Help with new & many diagnosis - 15 yr old daughter

[erbaledge]

Oh my! Where do I begin? My name is Patty, and I'm here for support, suggestions, ideas, tips, and to be with others who have special kids like mine.

My oldest daughter is 15 now. She is currently in voluntary PMIC for Residential Treatment. This is her 2nd PMIC placement, she was in PMIC when she was 9 for about 9 months.

Over the years here primary diagnosis was Oppositional Defiant Disorder. Along with Depression, ADD, and Anxiety. So I researched as much as I could and had/have a very good understanding of ODD and the best way to help my child, and felt pretty confident with my knowledge.

Well all of that confidence is coming to a terrifying crashing halt now. Her PMIC place does quarterly reports that state a current Axis diagnosis.

The last 2 reports have both stated these as her currents diagnosis's:
Conduct Disorder with Oppositional Traits
Auditory Hallucinations
Generalized Anxiety Disorder
Mood Disorder
History of ADHD combined type
Depressive Disorder not otherwise specified
Angry Episodes

Well the new ones to me are: Conduct Disorder, Auditory Hallucinations, Mood Disorder

Initially we (her team and I) thought the Auditory Hallucinations was just a mistake on the paperwork or that maybe she misunderstood a question her Psychiatrist asked. After doing more talking with my daughter, we've come to realize that is most likely quite true and accurate. And this scares the world out of me. Yesterday I actually witnessed her talking to no one, just a brief comeback, but it was scary for me as her mom.
- I'm currently reading up on Schizophrenia because that has Auditory Hallucinations, but does anyone have any reading suggestions that may pertain to just auditory hallucinations in kids/teens?

- Anyone have any book suggestions for Conduct Disorder? I've read Explosive Child and know it quite well, but that is the closest book I know of that would also discuss CD, but I'd like something to help me suggest ways to help my daughter deal with this, and our family.

- Mood disorders - book suggestions on that? What is your guys take on 'Mood Disorder'? What does it mean? Isn't that a general statement that specific diagnosis fall under? Or is it a diagnosis of itself?

Yesterday I found out that my daughter is now also having issues with food, primarily sweets. It hasn't been 100% confirmed yet - but we (the team & I) believe she may be making herself vomit when she eats too many sweets. We are closely watching this, trying to confirm or deny it - however while she's been home Yesterday/today for the Easter Holiday I do see it as a much higher possibility of being true.
I'm scared for her! And I have NO IDEA on how to parent her in regards to this. You see, when I was a teenager I did have Anoxeria/Bulimia - however my parents didn't treat it as an diagnosis, rather I got punished when I would not eat or would vomit when made to eat, to the point where I became EXCEPTIONALLY good at hiding it, this caused a huge strain in my child/parent relationship with my parents at the time and I eventually ended up running away for good. I don't want that for my child. I want to be there for her, support her in making healthy choices, and overcome this if it is deemed 100% accurate. What do I do?

And they say that you are never given more than you can handle. So first she got the new diagnosis of CD, and I'm like oh okay, we'll deal! Then came the Auditory Hallucinations, and i'm like OMG where did this come from?!? And now this food issues I just wanna toss my hands up in the air and running away screaming!!! I feel so overwhelmed, and I can't even imagine how she feels right now. This has brought many a tear these past 2 days.

help me please
Patty

 

[erbaledge]

Feel free to ask any questions, I'm an open book when it comes to this, as I feel the more info the better at finding help.

 

[Hound dog]

Welcome to the board Patty.

Just to help ease your fears a bit, schizophrenia runs pretty rampant in my family. It can be bad, but it can also be managed with the proper medications so that the person can lead a fairly normal life. The hard part is getting them to understand they always have to take their medications even when they *think* they are better. My youngest difficult child has a diagnosis of bipolar, borderline personality disorder but psychiatrists have suspected schizophrenia for a while be refused to diagnosis it as a teen and as an adult she hasn't sought treatment. And is currently showing signs of the disorder I'm all too familiar with. She has visual hallucinations, no auditory.......or at least they are rare.

