medication issues keeping difficult child 2 at home still...

[gcvmom]

To catch you all up, we pulled difficult child 2's stimulant this weekend because it was making him hypomanic (frenetic cleaning, worry and obsession, emotional outbursts to name a few).

He got sent to the office on Monday within the first 10 minutes of the school day for impulsive behaviors (headbutting one kid and throwing wood chips at someone else). I decided to just bring him home until he's more stable.

We also stopped the clonazepam because it was making him a zombie and he would fall asleep at 4:30 or so and sleep the whole night. It wasn't helping his tremor either, so why bother?

Saw the psychiatrist finally yesterday. difficult child 2 said he just can't stop the pacing and spinning he's been doing since Saturday. He doesn't sit for more than a minute or two, and then he's back up and moving. He also said that sometimes his thoughts are just really, really busy ("buzzing"), but sometimes they are quiet, too. Overall, he's in a pleasant mood and is cooperative, although he is processing things slowly and is still a bit impulsive. psychiatrist is convinced this is a kid with a mixed mood disorder (still can't technically call it BiPolar (BP) I guess because of the DSM).

SO... after a lengthy debate and discussion with psychiatrist over the acute dystonic reactions difficult child 2 has had with Risperdal, Zyprexa and Abilify, I agreed to give Seroquel a go. He explained that it's mechanism is very different from the other neuroleptics, so I'm hoping this will work. Neuro also gave his blessing on it because it acts on the dopamine receptors that will hopefully also improve his chorea/tremor. I have a lot of faith in this psychiatrist since he's been treating difficult child 2 for the past 6 years and knows our family history very well.

We're starting him at 50mg for 5 days to see if he tolerates it o.k. And then we'll titrate from there over the next month. psychiatrist said after about two weeks, we could try adding the stimulant back in at a very low dose to see if it helps and he tolerates it without more activation. The psychiatrist said his hope is to have him off everything except Seroquel and a very low dose of stimulant.

I gave difficult child 2 his first dose in the late afternoon yesterday so I could watch for a reaction. All it did was make him fall asleep for about an hour and pee the bed. He woke up for a few more hours and then slept the night without incident.

This morning he was a little tired, but it wasn't a huge struggle to get him up. I wanted to see how he was functioning and whether he's able to go to school today, but he's still pacing a lot. He says he feels like it's a little better, though.

I emailed his principal, teachers and school psychiatric this morning to update the situation. There's a school-wide assembly program today to celebrate the school's Blue Ribbon status with the state, and easy child wants me to come watch, so I'm going to take difficult child 2 with me and we'll see how he does. If anyone asks, we'll tell them he hasn't been feeling well.

There's a class field trip to a farm tomorrow, and I asked if there's an adult going who could stick to him all day or, if not, could I just drive him there myself. So we'll see how that goes.

 

[butterflydreams]

I certainly hope this works! Poor thing. When my difficult child started taking seroquel, it would make him very sleep too - he would be out within the hour of taking 50 mg. Now he takes 50mg 3x day and is not overly tired after taking it. I hope difficult child 2 is able to handle it.

Christy

 

[Steely]

Certainly hope that the Seroquel will do the trick. It takes a little time sometimes for it start to have an effect, but for my difficult child it worked wonders. I would probably give it to him at bedtime to avoid the sleepiness.

Kudos to you for not sending him to school when he was so mentally unstable.

Hugs.

 

[witzend]

Poor guy! I hope this will help him to balance things out! Did you break out the mattress liner? It sounds as though you are going to have to cut liquids in the evening and make sure that there is a definite potty break before bed.

Have a good time at easy child's celebration!

 

[Andy]

Oh, I do hope he can make the field trip. I know it is exciting for him and a bit uncertain for you. If you remember, I went though the same decision to send my difficult child on what ended up being a 12 hour school field trip without my husband or myself.

As for the bed wetting, my 11 yr old difficult child has started that issue this past year. He is such a deep heavy sleeper. It was suggested by the psychiatrist that I get him up in the midde of the night. However, I have an extremely difficult time getting myself up and then it is near impossible to wake him up. So, difficult child has started wearing Good Nights overnight. He hates the feel of them so wears regular underpants under them. When we first started, there were a few times during the day that he would wear them if we were unsure as to were bathrooms were (he had also started having accidents during the day so teachers knew if he asked to go then he needed to NOW.
He was allowed to just go if he couldn't get the teacher's attention or didn't have time to get her attention). I always talked to him about these days and asked if he thought it would be easier to do this than deal with an accident in an unknown area. The decision was always his to make. On a overnight class trip, we asked that he have privacy when changing for bed and in the morning so the other kids didn't know he was wearing a Good Night.

When he refers to them as "diapers", I always reply, "They are not diapers. They are protection for wetting."

I hope you can find the right medication(s) soon. I should add that my difficult child has always been a very deep sleeper, even before clonazepam but now that he is going off of it (hopefully will be off in about 5 - 6 weeks, we will see if night time issues will improve?

 

[gcvmom]

Thanks BD, Steely, Witz and Adrianne...

Thankfully, we have waterproof coverings on ALL our beds... just in case! I even had one put on mine because when I was pregnant, I was worried about my water breaking while I was in bed. Plus we've all got dust mite allergies, so it helps with that as well. I'm hoping the bed accident was a fluke, but I do know he's had problems with that when he was taking too much Depakote at one time, that's why we now split the dose.

