I officially think the psychiatrist is crazy...... (longish, as usual)

Discussion in 'General Parenting' started by keista, Aug 23, 2011.

  1. keista

    keista New Member

    .....and I officially think that she thinks I'm crazy.

    First, I am 100% aware of the fact she's got a tough job. We have 15 minute appointments. DD1 doesn't talk to her. She has to go by what she sees in DD1 and what I tell her. At the end of appointments, we are usually in agreement as to the course of action/medication. That's why I keep sticking with her instead of changing psychiatrists. The problem is, I don't know what the problem is, but I know I get crazy frustrated.

    A year ago today, psychiatrist was pushing for an Autism Spectrum Disorders (ASD) evaluation for DD1. In the office, DD1 would not talk, barely made eye contact and her brother is on the spectrum, so from her perspective it seemed a reasonable supposition. Sure, refer her for whatever evaluations you want, but she is NOT on the spectrum.

    So DD1 was referred to staff psychologist for whatever evaluations. The ones I know for sure included TOVA for ADD, a BiPolar (BP) questionnaire. There were others I'm not familiar with, and am still waiting release of the written report (don't know why I didn't get it last year) The verbal report I got didn't reveal anything I didn't know. Depression and anxiety manged reasonably well with the medication. Wellbutrin and Paxil.

    At that time she was already on the Paxil. DD1 only became mildly more talkative with the psychiatrist, but at home, she was much more out of her anxiety shell. Then I started reporting the emergence of "new" symptoms. psychiatrist started bringing up the possibility of BiPolar (BP). Didn't Dr W rule that out? Hmmmm well, yeah, I can see bits of BiPolar (BP) but it just doesn't fit the criteria - gotta really stretch the definition. That kept going on until the the "new" symptoms became 'creepy' and I asked to get her off the Paxil. I'm still not sure why we took away the Wellbutrin and replaced it with the Abilify except that we were caught up in "looking out for" BiPolar (BP).

    Once she was off the Paxil, "creepy" went away, but she was agitated - the chronic boredom to the point of tears sometimes. Other than that, she seemed pretty OK, but I was becoming increasingly aware that the 'boredom' is actually better defined as restlessness/agitation. She NEEDED to do stuff, but could not find stuff to do that would bring her sufficient interest/joy. This culminated in her being admitted to crisis stabilization for a serious suicide threat. I thought the Abilify was at fault so stopped it. At the followup appointment, psychiatrist not only mentioned BiPolar (BP) and BPII, but also cyclothemia and Borderline Personality Disorder - where did that come from?

    Since she's been medication free, she experiences many moods, from matter of fact suicidal ideation, to silly goofy giddiness, to tearful sadness, to extreme anger (not rages), to 'normal', to restless/agitation although that is no where near as extreme as it was in the past. However, after one month, in my opinion none of these symptoms are extreme or frequent enough to merit medication. I tried my best to explain this today. psychiatrist suggested that DD1 is "playing" me. Ah, HUH? Yes, this is always a concern of mine and I need to observe carefully and act prudently so as not to get played, but also not overlook when DD1 is in real pain - that can be a REALLY fine line with this child, but again in my opinion it seems more like 'real' issues as opposed to "playing"

    One of the reasons psychiatrist felt this way today was because DD1 was still refusing to talk to psychiatrist, but was being completely goofy, giddy, silly and would not sit still in the chair. Several times she was upside down. psychiatrist described her acting like a 4 y/o. YUP! Sooooooooooooo psychiatrist pulled out the ADHD survey (she uses Vanderbilt) for the teacher to fill out. Ah, Dr W ruled that out with the TOVA. But this also asks about other behaviors. OK.

    One thing that REALLY aggravated me was when she was trying to talk to DD1 she said, "The medicines we have tried seem to work for a while and then stop working" I called he on that right then and there asking her what she meant by that because Wellbutrin and Paxil never stopped working. The Paxil was eliciting new symptoms, but it was still doing what it was supposed to do - curbing the anxiety. She just looked at me and changed the subject.

    Just venting mostly, but am I being unreasonable to think she should be tracking symptoms and side effects better? Is it me? Is it her? Both of us?

    On a good note, Son saw her first and he was able to reasonably articulate his problems and ask - HIMSELF - for a dosage increase. I did have to remind him to tell her that he actively sought out and started therapy to learn better coping strategies. I only elaborated on the fact that we noticed an increase in his frustration as long ago as January and have been trying to work them through, but it is getting more and more intense. My boy is learning self-advocating!
     