You might want to ask the psychiatrist what particular behaviors made him think conduct disorder. Not that the diagnosis is wrong, but most people I know with schizophrenia don't really act out quite like that, not necessarily defiant anyway. Sometimes, but not enough to be diagnosed with conduct disorder I wouldn't think.

As for mood disorders, you could research bipolar, I think during a manic phase people can have hallucinations, but I'm not certain.

As for the anorexia/bolemia issue, you can have her therapist and psychiatrist work with her on those issues. Punishment, as you know, can only make it worse because then the behaviors become even more hidden. Praise and rewards for not skipping meals or vomiting and for maintenance of normal range weight does help, but you've got to treat the underlying cause too.

Any chance one of her medications could have the side effect of hallucination? Might want to check into that too.

You've landed in a wonderful place full of caring helpful people.

(((hugs)))

 

[smallworld]

Patty, welcome!

Is your daughter currently taking any medications? If so what and at what doses? Some medications can CAUSE hallucinations as well as some of the other symptoms you're describing.

 

[erbaledge]

Patty, welcome!

Is your daughter currently taking any medications? If so what and at what doses? Some medications can CAUSE hallucinations as well as some of the other symptoms you're describing.

She takes:
Clomipramine - I think 50 mg
Lexapro - 20 mg
Abilify - I *think* 15 mg

I believe that is all the psychiatric medications. I'd have to look up the doses, but I believe I have the correct current doses.

Oh! And thank you for the welcomes!

 

[erbaledge]

She takes:
Clomipramine - I think 50 mg
Lexapro - 20 mg
Abilify - I *think* 15 mg

I believe that is all the psychiatric medications. I'd have to look up the doses, but I believe I have the correct current doses.

Oh! And thank you for the welcomes!

Okay, I found the paperwork quite easily. I was semi right

Clomipramine - 100 mg
Abilify - 15mg
Lexapro - 20mg

 

[smallworld]

Patty, your daughter is taking two antidepressants -- Clomipramine and Lexapro. Either one or both in combination could be causing auditory hallucinations as a side effect, particularly if she has an underlying bipolar-like mood disorder. The angry episodes and conduct disorder/oppositional behaviors could be fueled by the antidepressant medications as well. Even though she is taking the atypical antipsychotic Abilify to treat the hallucinations, it often can't work unless the antidepressants are discontinued.

Quite freuqently, teens in your daughter's situation don't truly achieve stability until they take a combination of a first-line mood stabilizer (Depakote, Lithium, Lamictal, Tegretol, Trileptal) plus an atypical antipsychotic (Seroquel, Risperdal, Abilify, Zyprexa, Geodon, Invega). Antidepressants and stimulants tend to destabilize them, even with mood-stabilizing medications on board.

You might want to take a look at the Treatment Guidelines on the Child and Adolescent Bipolar Foundation website at this link:
http://www.thebalancedmind.org/sites/default/files/treatment_guidelines.pdf
These guidelines, based on medical literature and formulated by a consensus conference of child and adolescent psychiatrists, provides step-by-step strategies for the treatment of mood disorders in young patients. Many parents find it helpful to print the document out and bring it to appointments with their children's psychiatrists.

Hang in there and keep posting. We're here for you.

 

[smallworld]

One other thought: My younger daughter developed a serious eating disorder at age 8. The atypical antipsychotic Zyprexa has been shown in a few small clinical studies to be helpful for treating the distorted thinking around eating issues. It was a miracle medication in my daughter's treatment. If your daughter is having eating issues, you might want to ask her psychiatrist about substituting Zyprexa for Abilify. You may also need to find out about getting your daughter into an intensive specialized eating disorders program.

 

[SRL]

Hi Patti, I'm glad that you found us.

In addition to reviewing the medications, whenever we see a long list of diagnosis's like this in a child that's had issues for a long time, it's often a good idea to look back to the early development to make sure something wasn't missed. For instance, if high functioning Autism is missed in the early years and goes untreated or mistreated, it can result in a long list such as you posted and/or unresponsiveness to treatment because the child wasn't getting what they needed. Another example is that sensory integration issues can lead to food issues. I'm not saying she has either of these, but I am suggesting that this might be a really good time to step back and revisit her early development.

