Please help - really angry

Discussion in 'General Parenting' started by notwilling2giveup, Dec 8, 2007.

  1. notwilling2giveup

    notwilling2giveup New Member

    I don't even know where to begin. I found this forum a couple of months ago and just reading the posts has helped me a lot. But now I am at a loss for what to do.
    Short version of the situation:
    difficult child - D-man is 16 and has lived currently with me and his aunt since August when he ran away from his grandparents house (aunt's parents). We agreed to take him in and thought we were making progress. He has a real problem with me and thinks that I took his aunt from him, etc. When he is on his medications we can get along, especially if it suits him, i.e when he wants something. I keep telling myself it is not about me when he makes personal attacks and his therapist is good and dealing with the issue. Problem is the blankity blank NURSE PRACTICIONER that he sees for his medications. About a month and a half ago, when he went for an appointment and she asked he how he was (that is how she evaluates him, nice huh?) he actually commented that he had been feeling very angry, irritable lately. I have had issues with this women for a while because she makes his diagnosis seems like a national security issue - finally she told his aunt he had been diagnosis Bi-polar, but told his g-mother they were waiting until he was 18 to give him a diagnosis ( I think this is for the Borderline Personality Disorder (BPD)?) Anyway her choice of medications has always been strange based on what I have read in numberous texts about Bi-polar treatment. He was on Risperdal 1.5 mgs, Effexor XR 75, Concerta 54mgs, and Visteril to help him sleep. Well he had started to develop breasts and we were concerned about the side effects for the risperdal, but here the kid actually says he is feeling angry all the time, and having trouble concentrating on homework, instead of his usual fine and what does she do - she ups the Effexor to 175, changes to Vyvanse, removes the rispersal and visteril and puts him on Geodon. He current is at 80 mgs and from the stuff I have read Geodon works to stop manic attacks but not to prevent future attacks. Needless to say the last two weeks have been getting progressively worse. Last Monday the aunt called the office to move up his appointment and get some more Geodon cause she only gave us samples instead of a script and SHE DID NOT RETURN OUR CALL. The next day G-mother called, same thing. Every day last week they called and no return call. I told SO that I was going to call myself and speak to the office manager because he actually ran out of Geodon on Thursday night. Luckily? Grand mother found some 60 mgs Geodon that he had been on in the last group home and we gave him those. His aunt actually went to the office on Friday and talked to the receptionist. Both were upset and she forgot to ask for more samples, but we did get his appointment moved to Monday. He is gone this weekend with his grandfather (they go hunting almost every weekend - smart- give the kid a gun, right?) and will be back on Sunday.
    Here is the thing. He is basically off his medications right now - I see the difference in him right away. He flipped out on Thursday night demanding a cigarette. Very calmly we asked him to put down the butt he picked up and his aunt continued telling him she would not give him a cigarette. Finally he threw it on the floor insulted us and went and took a shower, telling us to stop wispering from the bathroom and that he would smoke a cigarette before the night was through. He also got his report card that day and refused to give it to her. We already know that it is straight F's cause she had been in touch with the school and we were planning to let him go the the community college in January. The rule is he goes to school or gets a job. He really does not want to work. He is fairly managable when he is on the proper medications. Why have they not put him on a mood stablizer with the a-typicals?????????. Here is the kicker. He has never been physically violent with us although he is emotionally abusive. On Friday morning he made it clear he thought everything was my fault by ignoring me, slamming the door, etc. He was laughing in the car on the way to school according to his aunt. On Friday his granddad picked him up from school and brought him here, why I dont know. He was here along for a little while until his aunt got home. She then took him back to the Granddad's house so they could leave for the hunting trip. D-man called later that night and asked his aunt if she noticed anything different or interesting and where we had been in the house. She told him I was cooking and she was working and left it at that. We searched the house after the call but could not find anything. I had to have part of my toenail cut off on Tuesday (something he himself had done in September, the last big meltdown) and he knew and saw me cleaning it with the Bactine and other supplies. Finally around 10pm. he called back, three times in fact cause she was not going to answer the phone. He went through his normal where are you, want are you doing routine and then said he thought he would play a joke and was'nt it funny and had we figured it out yet. She told him no and he said he had dumped out the bactine and replaced it with alcohol.. I checked and he really did. He kept asking her if she thought it was funny, she said no that it would have hurt. I encouraged her to get off the phone which she did. Needless to say I was shaking. He was here in my house plotting how to delibertly hurt me. I am afraid that he will end up hurting the animals or one of us. I was not even the one who told him he could not have a cigarette! What can or should we do? He is not stable and we talked about trying to get him admitted some where inpatient. I really think that this situation is not going to work for him because he has said it is not want he wants - he wants a mother and a father or his aunt without me. His mother cannot keep him, in fact she has told him throughout his life she does not want him because he is hard to handle - also she is bipolor and has a personality disorder herself. Actually his therapist made D-man and his aunt agree that he was not to even go back to visit with his mom, because last weekend he argued to stay there and ended up smoking pot - though he swears not with her this time. The therapist said if they could not agree not to let him go there then she would have to call social services. I would really appreciate any advice. We live in the Charlotte NC area and he is on Medicaid. I think he would benefit from a highly structured residential treatment program, but I don't know if they will take him because he will say he is not suicidal or does not want to hurt anyone (except me). Please help. I don't want to give up on him and I made a promise to myself that I would not tell him to leave, but I don't think we are able to help him. Even on his medications he is not making much progress.
  2. guest3