  2. InsaneCdn

    InsaneCdn Well-Known Member

    {{hugs}}

    I don't mind if psychiatrists are not tracking 4 years worth of history - we only see psychiatrist 3-4 times a year, and while we get more than 15 mins, it still isn't significant.
    Its my job as a parent to track history and bring it up as it applies.
    BUT...
    Its psychiatrist's job to recognize that this is YOUR job, and to work WITH you on every point you bring up.

    We're lucky - we've got one hf the best pediatrician psychiatrists around. We get 1hr appointment 1x/yr, and the others are 30 mins... and she LISTENS. We DISCUSS. At the end of the session, we have a game plan, and a new appointment based on the game plan (4 weeks out? 3 months? 6 months? depends on what if anything is changing). Last round, we'd just added a medication, and wanted an increase. She wasn't so sure. But is a fine line... too little, too much, or just right... how do we know if we don't try? So, she wrote the script and gave directions allowing for us to have two rounds of tweaking - and a 3-month appointment.

    on the other hand - lots of psychiatrists are insecure when presented wit a case they can't figure out. Might be part of why psychiatrist is working for your son and not for your daughter?
     
    Last edited: Aug 23, 2011
  3. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    This is exactly why I have NeuroPsychs do the diagnosing. Rather than just listening to our complaints (although they do), they do extensive testing in all areas of function plus they do a lot of observing to see how our kids respond in all situations. I think they make better judgments through their testing than psychiatrists do. I use psychiatrists after the neuropsychologist. And there IS a difference between the testing a regular psychologist would give and neuropsychologist.
     
  4. ML

    ML Guest

    All I know is our kids are so very complex and this symptom management is extremely difficult. Kudos to your son for self advocating.
     
  5. susiestar

    susiestar Roll With It

    I read this earlier and wanted to think on it before I posted. My first impression upon reading the post was that she was mixing up patients and either not reading her notes from the last sessions/sessions or she takes lousy notes. I didn't want to post this at first because I wanted to see if any other possibilities came to me. That first impression is still what I think may be happening.

    The way to cope is to start taking a list in with you. A list of symptoms and how often they are occurring, a list of medications and the changes made in the last appointment and changes made since the last appointment. Also a list of questions that you need answers for. A copy of this needs to go into difficult child's file and a copy needs to stay in your Parent Report. You also NEED to start a journal where you keep a daily log of behavior, problems, medications, and any other issues. Be sure to include difficult child's moods in the journal.

    With the journal you have evidence of what is going on, rather that going by memory. It gives the doctor something to see what daily life is like for difficult child other than just what you can remember to tell her during the appointment.

    You also need to create a parent report. It is a document that you create that details just about everything about your difficult child. It lets you keep track of everything and organize everything. You can give copies of whatever parts of it that the psychiatrist/therapist/school/whomever needs. Just be sure that you only give htme what they need, esp school people (teachers, sp ed teachers/director/school therapist/etc...) because many of us have had material from the report get into the hands of people who had no business with it and/or poeple who would use it against difficult children.

    The outline for the parent report was figured out many years ago by moms here on the board. The link in my sig will take you to the thread with the outline and explanation of the report. It truly is an amazing tool. Be sure to work on it over several chunks of time rather than trying to do it all at once. It is too big to work on all at once with-o forgetting a lot and getting overwhelmed.
     
  6. keista

    keista New Member

    Susie, I think she takes lousy notes. I had never thought of that. I did start the parent report, I guess I should work on it some more. I do keep a daily journal of her moods as well as behaviors. I even note when she's being "normal". Of course, I really don't have an understanding of what that is anymore.

    Insane, Thanks, that made me feel better. Like I said, she ultimately works with me. I have no problems exploring things she sees in DD1. I guess I just get frustrated by this "dance" we seem to do all the time. she probably feels the same about me.

    MWM, I'm trying to get neuropsychologist for her, but I don't think it's going to happen. But then again, she's in yet another new program within her program, within her program (insurance), so we'll see.

    My concern for her is that her issues are subtle. With age and experience, she's learning to cope better and her public (even to me) expressions of what's going on inside are getting more limited. Sounds good, but if all the 'negatives' are internalized, and she doesn't share them, they become the norm in her mind. She can function, and function well, but it doesn't mean there's not warped thinking going on. Personally, I thought it was perfectly normal for ALL teenagers to contemplate suicide. I did, on an almost daily basis, I figured everyone else did too. How many times have we all heard about suicide stories and the ppl closest to the victim are quoted as saying "We never knew there was a problem."

    ML, thanks. I am so proud of him! But I have to resist the urge to over-praise him - he doesn't like that.
     
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