 

[erbaledge]

Well, lets' see, most recent updates:
Beginning of last week we found out daughter had been stealing from another kids' locker at school. Denied everything, finally fessed up, but with a lie, then fessed up to that lie with another lie, and finally 3rd time around and 2 days later, we found out the exact truth where everything came from etc.
All of that got her dropped to Level 0, meaning no home visits. Among a few other consequences the PMIC gave her, incl restitution, return the items, and community service.

Late last week, Katy started VERY superficial self injury, albeit scratching with fingernail, claiming she was attempting to hurt herself to release the pain, brought it to staffs attention right away. Eventually she ended up having to sit all the time in within eye sight of staff at all times. (these injuries didn't even bleed other than surface)

Then one day this weekend, she started saying the voices she's been hearing are happening and telling her to kill herself, and saying negatives about her. I think this was on Sunday. All precautions were taken at PMIC, and when she got to see her psychiatric on Tuesday, she still said she was hearing it/feeling it, and had a plan (albeit the plans she shared are very hard to actually do) - soooooo he admitted her into the child psychiatric unit at the local hospital Tuesday morning.

She's been at the hospital since. Wednesday morning, she saw the hospital psychiatric and being that daughter could not contract safety, he placed her in the Quiet Room until further notice. The quiet room from my understanding: is a padded room, with either no door or door open, with only a mattress/pillow. She was allowed out for meals and groups. Just about an hour ago she FINALLY got to get out of the quiet room, as she's now saying she WILL contract safety, so she is in a regular psychiatric room. She says she feels safe now, is ready to go back to PMIC, however she still is saying she's hearing these voices.

I've been doing research on Schizophrenia. Can anyone recommend a good book on this? It would be nice to read about how REAL parents dealt with a kid that had it or auditory hallucinations. Just doing the research, her school problems fit, the auditory hall. fits, the behaviors fit - it all seems like she is developing it. WEll, looking back, I would say she's BEEN developing it through time, but now the voices are now prominent.

THAT IS, if my daughter IS telling the truth about the voices, and not trying to get a pity party. But with the fact that she says they are still present, but is willing to say she will be safe, in hopes of getting out of the hospital makes me believe she's probably telling the truth.

How I wish there was some medical test that would 100% confirm.

Oh regarding the superficial self injury she was doing this past weekend - after thinking way too much about it, and then asking the family counselor if she thought my idea was on target, she agrees - we think daughter may have been doing that for attention. And the part where she wanted to kill herself, possibly because for the first time ever in my daughter's life I think she is finally feeling guilt, feels bad about all the stealing and all the people it hurt. She's never felt or expressed that before, guilt/remorse/sympathy for actions. Not sure if this all good stuff, but it's just part of our fun journey.

Oh blah! Now I would just like my daughter to get her hiney out of the hospital, back to PMIC, where she can choose better behaviors and earn back her Levels up so she can come home for a visit soon.

I personally think that Mental Health of our children appears to be the most brain-racking disease out there, but alas, I say that as a parent that has not dealt with life threatening illnesses/cancer - it just seems that this mental health puzzle book is so hard and there are no clear answers to anything. Makes me feel useless.
--------------

oh, update on medications since being in the hospital:
doctor doubled the dose of Abilify & Lexapro

 

[smallworld]

Lexapro can CAUSE hallucinations. In your shoes, I would not even consider a diagnosis of Schizophrenia until she is OFF Lexapro.

 

[erbaledge]

Ya I brought that up, and I thought I had seen somewhere that it combined with-the clomipramine can - but alas, my thoughts were shot down.

 

[smallworld]

I got my info from a well-known mood disorders researcher at the National Institute of Mental Health (NIMH) in Bethesda, Maryland. Obviously, I'm a parent, not a medical professional, but I do know that it would be a tragedy if your daughter were not allowed to get well because she's on the wrong medications. Please do your own research. Can you get projective (psychological) testing? Can you get a second opinion?