    guest3 Guest

    wow, I am so sorry and applaud you for trying to help this boy who is not your own. There are alot of red flags I would definatley wait until his next outburst and call mobile response and push HARD to get him admitted somewhere. He sounds like a candidate for a residential program hopefully his therapist will help support this and that would be a big help. Prayers coming your way
  3. Hound dog

    Hound dog Nana's are Beautiful

    Welcome to the board.

    My first question is Why is a nurse practiioner prescribing medications for this child and not a psychiatrist?? I know they can write scripts, but if she isn't getting instructions directly from the psychiatrist on what medications and doses to prescribe for difficult child, she's working outside of her scope of care.

    Only a psychiatrist should be deciding on what medications and doses difficult child should be taking. NP has no authority to diagnosis anything. What you're getting is her opinion. (although it might mesh with psychiatrists opinion)

    Dealing with a teen with bipolar and borderline is NOT what I'd wish on anyone. Especially one that isn't stable.

    What sort of evaluations established that difficult child has these dxes? Do you and aunt think they "fit" with difficult child?

    If it were me, the first thing I'd do is complain to psychiatrist about his NP. Then I'd be going for a second opinion and maybe a new psychiatrist.

    As for the alcohol thing. Well, he could just have a weird sense of humor. I mean, my son Travis would do something like that, and it wouldn't be intended to hurt. He has trouble understanding "funny".

  4. Hound dog

    Hound dog Nana's are Beautiful

    Oh, I wanted to add....

    Some medications can actually cause irritability and anger.
  5. meowbunny

    meowbunny New Member

    I applaud you for trying to help this young man. It sounds like he has been through a lot and been bounced around quite a bit. I'm sure he has major anger issues on top of his probable BiPolar (BP) diagnosis. Not an easy combo for anyone to deal with.

    Why is a nurse practitioner prescribing his medications? It sounds like it is time for a new evaluation by a neuropsychologist. I really would have problems with a nurse prescribing at this point. He may need to be hospitalized at this point to get him on the proper medications. If he starts to get violent or out of control, get him to the ER ASAP and have him admitted. It may be your saving grace.

    Since he really isn't medicated at this point, I'd let go as much as possible until he is stable. Do your best to not take things personally. Hard, I know but it may be your sanity right now.

    Do get a copy of The Explosive Child. Even at 17, it can help you get a little into his head.

    Good luck and welcome!
  6. TerryJ2

    TerryJ2 Well-Known Member

    I hate to address a sep issue but I noticed you said he was developing breasts ... have you had his hormone levels checked? Too much estrogen makes men aggressive. Sounds counter-intuitive but it's true. If he eats a lot of meat with-hormones in it, or lots of soy, or if you have lots of pesticides in your lawn or water, those mimic estrogen, too.
    I agree that a nurse practitioner has no biz dxing or prescribing for him. This is WAY out of her league.
  7. smallworld

    smallworld Moderator

    Terry, an increase in prolactin resulting in developing breasts in boys is a side effect of taking atypical antipsychotics like Risperdal.

    Notwilling2giveup, if this difficult child has bipolar disorder, he's not on a first-line mood stabilizer (Lithium, Depakote, Lamictal, Tegretol and Trileptal). Furthermore, antidepressants like Effexor XR and stimulants like Vyvanse can make teens with BiPolar (BP) much, much worse. Even Geodon has been known to induce mania in some kids. My guess is these medications are making him worse, not better. I agree with others who have urged you to get a second opinion with a new child and adolescent psychiatrist who can do a medication overhaul. Sounds as if that's what he really needs.