The party at school was fun. A kid named Austin Anderson who has a few songs on Radio Disney made and appearance and sang a few songs for the kids. Radio Disney also sent a music van with a booth...

difficult child 2 had about all he could handle after about 30 minutes of people doing little skits and songs. He kept pacing and asking to leave, but I managed to stretch it out for a little longer so we could see his sister and listen to the new school song he and everyone else had learned recently. By the time we headed for the parking lot his mood was very different and he was irritable. I can definitely see that it was a good move keeping him home this week.

As for tomorrow's field trip, I haven't heard back whether they would have an aide availble for him or if we can just go in our own car. I'm thinking the best choice would be to meet them there so we can leave if we have to.

I just hope this is the right path we're on. I feel like SO much TIME has been WASTED in his short life dealing with all the different issues. But I know that we have to resolve this even if it takes a few more months.

 

[smallworld]

I have to ask: If psychiatrist is convinced difficult child 2 has a "mixed mood disorder," why does he think Seroquel with a low dose of a stimulant is the right treatment? Furthermore, what is he proposing as the target Seroquel dose?

 

[gcvmom]

Hi smallworld,

He said it has been shown to be effective for both manic and depressive ends of the disorder. He's not saying that the ADHD is gone, either. That's why he still thinks a very low dose of stimulant could be tried once we get him stabilized (and of course providing he still looks like he needs it). He said the target is somewhere around 300-400mg, I think. We won't be pulling the Depakote for a few weeks...

 

[gcvmom]

I just spoke with difficult child 2's principal and she said that she and the teacher absolutely want him to be able to go on the field trip tomorrow. They agreed it would be best if I went along, and that taking my own car would be safer in the event he needs to leave. So that's what we'll do. She also said it would be fine if he wants to try some 1/2 days next week, but we'll wait to consider that after we get through the weekend. Next Thursday is the last day of school, and it's a short day at that.

Principal said she knows some families for whom Seroquel worked very well -- I know everyone has an anecdote for a particular medication. We just have to be patient and see if this will work since every person is different.

 

[ML]

I'll be following your trials with this. Wishing you the best of luck. Give difficult child an extra hug tonight for me.

 

[smallworld]

Seroquel has absolutely been a miracle medication for my son -- for treating anxiety, depression and mania. But it's rarely used as monotherapy for mood disorders. Generally, it's an adjunct to a mood stabilizer (or two).

I believe that recent research has shown that anxiety is greater in the middle ranges of Seroquel (in the 300 mg range). Sleep issues and anxiety alone are dosed between 25 and 200 mg. Mania and mood instability are dosed somewhere between 300 mg and 600 mg, but sometimes as high as 800 mg.

My son's Seroquel dose was increased very rapidly (100 mg a day) up to 800 mg while in day treatment because he was manic and staying up all night for many nights. He was very sleepy at the beginning, but the side effect wore off after a couple of weeks. We recently lowered him to 600 mg because he was having a hard time waking up in the morning. His mood is still very good.

Good luck to you.

 

[Big Bad Kitty]

Best of luck! How cool that Radio Disney showed up at the school.

 

[gcvmom]

Thanks, ladies.

Okay, third trial dose of Seroquel tonight... so far he's still pacing -- maybe I'm imagining that it's a tiny bit less. I escorted him on his field trip today (Revolutionary War re-enactment) and that was definitely a good move. He seems to cycle, if that's what you call it, throughout the day. He was very quiet on the hour ride up to the mountains and he even slept in the car for a bit. Once we were there, he perked up and became more agitated, pacing, doing his little tap-dance thing, wandering back and forth as we waited for the school buses to arrive. When his class got there, he became excited and joined the group right away. He is having a very hard time with personal space and touching people too much. Very in-your-face. I gave him just so much room and then had to reel him back in, separating him from the group for a bit until he had calmed down. That was pretty much the way things went for most of the day. He paid attention pretty well during the re-enactments and participated in the activities fairly appropriately. He got very hungry before lunch so I pulled him aside and gave him a snack, which helped him settle down a bit. He ate lunch well sitting with some girls he really likes. But there were definitely times when his behavior was irritating some kids and he was just clueless or thought it was funny. He slept on and off on the ride home. husband had the day off so when we got home we took all three to see a late matinee and then walked next door for dinner. That's when difficult child 2 started to lose it. difficult child 1 was getting bossy with him and so he let loose a scream that made EVERYONE in the food line jump and turn around to see where it came from. I didn't know whether to laugh, be angry, or crawl under a rock. It caught me by surprise too. He had a few more explosions like that, directed at difficult child 1 of course, with some feigned punches. Too much fun for one day, no doubt. husband has a habit of leading us into situations like that -- loves to bite off more than the family unit can take sometimes. He was amazingly patient and tried hard to help diffuse things while I (who had not had a minute alone to myself all day) was slowly falling apart!

So the house is quiet. Everyone's medicated and in bed -- and it's only ten after 9! WOW.

 

[TerryJ2]

Quite the busy week! I'm glad you are pulling some medications and that you're trying something new. If it doesn't work, don't use it.
I'm glad you both went on the field trip. It sounds like it went very well --at least, nothing terribly unexpected.
You've earned a good night's sleep!