5 days at psychiatric hospital so far & met with Social Worker

[Alisonlg]

So difficult child#1 has been at the psychiatric hospital for 5 days now (since Thursday) and today we had a meeting with the Social Worker assigned to him.

He's had a rough couple of days with some big meltdowns...last night he even attacked my father during our visit and then ended up attacking some of the staff, leading them to get a PRN from the psychiatrist for some Thorazine. Today was another bad day for him as well.

The Social Worker seems to be leaning towards the same initial impression of the other Social Worker- ODD with some Depression. I'm still not convinced that's the whole picture, but I'm not a Dr. We'll see...he hasn't been discharged yet.

They're going to start him on Risperdal tonight to "lengthen his fuse" to help give him more time before he explodes so hopefully he can calm down and control his reactions a bit more and be less impulsive.

 

[Wiped Out]

Alison,
I'm sorry he is struggling so much but it seems the hospital is definitely the right place for him right now. I hope they get a clear picture of what is going on. Hugs.

 

[timer lady]

Alison,

I hope you find answers soon & that the risperdal helps difficult child. It was a godsend for wm.

 

[Alisonlg]

Oh, and by the way, I DID request a neuropsychologist Test and the Social Worker basically dodged my request...he said something along the lines of how this a critical year for learning disabilities to turn up, so I should push the school to do that testing. Which, of course, we are starting the process (our PPT meeting is Friday) to get the Special Education testing done, but a neuropsychologist test IS NOT guaranteed and if it were going to be done by the school, it would be done at the END of the road and with it being already at the end of the school year, it's not going to happen any time soon.

 

[Liahona]

Is there a psychiatrist working with him? Can a social worker diagnos? I always thought odd was a symptom of what was wrong. What the schools call behavior problems because they can't diagnos. And after the BiPolar (BP) or AS or whatever it is gets helped then the odd goes away. Its like morning sickness vs food poisoning. The symptom is the same but the cause is very different.

I'm a bit confused. I though the school did an IQ test and an achivement test and sensory testing (through the Occupational Therapist (OT)) and behavior observation. Is this a neuropsychologist test?

 

[totoro]

I hope the medications work for difficult child and help with his stabilization...

 

[oceans]

I HOPE they do LOTS of psychological testing while he is in the psychiatric hospital. A social worker cannot make a diagnoses, and without the testing they can only guess at what is wrong. If they do the right kind of testing, they will have some good information that will help to complement the information that the school gets. This is so important! Talk to the DR's that he is assigned to and request the psychological testing to be done while he is there!!!

I will be thinking of you!

 

[timer lady]

Please find time to speak with the treating psychiatrist. I believe only a doctor can order a neuro-psychiatric exam, especially in this setting.

Additionally, school testing generally isn't as extensive as the neuro-psychiatric evaluation.

It's better to get it done sooner rather than later. It will help the school evaluation.

 

[Alisonlg]

Ok...so in addition to the neuropsychologist test, are there any other names of tests I should be throwing out there when I talk to the psychiatrist rather than just ask if/request that additional psychiatric testing be done?

They had to medicate him TWICE yesterday with the Thorazine for his hour+ rages and attacking the staff. Depression? Seriously?

 

[smallworld]

Could be depression, could be anxiety, could be a mood disorder, could be any number of things that only a psychiatrist can diagnose. Any competent psychiatrist will be able to refer to a competent neuropsychologist to do the testing (and neuropsychs do differ somewhat in what tests they choose to administer). All neuropsychologist evaluations are long (8 to 10 hours of testing) and always include an IQ test (generally the WISC-IV) and achievement testing (generally the Woodcock-Johnson-III). But then there are a slew of other tests on executive function, visual-motor integration, written output, psychological functioning, etc. that a neuropsychologist should administer.

 

[timer lady]

Alison,

A neuro-psychiatric is an excellent evaluation tool. http://en.wikipedia.org/wiki/Neuropsychological_test

There are some additional psychological tests that kt & wm have taken. The most recent that comes to mind is the Vineland Adaptive Behavior Scales.

I hope you can connect with the psychiatrist soon. A SW is a big part of the treatment team, but you tend to get more info from the psychiatrist.

 

[BusynMember]

Depression *is* a mood disorder. On top of that, bipolar is often missed and called depression. That happened to me for ten years. They didn't see the mania because it wasn't full-fledged. I'd say a mixed state (in between mania/depression) is most apt to cause extreme rages. Have they thought of trying a mood stabilizer to see if that helps? A social worker shouldn't be the one observing and diagnosing your child, in my opinion. She doesn't have the training.

 

[smallworld]

Yes, depression is one form of a mood disorder. There is unipolar depresison and there is bipolar depression, and they are very hard to distinguish in a child. Between 30 to 50 percent of children intially diagnosed with depression eventually end up being diagnosed with bipolar disorder.

 

[Alisonlg]

Again, I'm no Dr, but my inclination has been leaning more towards the BiPolar (BP) than straight up Depression. My only comfort here is that the medication they're putting him on (Risperdal) seems to be a BiPolar (BP) medication, so even if they're missing the diagnosis, at least maybe they have the medication right?

According to what I've been told and what I've read in the paperwork, he *should* be assigned a Psychiatrist too and should be seeing him daily, BUT, he didn't get admitted until Thursday night, then Friday we had a snow storm and I don't think the psychiatrist went in, then there was the weekend (only an "on-call" psychiatrist) and then it was Monday...so, out of the first 5 days my son was there, I think he only saw his psychiatrist ONCE. Plain 'ol crummy timing. So, basically, if they stick to their 10 day-2 week discharge plan, my son gets shafted out of 4 days of psychiatrist visits.

 

[oceans]

Risperdal can help, but in my difficult child it was not at all long lasting. If he is bipolar, then he needs something like Lithium, Lamictal, Tegratol, Depacote (spelling?).

I don't know what the best psychiatric testing would be, but he really needs some done!

It was like that for us for our stay too, where nothing would happen on the weekends. In out case he was in for 3 weeks and then the insurance denied us, so they transferred him to a state hospital where they have a sliding scale and he was there another 3 weeks.

 

[BusynMember]

I agree with oceans. And ADHD medications can destabilize a bipolar kid, or one with any mood disorder, even if there is a mood stabilizer in place. I would personally want to treat the mood problem and skip the ADHD for now. Sometimes ADHD behavior is childhood mania. They look alike, except that stims can make mood disorders worse. I'd insist on seeing that psychiatrist. He sadly hasn't seen your son much, but it's better than relying on a social worker for a diagnosis. Risperdal is more a short term fix or a PRN than a long term medication that works alone on mood stabilization. The five first line mood stabilizers are Lamictal, Lithium, Trileptal, Depakote and Tegretal. They take eight weeks to kick in, but can work for years and years.

 

[Alisonlg]

Thanks for the input, ladies and MidwestMom, that's for listing out those moodstablizers for me! It's a big help. I think on Thursday, when we meet with the SW again and after the psychiatrist has had a chance to see difficult child for almost a full week, hopefully everyone will have a better picture of who difficult child really is and what's really going on. I just hope at that point they won't be ready to discharge him, since we'll be nearing the 10 day mark.

He's on day 3 of trashing his room and attacking the staff :frown: