DSM-V draft available online for public comment

[smallworld]

klmno, the way husband and I understand it is that J has anxiety and that he has experienced bad (manic) reactions to SSRIs. He also suffered from severe depression from ages 12 to 16 that improved after undergoing intensive therapy in his wilderness program and now at his Residential Treatment Center (RTC). In addition, he has ADHD-like inattention and suffers from significant executive dysfunction. He is currently taking Wellbutrin XL for depression and ADHD symptoms and Propranolol for migraines. I would agree that he fits somewhere along the mood disorder spectrum, but he does not fit the full criteria for BiPolar (BP).

The same hold true for our daughter A, who had a psychotic reaction to the SSRI Paxil at age 10 (rxed for depression). She is stable on Lamictal and Lexapro and 25 mg of Seroquel for sleep.

The irony is that our daughter M fits the criteria for TDD most closely, but her diagnosis is definitely anxiety. She is stable on Lamictal and Remeron. We are currently weaning her from Zyprexa, which she has been taking for her eating disorder.

This stuff is so hard to figure out.

 

[klmno]

This stuff is so hard to figure out.

Boy do I DITTO that!!

I went back thru and read the TDD list again- my son wouldn't have met it for a couple of reasons- at least two. I think my son sounds a lot like yours- in regards to their history in this area.

I realize that the profs and DSM don't support this, but in my mind some of the specific anxiety disorders are mood disorders, or at least very closely related. (Not that anxiety is mis-diagnosis'd depression, but that some forms of anxiety seem like they shhould be called mood disorders to me.) My son shows clear signs of anxiety, as most in my family including myself, but they have never diagnosis'd him with it. At least not yet. I personally wish they had started looking at that and addressing it earlier but we all kept pushing for the treatment for the adjustment disorder first, but he didn't get it appropriately addressed anyway.

SW, do you mind if I ask if J's depression came without anything situational causing it, or did something percieved or real happen that caused it (I'm not asking for what that was- just if you think a situation triggered it)??

 

[smallworld]

Anxiety and depression frequently go hand-in-hand. It is depressing to be anxious all the time, and it is anxiety-provoking to be depressed. They are on a continuum.

We are not entirely certain what triggered J's depression. He was 12 (puberty was starting) and in 6th grade at a new middle school for GT kids. He found the work stressful, and although he made new friends, he missed the kids at his old school. He was also on Concerta, which he said made him feel apathetic, and asked to be taken off. We agreed, but it didn't really seem to perk him up. He resisted doing homework, and he didn't want to go to school. Monday mornings were torture. He would swipe all the books off the shelves in his room in anger. If husband were out of town on business, I couldn't get J to school on my own. He started seeing a therapist, and we began a search for the right psychiatrist (we went through 4 in quick succession). So it could have been situational, but it could have been chemical as well.

What do you think was going on with your difficult child, if you don't mind my asking?

 

[klmno]

Given my experience and knowledge of others in my family, many times the same things that cause/trigger depression also trigger anxiety.

I tend to think that with many people, the genetic predisposition for these things is there and it might not take as much of a major situation to trigger it into becoming an active problem, which happens around puberty a lot of times when chemicals/hormones are not balanced the same in the body anymore anyway.

Dr. S, who led difficult child's MDE also said something along those lines and she said that some of these kids who have MD's that appear true BiPolar (BP) thru adolescence, but not before, might stable out some after puberty and the chemicals/hormones stabilize on an adult level (mid-late teens usually) and they would not meet the criteria for BiPolar (BP) in that case, but still might have a milder MD or anxiety, etc. that they need to watch.

I think I've gotten too Occupational Therapist (OT)- sorry!!

 

[pepperidge]

Small world and others,

This TDD is certainly closer to my kids than BiPolar (BP). My kids especially oldest has some similarities to SW's. My oldest clearly benefits from stimulant, but it doesn't seem to be enough to deal with irritability. SW, I find it interesting that they have taken your oldest off Lamictal and that he is stable.

Has anyone explored with you what that might mean? Did he really need it before? What has changed?

It is so interesting because I don't believe my kids really have BiPolar (BP). But they clearly have something. Will they grow out of it?

what bothers me most is the lack of motivation. How much of that is biochemical, how much is learned behavior (giving up?)

Anyway, just rambling here but I really don't feel they have this class of kids figured out.

