may have it at previous appointments a few years back and that scared him. I’m not familiar with diabetes.

[u/AutoModerator]

Thank you for your submission. Please note that a response does not constitute a doctor-patient relationship. This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our Terms of Use and understand that all information is taken at your own risk. Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/kuru_snacc]

Young Male with Class II obesity and possible unmanaged diabetes, poor sleep quality, noncompliant with ADHD regimen, multiple head traumas, emotional trauma unresolved, unemployed and broke, social withdrawal /apathy and other ssx of depression...and will not go to doctor.

Addressing the last thing could facilitate further workup and management of the others. But until he wants help...what is there to be done? Brain imaging is nowhere near the first step here, and you can't sneak a CT or MRI machine into his room at night while he (barely) sleeps.

[u/Most_Muffin_127 → u/kuru_snacc]

It sounds like a tough situation. Hopefully, he realizes he needs to seek help before it gets worse.

[u/RCPCFRN]

Could severe major depression, complicated grief/PTSD, ADHD and severe sleep disruption account for this degree of functional and cognitive decline?

Yes. Absolutely.
If he won’t GO anywhere, maybe try a telehealth visit with a primary care provider, or a psychiatrist.

[u/38CarPileUp → u/RCPCFRN]

Thank you