Not 100% comfortable with psychiatric hospital game plan

Discussion in 'General Parenting' started by Alisonlg, Apr 28, 2007.

  1. Alisonlg

    Alisonlg New Member

    So, we ment we met with the Social Worker at the psychiatric hospital yesterday. He has the same SW as last time and he's just not very personable at all. We explained how we had a very short "honeymoon" period after discharge and then thinks basically went back to normal at home and then this past week went rapidly into crisis at home and school, which is how he ended up back in the psychiatric hospital. Also explained the new suicidal thoughts since adding the Adderall last Friday and my great concern with the apparent visual hallucinations ("I can see the future") which we're not clear on if that is new since the Adderall or not.

    SW sort of blew off the severity of the visual hallucintations as him just being imaginative, worrisome, and anxious and used that as the reason they switched him to the Seroquel, which has some more anxiety control components to it. He didn't even bring up the suicidal thoughts. They're LEAVING the Adderall XR!!! And early next week they're going to add an SSRI, possibly Zoloft I think is what they said, for the anxiety they think he has.

    husband & I AGAIN requested a neuropsychologist exam. Of course, husband mispoke and said the wrong thing first (I think he said Neuro testing or something) and the SW started saying..."well, a CT scan or MRI.." and I quickly inturrupted and said, "No...a neuropsychologist EXAM" and SW again started saying, "Well, a CT scan or MRI..." and I said again, "NO..we want a neuropsychologist EXAM!" and he said, "Well, we could look into getting a MRI or a CT scan" and I felt like jumping accross the table and shaking the idoit and saying don't play me for an idiot, I know what freakin' field you work in and I know YOU know what I'm talking about and I've asked you for one before..."I WANT A neuropsychologist EXAM FOR MY CHILD!" and then my husband said, "OUR INSURANCE WILL PAY FOR IT" and then he said, "Oh? Will it? Well, maybe we can look into that?" OMG...I just wanted to shake the man. You're not going to LOOK INTO're going to DO IT. Stop guessing on medications for my child...he has obvious triggers and nobody knows WHY they are triggers...can we get the :censored2: exam and find out WHY and figure out WHAT we're trying to medicate?!?!? AGRGGGGGGGG!!!

    But, of course, the night before, we had "Family Night" which is run by the woman who does the insurance billing for the unit and she was saying she totally agrees that our son should have a neuropsychologist, but that since the unit bills as a package, we'd have to take him off unit to get the exam done. So, looks like we'll have to wait for discharge to get any answers. Meanwhile, we'll have to put up with the medication cocktail they think will stabalize difficult child to get him safe and out of there. And who knows how quickly we'll be able to get the neuropsychologist scheduled. :::sigh:::

    Meanwhile, I'm anxious to see if the SSRI induces a mania...I read on that they can do that and cause some pretty violent rages. Any of you have any experience with that? How long does it take a SSRI to take effect? I'm sort of afraid they're going to put him on the SSRI and then quickly discharge him....only for us to have to deal with the fall-out at home. :frown: That's what they did with the Zyprexa...switched him off Risperdal to the Zyprexa...and VERY quickly sent him home on a non-theraputic dose. (heck, no dose was ever theraputic for him!)
  2. oceans

    oceans New Member

    Will they do psychiatric testing while he is there instead of a neuropsychologist exam? My son had some testing done to evaluate his thinking while he was in the psychiatric hospital. I can't understand why they would not do SOME kind of testing while he was there. It makes so much sense to do that instead of guessing which medications to try.

    Everyone is different on medications, but AD's take a good few weeks to have an effect if they are going to work. If they are to send someone into mania....well that can happen pretty quickly. The AP might help keep him stable if that were to be a reaction...maybe.

    My son is on Zoloft and it was the only AD he tried that he did not have a bad reaction to. At too high a dose it caused him cognitive dulling, but it did not cause mania or agitation for him. It also did not work for his depression, which is the reason he was taking it. AD's can also cause suicidal thinking, so you need to watch out for that....especially since he already seems to have some issues with that.

    I am glad that the stimulant is going. I am glad that you are speaking up and being an advocate! Yea!!! I am hoping that the Seroquel helps. I hope they do not discharge him too soon this time!!! Hang in there!!!
  3. Alisonlg

    Alisonlg New Member

    No...the stimulant is not's STAYING...they're leaving it in his medications... :frown:
  4. timer lady

    timer lady Queen of Hearts


    While working with the SW is good - have you met with the psychiatrist? You, husband & psychiatrist need to sort out the medication issues. I always want to hear it out of the psychiatrist's mouth.

    As for testing - get any & all testing done while in the hospital. If psychological testing of any sort is offered - take it. The same with any psychiatric evaluations.

    Neurology would rule out any neuro problems (i.e. seizure disorders, etc.).

    Cover any & all bases you can while in the hospital.
  5. smallworld

    smallworld Moderator

    Alison, a few questions for you:

    First, who treats your difficult child when he is not in the psychiatric hospital? Do you have a relationship with a board-certified child psychiatrist who has evaluated your difficult child and who handles his medications? If so, you need to get that person involved in medication decisions at the psychiatric hospital. If not, you need to line up an appointment now for as soon as your difficult child is released from the psychiatric hospital. Your difficult child is a complicated case and needs ongoing (as in weekly) follow-up appointments to check on his medications. Unfortunately, medications are not an easy or fast fix. psychiatrists need to be involved to make changes based on response. Because you live in Connecticut, I'd recommend looking at Yale or Hartford Hospital.

    Second, can you refuse to approve medication changes at the psychiatric hospital until you and husband have had a chance to have a sit-down appontment with the psychiatric hospital psychiatrist. I agree with Linda -- you need to hear the reasoning behind the medication choices directly from the psychiatrist plus you need to express your concerns directly to the psychiatrist instead of through the SW (who in my humble opinion doesn't sound all that swift).

