Another psychiatric hospital Update

Discussion in 'General Parenting' started by jal, Aug 15, 2008.

  1. jal

    jal Member

    Well as we predicted the Ritalin didn't work. Just made difficult child more agressive. They are going to trial Nortripaline. At least he is there because they have to do vitals 2x day. Poor kid cannot control himself and is really presenting now. They see it too that he just has no control of himself. husband is going to have a fit when he hears this as he just thinks difficult child is being used as a guinea pig. Nothing seems to work for this kid. He spins from the moment he gets up until he goes to bed, day in and day out. It is so sad.
  2. smallworld

    smallworld Moderator

    You are aware that Nortriptyline is an antidepressant? Is the psychiatric hospital staff now saying his symptoms are from anxiety and depression and not bipolar disorder? What happened to Seroquel?
  3. jal

    jal Member

    Yes, I am aware it is an anti-depressant. They are trying to knock down the hyperactivity (still trying to address ADHD). psychiatrist wants try to get him somewhat calmer so they can work on the mood - they do agree there is a mood component.
  4. smallworld

    smallworld Moderator

    Unfortunately, any antidepressant can increase aggression, violence and mania in a child with a mood disorder. I've also never read that Nortriptyline is used to treat ADHD hyperactivity. Furthermore, the hyperactivity could actually be mania instead of true ADHD.

    You might want to familiarize yourself with the pediatric bipolar treatment guidelines:

    Hang in there.
  5. klmno

    klmno Active Member

    jal, I think I'd talk to them a little more about this. A kid with bipolar or mood cycling will have hyper periods- a stimulant or AD is not the medication to give them, even in the hyper periods. But, a mood stabilizer will address the the hyperness without making symptoms worse- if this is what he has. I don't know what he has, I just don't understand why they are continually using similar approaches if none of them have helped.
  6. TerryJ2

    TerryJ2 Well-Known Member

    That is so frustrating. I feel for you.
    And I'm sorry about your husband. been there done that!
    Take care. Sending hugs.
  7. Wiped Out

    Wiped Out Well-Known Member Staff Member

    I'm sorry he is still struggling. I know at one point difficult child's psychiatrist thought about using an anti-depressant to help control the ADHD symptoms but then decided against it because of difficult child's Bipolar Disorder.

    I'm sorry husband isn't on board. That can't be easy. Hugs.
  8. jal

    jal Member

    Well they started Seroquel Monday night in addition to Pamelor (nortriptaline) that he's taking twice a day. difficult child had moderate activity when we visited, but by the time we were getting ready to leave the Seroquel was knocking him for a loop - he was quiet, non-talkative, but calm and loving with-us. I have never seen my child like that (calm and quiet, but I didn't like it because I knew it was from the medication). They are leaning towards a severe case of ADHD with-a mood component (which is the road we've been on and we agree). I saw him this am (he had had Pamelor only) and he was active (not hyper), polite (he is most of the time anyways). Still had moderate impulsivity, but seemed to be faring pretty well. No discharge date for him yet. Poor thing, he has been in there 2 full weeks this Friday. If he is released next week school will start in a matter of days (he is looking forward to it). They moved him to a private room this am (his roommate was discharged a few days ago) and he is now on CM (constant monitoring) because of his age, impulsivity and tendency to be a flight risk. The staff seem to love him and he gets along with-the kids (they are older, the only other 6 yr old was discharged). husband is upset, hoping he would be home by the weeks end, I was hoping too, but I think we may have just started on the right medication path for him. There has been a small change.

    Also he called me at work yesterday (1st time ever) and says:

    difficult child: Mom, Can I spspsppsps?
    me: What difficult child? I can't hear you, honey.
    difficult child: Can I spspspsps?
    me: difficult child, speak up, I can't hear what you are saying!
    difficult child to nurse: Can I have my privacy please? (Nicely & calmly)
    nurse: I'll be right down here.
    difficult child: Mom, can I spspspsp?
    me: difficult child, are you OK? I can't hear you.
    difficult child: Can I paint my nails?
    me: Sure honey - if that's what they're doing.
    difficult child: The girls are, ok thank you. Love you. Goodbye.

    Had to die laughing. husband said the only color it had better be is black. Found out at my visit today it was hot pink. difficult child did not color his nails!

    Normally, by the second time I would tell him I could not hear him he would scream at me "I hate you", "you don't understand anything!" This whole thing took place in a cool and collected manner. Almost fell out of my office chair!
  9. crazymama30

    crazymama30 Active Member

    JAL, I think that was a good conversation you had with your difficult child. Mine will do the same thing in that if you cannot hear/understand him and ask him to repeat he gets upset and yells you are not listening, you hate me, yadda yadda. When he is stable this does not happen.

    I am glad he is in a psychiatric hospital to go thru all these medication changes.

    I hope things continue to be positive and hope they find some medications to help him soon.
  10. I am glad they seem to be making progress with difficult child. I know it is very hard for you to have him in there. It's good though that he is in there for these medication changes. With Seroquel, I know it can be kind of sedating at first, when difficult child was taking it (and it was a relatively low dose) for the first little while he would be asleep within 30-45 mins of taking it. After a month or two, it didn't sedate him anymore. Before difficult child stopped taking it, he was taking the same dose in the morning and at noon that used to sedate him and it didn't anymore.