    Welcome. I'm glad you found us.
  8. notwilling2giveup

    notwilling2giveup New Member

    Thanks to everyone who responded so quickly. I appreciate the understanding, advice and prayers very much. Validation, it makes a difference - for him and myself.

    I have a couple of questions and I was not sure how to respond to the indivdual responses so its all together.

    First for lost yet found - what is mobile response?

    We are going to try to make it through Sunday night (we will see, pray, pray) and Monday afternoon his aunt will take him to the medication appointment and then to his therapist (he sees her every Monday). She is going to talk to his therapist about residential placement. I interned at Eliada in Asheville, NC (awesome place, they have a website) while I was in school and really feel like this would be the best place for him, at least that I know of. His aunt is going to talk to his grandparents about it. His therapist will most likely support it because they have talked from the beginning about alternatives and if him being in the home with us was beneficial for him. His aunt is open to the idea and we talked pros and cons, really the only con she thought of was she will miss him. He needs the structure, and more intense therapy and sadly we, nor his grandparents can provide him with the amount of structure and care that he needs. He tells his grandmother what to do and him and his grandfather were almost to blows.
    We are debating on whether to have him admitted to short term care in the mean time or to try and keep him in the home for Christmas, while working on the admission for the first of the year. That is a major risk because if he finds out he is being admitted he is likely to run away again. Comments?? I admit we really are walking on eggshells every day. I am lucky that my SO and I have a working relationship and are able to support each other. She said from the beginning that it was up to me if he came to live with us because she could not do it with out me. Just don't know what to do for now. Hopefully he will stablize pretty fast.

    The Nurse Practiction situation is one that has bothered his aunt and I since he came to live with us. We are thinking of contacting Medicaid to see how they have been billing it because she made the changes without any consultation with the p-doctor (and they could be committing fraud). In fact, his aunt has not even met this p-doctor. His initial diagnosis was three or so yrs past and he was with his grandparents. I have mentioned the neuropsychologist evaluation to her and we and have looked for one in our area. That is something to follow up one. His aunt began looking for a new P-doctor last week and found one highly recommended.

    We agree along with his therapist that his diagnosis's fit him. When I first read stuff about Borderline Personality Disorder (BPD) I jumped up and showed his aunt, because it explained everything! and gave me my first understanding of what was going on with him. I remind myself constantly it is not about me, he is coping the best he knows how, etc. This is why I think a residential program would be beneficial. We bought walking on eggshells + and the workbook, I hate you don' leave me, the Dialetical workbook, but we have such busy lives and honestly trying to get him to do anything other than play a video game is a full on battle. He deserves to have a chance to learn this coping skills and we have got to stop kidding ourselves and feeling guilty and do what is really best for him.

    D-man is really very smart. One of the characteristics that can drive me mad about BiPolar (BP) is that he can be totally charming and confident when it is in his interest. He is highly manulipuative and passive agressive. He waited until after he thought I would have already changed my bandage on my toe to call back and 'fessed up only because he though his aunt was mad at him because she was not engaging him. He quite understands a normal sense of humor, he is a funny kid (coping mechanicism)and when he is manic it is non-stop. This was passive aggressive - asking if she thought it was funny and saying it was a joke. For example, in the past he has made hurtful commments and then stated, I am just joking. This is scary because it is something he has not really done before. He is more talk than action. For him this took for-thought and meant he was at the house thinking about not liking me and what he could do to me. He tries to play it safe, because he could have been more direct and just physically hurt me himself, but he is smart enough to try and avoid huge negative consquences, by saying it was a joke and he did not mean it. You know how a person can look at you when they want to hurt you? I know that look, and the fact that he is 6'3 and 215 pounds (honest he wears a size 14 shoe) to my 5'3 130 pounds scares me.
    I do feel for him, he is so tortured inside with his thoughts and inability to accept any personal responsibility. We can have our moments when he wants me to watch him play his games. Really he emotionally about 9.

    Him developing breasts was from increased prolactin from the risperdal because once he was off it they went way down.

    Small world you made the comment that he is not on a first-line mood stabilizer and provided examples. This has drove me crazy since August and has been my number one question - WHY WHY WHY is he not on a mood stabilizer? I do not know why this nurse practioner feels as if he is best treated with an atypical and anti depressant. He for sure, has been diagnosis's bi-polar but I dont know the evaluation process. For sure we are going address this on Monday - thank heavens.