    Third, have you involved a patient's advocate or caseworker at the psychiatric hospital? It sounds as if you could use some help in advocating for your difficult child.

    In terms of the medications, I'd be concerned, too. You don't have even a working diagnosis (ODD is not good enough), and the psychiatric hospital keeps throwing medications at your difficult child, some of which could be making him worse. If your difficult child has ADHD, Adderall is fine, but it sounds as if it has revved him up (and possibly caused hallucinations, anxiety and agitation) instead of calming him down (the "normal" ADHD response to a stimulant). Seroquel treats hallucinations/delusions as well as the mania, anxiety, agitation and aggression associated with bipolar disorder. Even if he has straight anxiety, it should help, and if he has bipolar disorder, it may help as well, at least in the short term. But it may not be enough to offset the bad effects of the Adderall if the Adderall is continued. And it won't do much of anything if the psychiatric hospital doesn't bring him up to a therapeutic level. Zoloft is prescribed to treat anxiety and unipolar depression. According to many psychiatrists, 30 to 50 percent of all kids who present with an initial depression actually go on to have bipolar disorder. It is impossible to tell at this point whether your difficult child has unipolar or bipolar depression unless he has a thorough evaluation by both a child psychiatrist and a neuropsychologist (and even then it is hard to tell -- I know because of my own kids). If Zoloft is given to a child with bipolar disorder, it can send him into hypomania/mania. It even happens to some kids without bipolar disorder who just don't do well with SSRIs. Again, it is impossible to tell what will happen if Zoloft is given to your difficult child, but you should be aware there are risks.

    I will tell you that my own son had a very bad reaction to Zoloft. It was prescribed for anxiety when he was 12 years old, and after 3 weeks, he had a prolonged intense manic reaction (bad reactions to SSRIs are very common at both the 3-week and 3-month mark). My son did not recover from this reaction until he had been on the mood stabilizer Depakote for many months. In all honesty, I don't think he's ever been the same since Zoloft, but that may have just been the progression of his mood disorder. My husband and I do refer to his disorder as pre- and post-Zoloft, however.

    I'm sorry you're struggling so with the psychiatric hospital. I do hope you get some answers soon. Many gentle hugs coming your way.
  6. oceans

    oceans New Member

    Is there a reason why you need to keep going back to that hospital? I know that our psychiatrist and therapist told us which ones they would feel comfortable having difficult child at, and which ones they would want us to stay away from. So, I know there are differences in psychiatric care from one to another. I agree that it is important to get an outpatient psychiatrist that is involved in his care. He needs care on a regular bases along with medication management and testing.
  7. Alisonlg

    Alisonlg New Member

    Why did we go back to this hospital? Well, the first time we ended up there, we had only been working with an outpatient place going on ONE VISIT and it was a SW whom we felt did not get an accurate read on our son or our situation (after all, she obviously did not grasp the severity of our situation, because she did not refer us to the psychiatrist in their office, which we were hoping to get an appointment with right away) and it was within 48 hours of our appointment with her that we found ourselves in the ER awaiting a psychiatric bed. Pediatric psychiatric beds are hard to find in this state (probably all states, I would imagine) and St. Raphael's has a 20 bed unit and they had a bed open up during our second day in the ER, so he went there.

    After discharge, he started attending the Day Hospital program through the same hospital, under the care of the same Dr who saw him through inpatient. So...when less than 3-4 weeks later we were looking at psychiatric hospital admit #2, it seemed to make sense to stick with the same place and the same Dr with whom he already had a "relationship" with and who knows his history and they could "pre-admit" him to speed up the process of getting him a bed.

    He's also more comfortable there and he knows the layout, the rules, the staff, and his Dr and his therapist (SW), so it's an easier transition for him.

    It's just frustrating that I feel like I KNOW MORE than THEY DO. I think they're just soooooo hesitant not to diagnosis him and not to label him that they're doing him a great disservice!

    I need to sit down, face to face, with this psychiatrist and get some answers. I see no reason why he needs to be on the Adderall.

    Oh...and get this!!!! So, we visited him on Friday (1 week and 1 day on Adderall) and he had a bandaid on his we asked him what happened?! He said, "I PUNCHED THE WINDOW!" We were stunned! I asked him, "Wow! Were you mad?" He ever so matter of fact said, "No. I was just crazy." Oh yeah. Sounds like the Adderall is really helping him think clearly! I'm seeing an immediate effect! NOT!
  8. oceans

    oceans New Member

    It all happened too fast, didn't it. My difficult child has been "read wrong" for years. I can't believe how long it took me to convince anyone to add the Lamictal. Now he can tell me what was wrong all those years and why he behaved the way he did. It is very enlightening. They still don't seem to "believe it", but at least the medications are finally working and he is well now. Keep being persistent. After all, he is your child and you need to feel comfortable with his care. It certainly does not sound like he is stable.
  9. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I would not trust a social worker to be the primary person in charge of my kid. Zoloft can cause aggression, mania, rage, the works. It may not, but it could (did for me when I took it) and it takes about four weeks sometimes before you see it, because the Zoloft builds up in your system. You sound uncomfortable. Frankly, if I were uncomfortable, I'd be gone. A neuropsychologist tests for Psychiatric problems too. It was the best person we ever saw for my complicated son. I wish you all the luck--stick to your "mom" gut. An MRI or CAT scan will only tell you if there are no tumors or aneurysms...etc. I just had one, and I have bipolar and neurological problems. They DON'T show up on these scans. The best way to find any tendencies towards certain disorders is to do the neuropsychologist tests--and they should be administered over a span from 8-12 hours.