    Hot pink, huh? Glad he passed on that, I think if I would have seen my boy with hot pink nails, I might have freaked out.
  11. Andy

    Andy Active Member

    I am so sorry. This is so hard on your entire family. I hope they find something real soon. Hang in there and stay strong.
  12. jal

    jal Member

    Thank you everyone. I just recvd an update from the dr that difficult child lost his tooth biting a staff member during one of his worst tantrums ever this am. The tantrum started when I was leaving (not because I was leaving-it was over something else). After they scuttled me out I could hear him & I knew it was going to be a nasty one. The tooth was loose anyways. Poor staff member. Dr feels he is not stabalizing as quickly as they would have hoped and he has a lot going on with-cognitive, executive, emotional functions (we know that), but they will not lethim leave until he is stable. He may have to start school there if somthing doesn't turn around soon. husband will hit the roof!


    Butterflydreams- he called me on my cell (2nd time ever) and wanted to PAINT HIS NAILS TODAY! (He never did yesterday).

    Pink, black-whatever I said. Go to town!
  13. Oh, Jal, I'm sorry to hear that he is having such a difficult time.

    On the nail polish note, I think I would freak from the point of seeing it and not expecting it, but I probably wouldn't have had a problem with it either. When difficult child was that age, he used to get into his sisters lipgloss!
  14. busywend

    busywend Well-Known Member Staff Member

    Jal, does this doctor specialize in pediatric psychiatric? Things are so different in kids than in adults with treatments.

    Please consider what Smallworld has posted to you. I am no medication expert and neither is she, but I have seen this mentioned over and over again on this site. Many docs get it wrong. BiPolar (BP) looks a lot like ADHD and vice versa. Just the idea of trying Ritalin on an unstable child sends chills up my spine. I am not trying to be flippant or mean or rude. I just want you to get a sense for what we see.

    HUGS! I am sure this is terribly difficult on you and husband. Take care of yourselves.
  15. Andy

    Andy Active Member

    Hugs, Hugs, Hugs, Hugs, Hugs.

    Oh how hearwrenching! To have to walk away as difficult child is loosing it. Your husband must be in denial and that is very hard for you to deal with too. I know how hard it was for me to tell my husband that difficult child has in the psychiatric hospital. I knew he was very upset but only asked, "Does difficult child want to be?" "Yes, in fact he asked to be."
  16. Wiped Out

    Wiped Out Well-Known Member Staff Member

    I know this is so hard, it does sound like it is where he needs to be still. I wish your husband could understand that it's better for difficult child to start the school year in the hospital than to leave before he is stabilized.
  17. jal

    jal Member

    husband does understand he needs to be there, he is just upset that difficult child has to be there and I guess I wasn't so clear about "upset". He's not mad or in denial - he's just so emotionally sad that difficult child has to go through this and be away from us and he just wants his little boy to be home.

    With regards to the ADHD vs Bipolar. Under difficult child's reg psychiatrist we were doing a wash because difficult child has been on this protocol for over a year and we just did not see the improvement that we had hoped for. During the wash difficult child became worse. This is what prompted the inpatient. On his 4th day there the wash was completed (we had been doing this for around 4 weeks). They began to observe and see that difficult child has a motor that just does not shut off, can't sit still, frustrates easily and it escalates to lashing out.

    Reg psychiatrist wanted to address ADHD after the wash anyways. I felt it was fruitless since we've tried every stimulant under the sun, but it had to be tried because the poor kid CANNOT concentrate on anything for more than 2-5 minutes, CANNOT sit still and is constantly going. (he's been like this since age 2 and I cannot believe he has been in a manic state for 4 years 24/7). As we predicted, Ritalin did not work and they saw how much more agitated and agressive he became on it. So they switched to the older class that used to be used for ADHD, the anti-depressant Pamelor (nortriptaline). It is actually seeming to have some effect. He's been able to play Monopoly for up to 25 minutes with only getting up 2 times. We play Sorry yesterday and he did not leave the table (normally he would be up 10+ times). I have always known in my heart he has ADHD although alot that presents falls in the bipolar catagory too. I am just wondering if that all these years of constant going and going and the frustration that comes with it brought out the physicality because he couldn't express himself any other way.

    The psychiatrist at the inpatient is very hesitant on giving difficult child diagnosis of bipolar as it will stick with-him throughout his lifetime. He is insistant that he will not let him go until he is stable. He does see issues with his cognitive thinking and emotional thinking, but says his executive function is good that he's as sharp as a tack and his vocabulary is great. But all in all some things slightly touch the austism spectrum (which I have been questioning for awhile). Unfortunatley it appears that difficult child has a HUGE mixed bag - a little of every disorder - he even threw in a little Obsessive Compulsive Disorder (OCD) for good measure (that one I see a bit of too, when it comes to fixating on something).
  18. busywend

    busywend Well-Known Member Staff Member

    I am glad game time went well! Fingers crossed the medication continues to help.

    Yes, for sure kids can present with other symptom-like issues due to being different than everyone else. Imagine being frustrated every day of your life and nobody understands you. Of course that would make you angry eventually.