    Thanks again everyone for the support and welcoming me to the board. Maybe eventually I will learn to do a short reply!
  9. flutterbee

    flutterbee Guest

    Just wanted to add my welcome. :flower:

    I was going to talk about the medications and the Nurse Practitioner, too, but the others have already covered that. It amazes me how many people in the mental health profession will put an unstable bipolar patient on AD's and stims without a mood stabilizer - while us lay-people know better - and then act surprised by their behavior. :hammer: My difficult child's psychiatrist backed me on that 100%.

    Anyway, hang in there and good luck!
  10. TerryJ2

    TerryJ2 Well-Known Member

    Don't worry about the length, NWTGU, you have a lot to say! A lot of issues.
    Sounds like you've got a good plan.
    Unfortunately, the only place you really asked for help was in regard to having him find out about placement and possibly running away... and I cringed, because I wouldn't know what to do, either. Sigh.
    Thanks for the info on Risperdal.
    I'm sending strength, peace and calm for your Christmas holiday.

  11. notwilling2giveup

    notwilling2giveup New Member

    His aunt just told me about a post it note she found this morning under the alcohol bottle he used to fill up my bactine bottle:
    It read: You get what you deserve.

    I really don't know what I am doing. We are thinking of asking his grandfather to keep him at the hunting camp an extra night and let him miss yet another day at school so that they two of us will not see each other. Good idea? His aunt would really like to avoid an emergency placement until they can talk to his therapist but she know it may not be avoidable. I really need all the advice so please lay it on me.

    I know this will pass.
    I am not willing 2 give up, but also I am wanting to be part of the solution rather than the problem.

    Thanks a million
  12. Hound dog

    Hound dog Nana's are Beautiful

    Don't worry about the length of your posts. It's not an uncommon thing around here. lol

    If difficult child in any way becomes violent call 911 and have him transported to the ER. Violence should always have zero tolerance. You and SO have a right to be safe in your own home.


  13. Hound dog

    Hound dog Nana's are Beautiful

    I just saw your last post.

    Honestly, after finding that post it, I myself would be more than a bit nervous having difficult child on a hunting trip with grandpa. Has he ever shown any indication toward even passive agressive violence with them?
  14. notwilling2giveup

    notwilling2giveup New Member

    He hasn't actually. This really is new for him. He tends to be more verbal and really cares about the multiple men at the hunting camp and what they think of him. I worry mostly about self-injury because before he started any medications he self injured daily and was hospitalized several times for talking about suicide.
    The worrisome thing is that this is different and I worry just because he has always been responsible down there he could still flip. His aunt is going to call the grandpa to discuss Sunday night and how he is acting now. Should we base a decision on that? If his aunt says anything to the grandfather about this he will flip out and yell at D-man , of course making it all worse.
    What to do, what to do, what to do.... ahhh

    We have previously discussed what we would do if he became violent and she assures me we would call the police and follow through with charges.

    Thanks again
  15. Hound dog

    Hound dog Nana's are Beautiful

    If grandpa is going to yell at him, I wouldn't say anything about it while he's there. That's not going to help the situation.

    Calling and checking on him is a good idea. I didn't know if he'd done something like that with the grandparents or not. Will grandpa let you guys know if he's acting out of character?

    I understand the self injury worry. Nichole was a cutter/burner for years. Even now if she wears long sleeves I grow suspicious and make her show me her arms and legs. (awful, huh?) Has he shown any indication that he could be self injurying again?

    Just to give you something to hold on to.... Nichole has been fairly stable for almost a year and a half. Not perfect by any means, but the difference is night and day from just a couple of years ago.

  16. Sara PA

    Sara PA New Member

    Anger, aggression, violence, hostility and homicidal ideation are known listed side effects of Effexor. These side effects can begin to occur around the third month or so and get progressively worse. Unfortunately, despite the warnings on the Effexor (and all other antidepressants) label/precribing information too many practioners still think the proper response is to add an antipsychotic and/or increase the Effexor in an attempt to get back that initial positive response. It will never happen. The only way to stop those side effects is to discontinue the Effexor but then you have to deal with Effexor withdrawal (you might want to google that).

    Wyeth sent out a letter in 2003 tell health practioners not to prescribe Effexor to people under 18.
  17. notwilling2giveup

    notwilling2giveup New Member

    Good morning y'all
    Daisy lover thanks for all your help. Sounds like you have really been there done that.