 

[pepperidge]

Just to add in,
I think my son also has strong anxiety, though I have seen that lessen over time.

While I think there is a strong biochemical component, I wonder how much of early schooling experiences (difficulty, failure) have led to lack of motivation and depression.

 

[smallworld]

P, I do think J needed Lamictal earlier to counteract his bad reactions to SSRIs and his subsequent severe depression. I think what has allowed us to remove medications at this point is that his depression has lifted from the intensive therapy of the programs he's in and his mood is now stable from the structure of the programs. I do worry that he may relapse once he leaves his Residential Treatment Center (RTC). But we will address that issue when we make plans for after care.

J suffers from lack of motivation, but A and M do not. All three have different varieties of anxiety and depression in their mood disorders. You may be right that early schooling difficulties contributed to J's lack of motivation. J just never liked school from kindergarten on. A is a high-achieving student, and M is a pleaser. They are very different from J.

 

[BusynMember]

smallmom, sorry I started a new thread. I hadn't read THIS one until now

They are starting to diagnose what used to be Bipolar II as Mood Dysregulation Disorder in adults. I now have that label and think it's much more fitting. For example, Paroxatene works great for me. If I were really bipolar, I should be manic on it, especially since I don't like mood stabilizers.

 

[smallworld]

MWM, not a problem. We moved the new thread off the board.

I agree that Mood Dysregulation Disorder fits better as a diagnosis for some folks. My own children might actually fit into that category as well.

 

[TiredSoul]

Re: TDD

http://www.child-psychiatric.org/20...er-dysregulation-disorder-with-dysphoria.html

 

[gcvmom]

I agree that the therm "Temper Dysregulation Disorder" could be problematic in how it's perceived by the general public.

Aside from that, I understand the need to clarify and differentiate the subtleties that exist in the mood disorder spectrum. I could be convinced that my difficult child 1 is TDD and ADHD, because his issues present very differently from difficult child 2. And even difficult child 2 might not be considered classic bipolar because we believe his was induced by an autoimmune event in his brain -- although some would argue that if he weren't predisposed to BiPolar (BP), he never would have developed the symptoms even with the AI event.

 

[tictoc]

Hi,
I am glad to see a new category, but I definitely don't like the term Temper Dysregulation Disorder. For my difficult child, the irritable periods between "temper" issues are just as important, if not more important, than the tantrums/rages.

I think only time will tell whether this is a good addition or not. The description certainly fits my difficult child better than BiPolar (BP), but it doesn't change our treatment options at this time. I hope it will have some effect on research and that in the future there will be more options available.

 

[BusynMember]

Mood disregulation would work well for kids too and in my opinion it's more accurate. Who knows what the kids will grow up to have? Lots of adults with borderline act just like bipolar kids when they are young. I agree with the change in name, if they do it, and also with the MDD in adults who have what is now known as bipolar II. The insurance companies will hopefully adapt to the new labels. They already don't accept bipolar in kids...the doctor has to write "mood disorder not otherwise specified."

 

[gcvmom]

They already don't accept bipolar in kids...the doctor has to write "mood disorder not otherwise specified."

FWIW, our insurance accepts this diagnosis on our superbill for difficult child 2: 296.6, Bipolar Disorder -- Mixed.

 

[JJJ]

Medicaid accepts Bipolar as a diagnosis in children too.

 

[horserider]

It has been awhile since I posted.

"Changes proposed on how psy diagnose mental disorders"

Take care and Happy Valentines Day

 

[smallworld]

Horserider, thanks for posting. We already had a long thread going on the proposed DSM-5 changes so I merged your thread into this one.

 

[TerryJ2]

Gosh, that could have defined my son.

But this is a huge factor:

one thing leapt out at me. That TDD was, unlike bipolar, not something that will last a lifetime.


I sure hope this doesn't confuse things more. And Smallworld, there will be a lot more diagnosis's b4 it's all figured out, in 200 yrs or so ... ?

 

[TerryJ2]

On second thought, I can see that they are trying to be more specific and narrow it down. But it must be done in the context of BiPolar (BP), not alone. I am concerned that young doctors will miss other things with-o looking at the big picture.

We'll just have to see how it plays out.

In regard to whether it will cut off svcs, I'm thinking that it will still warrant svcs, since it would be a bona fide def in the DSM.