gcvmom
Here we go again!
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.
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.