    D-man's past mo with self injury has been he will do it and then make sure that someone sees it, be it family, friends or a teacher at school. I know what you mean about the sleeves. It hurts to think about them doing si. His aunt is close with him and she will give him a check once he is home. Evidently he has not flipped at the hunting camp so far. Still trying to work out that situation. It is an hour and a half one way there and he does not have medications for Sunday night, Monday morning if he stays.

    I am glad to hear that your daughter is going better. I look at his mother and we think - WE HAVE TO to our best to get him somewhere were he can be taught new coping skills so that he has a chance. He has ambitions and wants to do something with his life. He just got awarded his Star badge in boy scouts on Thursday night and plans to make Eagle. We really believe in this kid.

    I read a lot of the detachment posts yesterday as it is something his aunt and I have been working on. I have always said in the end it is up to D-man, we can't make him do everything he needs to do. We are working on what things fall into the category of leaving it alone and those that do require our action. I feel so grateful to have this forum!!

    Sara thank you for your post. We are printing out the info from Wyeth and info on first line mood stabilizers to take to the appointment. It really is sad that mental health workers, for whatever reason, don't heed the advise of the companies or other workers.

    Do y'all think that we should request they take him off all his medications right away and start new with a mood stabilizer?
    What mood stabilizer would be best?
    I read about them and I was thinking about the Lamitical ,sorry sp, cause depression is his major symptom. Also I forgot to put that he has Generalized Anxiety Disorder (GAD) and major insommnia.
    I looked up the Effexor withdraw and it seems really bad. I have an older brother on it and he said withdraw was hell from it. Should they taper him or remove it cold turkey?

    Thanks y'all. Also if anyone knows of natural treatments to help any of his symptoms, please recommend freely. We are going to the health food store today for cat food and will pick up anything if it can help.

    BTY, I looked up the Explosive Child and am ordering it right away!
    Thanks millions
  18. Sara PA

    Sara PA New Member

    Antidepressants should never be removed cold turkey unless there is a serious medical condition that requires it. While many people can and do stop them cold turkey, the risk of extreme withdrawal rises. That can include psychiatric as well as physical withdrawal symptoms. And the psychiatric withdrawal symptoms to abrupt removal of Effexor can result in that homicidal/suicidal thinking....and action.

    But then, tapering doesn't guarentee that withdrawal illness will not occur. It will make it less so but it may not totally prevent it.

    by the way, people who suffer withdrawal illness are indeed ill and should be treated as though they are sick.
  19. notwilling2giveup

    notwilling2giveup New Member

    Thanks Sara

    Grandma and another aunt,T for clarity, are on the way to pick D-man up from the hunting camp. The plan is for grandma and aunt G, the one here with me, to take him to our local pysch er for an evaluation and hopefully medication changes (possible admission depending on their evaluation).??
    We were going to wait until Monday's appointment with the NP and then see what his therapist recommended for short term, but Aunt G and I really do not have any confidence in the NP or the psychiatrist he currently sees.
    Not sure what is going to happen or if this is the right thing to do.???? Trying not to beat ourselves up and telling ourselves we are doing the right thing for him and it is not about just getting rid of him.
    This is a cycle he has completed before and although he has been in a couple of group homes (colossal waste of time and did nothing for him - non theraputic), and pysch wards of the hospitals, he has never been placed in a residential treatment facility for long term help.
    Trying really hard to be hopeful.
    His other aunt T thinks we should wait until Monday, but she has not seen him in the last two weeks.
    Are we doing the right thing?

  20. trinityroyal

    trinityroyal Well-Known Member

    NWTGU, You're doing the right thing.
    If there's a risk that your difficult child will get violent and either injure himself or someone else, then it's definitely a good idea to take him to the psychiatric er for evaluation.

    I don't think you should wait. I'm glad to hear that you're acting now.

    This summer when my difficult child came home from a summer Residential Treatment Center (RTC) and we were waiting for his permanent Residential Treatment Center (RTC) placement to open up, he was very agitated and started to get violent with easy child 1 who was looking after him during the days (while husband and I were at work). We had to send Little easy child to stay with relatives because he was so unstable and unpredictable. Like your difficult child, mine is well over 6 ft tall, compared to my 5 ft 2.

    Sending strength and prayers, and hope that the psychiatric evaluation at the ER provides you with good results.

    All the best,