 

[erbaledge]

Lexapro can CAUSE hallucinations. In your shoes, I would not even consider a diagnosis of Schizophrenia until she is OFF Lexapro.

Researching Lexapro, wasn't sure which site to use for best info, but found this:
http://www.drugs.com/sfx/lexapro-side-effects.html

Psychiatric

Psychiatric side effects including insomnia (9%), somnolence (6%), decreased appetite (3%), and decreased libido (3%) have been reported. Abnormal dreaming, yawning, increased appetite, lethargy, irritability, and impaired concentration have been reported frequently. Agitation, jitteriness, apathy, panic reaction, aggravated restlessness, nervousness, forgetfulness, attempted suicide, aggravated depression, feeling unreal, excitability, emotional lability, abnormal crying, depression, anxiety attack, depersonalization, suicidal tendency, bruxism, confusion, carbohydrate craving, amnesia, nervous tremulousness, and auditory hallucinations have been reported infrequently. Aggression, acute psychosis, and visual hallucinations have been reported; however, a causal relationship with escitalopram has not been determined.


With that said, ARE there ANY Anti-Depressants out there that are okay for a teen that don't have Auditory Hallucinations as a side effect? How would I find that out?
Is there a way to find out the rate of occurrence for Auditory Hallucinations side effect for someone on Lexapro?

 

[totoro]

Hi
I am no expert but I would think you would want her off of any AD until you were sure if she was truly having Hallucinations auditory or otherwise.

My Daughter K has Hallucinations she is not Schizophrenic. She has them when she is manic and unstable for the most part. If you read up on Bipolar Hallucinations it does happen and it does not mean you are Schizophrenic. SO before you stress yourself out even more! LOL Which is SO easy to do, I would first try to figure out if she is really having Hallucinations.

Most of my Daughter's diagnosis's are part of her Bipolar Disorder... she has also recently been diagnosis'd as Autistic. We are still waiting to see if it is ASF or High-Functioning Autism (HFA).

Hang in there and do not give up!!!

 

[erbaledge]

Tonight I did bring it up to my daughter's advocate, that I thought that we should investigate these hallucinations more, and see if any of the medications are causing it.
However, if we are to take her off of medications, I think I want to wait for a little bit, to ensure that she's in a stable mood. Being that she just got out of the hospital for minor SI and the suicidal thoughts, even if they are for attention seeking, I'd rather be safe than sorry.

One thing the staff said, she said that she thinks that if the Lexapro was causing the auditory hallucinations, that since they increased (actually doubled) the dose at the hospital, that she would think the voices would occur more frequently.
What do you guys think? (by the way, she was only giving me her opinion, and she's stressed she's no psychiatrist, but kinda guessing at that)

So far, past 2 days now, no suicidal thoughts or thoughts/attempts to self harm - that is a plus!

 

[smallworld]

It may be too early to tell. If the voices do come back, I'd ask to wean her from Lexapro, but keep Abilify in place. The problem is that if Lexapro is causing the hallucinations, there is no possiblity of a stable mood while she's taking it. Hallucinations are distorted reality, the very definition of instability.

 

[Marguerite]

It could be that the Lexapro (if it's the culprit) just has to be at a high enough level in her system to tip her over into hallucinations. Once she's having them, whether she continues to have them is not necessarily related to dose level. A sort of "on-off" switch, a threshold effect rather than dose-dependent.

The human brain is very complex and we can't always have simple answers.

Marg

 

[erbaledge]

I have another question.
When my daughter was in the hospital the nursing staff asked her once or twice each day if she was hearing voices, were they positive or negative, etc.
Well, from what i gather, staff at the PMIC do NOT ask her daily. They only discuss it if she says something about it. Shouldn't someone be asking her each day?
Obviously her psychiatric asks her, but she only see's him once a month.

 

[erbaledge]

Just lovely! Not! The school suspension she got for stealing and the hospitalization last week slowing down her testing to see if she's eligible for an IEP/Special Education. ugh! I *really* hope it gets done before the end of this school year, and this is cutting it quite close, in my opinion.