First time visit at inpatient facility

Discussion in 'General Parenting' started by neednewtechnique, Jul 12, 2008.

  1. neednewtechnique

    neednewtechnique New Member

    Okay, today was the first day we were able to go visit difficult child at the inpatient facility she was placed at earlier this week. I do not think the visit went well at all. She was nice and all, not mean or angry or in a bad mood, but my confidence level in the facility itself kinda plummetted and dropped through the floor while we were there. I guess I have HEARD GREAT things about the place, so their methods must work, but I just was a little put off by some of the way they do things. For starters, they meet with their psychiatrist every day (during the week), but I thought that they also had individual therapy and counseling with their therapist everyday, and then I found out that they don't actually spend much time in individual sessions at all...for example, her therapist was there today, but they didn't have a session, and he is off and will not even SEE her again until Wednesday.

    Not to mention, I am starting to notice that she was acting kinda drowsy and loopy while we were there. I would not consider it quite the "zombie" effect we worry about with overmedicating, but she was very obviously drugged and it wasn't far from the "zombie" behavior. I told them when they tried to order the Seroquel that she had taken it before and did NOT do well with it, but that at that point in time, it was being used in combination with several other medications, so I told them they could try it by itself and see how it works, but that if there were ANY problems, I did NOT want them to continue with it. I told them that the Lamictal works for her, and since she has gained some weight since her last increase and she never really got up to a full dose anyway, they had some room to work on dosages and things, and that I would prefer if they decided on a mood stabilizer to stick with the ones we know. But the FIRST thing they do is go back and try one we have already been through that we KNOW she cannot handle. She cannot take Seroquel for the same reasons she cannot take Abilify or some of the others. Anything with a drowsing affect will knock her out.

    I guess I am just a little frustrated. They think she will be ready to come home on Thursday, but she is scared, she said she was happy, and that she felt a little better, but that she doesn't feel like she has really done much work on anything, other than sitting in group. She said she talks in group, but that she doesnt really feel comfortable really talking about some of her feelings and problems.

    I dunno, I know that inpatient can be very helpful, but I have NEVER heard of a facility where they don't see their therapist or have individual counseling sessions regularly???????
  2. Andy

    Andy Active Member

    Is there someone you can talk to about this? Did the facility assign a case worker? Maybe the person stating when she will be released?

    I would think that a discharge date wouldn't be set until the correct medication is found? Will they make changes in medications on weekends?

    You should also call tonight and ask to talk to the head nurse on duty to review your medication questions and concerns. Ask what has been documented about her effects to the medication and see if they have picked up the same things you have. This also comes to mom knows best, you know what is normal for your child.
  3. klmno

    klmno Active Member

    Phosps probably all run a little differently in some ways, but I can throw a couple of things out just based on our experience. 1) I think it is more common to have group therapy than individual therapy. This can be beneficial in its own way, too, (I'm assuming that this is an acute psychiatric hospital stay??), 2) difficult child's psychiatrist told me that during the course of titrating up on seroquel, it is very common to go thru a "zonking out stage", then once the therapuetic dose is reached (for manic symptoms), that reaction goes away. psychiatrist changed difficult child from seroquel before going thru that- I'm not exactly sure why- I think maybe because psychiatrist thought risperdal would help with difficult child's raging quicker, but I'm not sure I would give up on seroquel just yet, 3) Someone (a social worker, counselor, or psychiatrist) should be meeting with you privately or you and difficult child together soon and you can discuss any concerns. Given that you already have concerns, I would think that you can put a call into psychiatrist and he should return your call by lunch time on Moday (just MHO!), 4) No matter how manic my difficult child seems when he has gone to psychiatric hospital, he has always seemed "ultra-calm" while there- I think it is the combination of the atmosphere and them figuring out pretty quick that it is quickest way to be released.

    So, try not to worry too much- I know it is hard, especially the first time. But, if the place has a good reputation and all the kids weren't sitting around with a zombie look in their eyes, try to give them the benefit of the doubt- but, still, express your concerns, ask your questions, and follow your mommy instinct!!

    Several others here have had more experience with seroquel and can give better advice than me on that. Personally, I wouldn't rule it out because I've seen some side effects from a couple of other AP's that I'm not crazy about.
  4. TerryJ2

    TerryJ2 Well-Known Member

    I'm glad others here have responded with-experience. I haven't gone through that, but I understand your frustration.
    Just wanted to lend support.
  5. Steely

    Steely Active Member

    What you described is the protocol for most phosphs I have experienced. They just do not have the funds or staffing for more therapy than that (or so they say). It is also the norm, in my experience, for the phosph to take little interest in the medications, as long as the patient is calm. Your only hope is to have your personal psychiatrist to start calling your childs phosph psychiatrist and demanding things. Our parental input is largely ignored. The very last phosph I put my son in, I demanded his release AMA. Although I did not feel they were harming him - it was clear there was nothing more he was going to get there than he already had. It was only a stabilizing place.

    I wish I could sound more hopeful. And maybe your situation will be different. I certainly hope.
  6. Sara PA

    Sara PA New Member

    After my son's suicide attempt he spent three days in the ICU and five days (IIRC) in the psychiatric ward. He was there for the 4th of July. For half the time he was the only person there who wasn't waiting for an Alzheimer's bed in a nursing home. They actually put him in the adult unit because they weren't staffing the adolescent unit during that week. I guess everyone wanted to take vacation at the same time.... The woman in the next room walked into his room in the middle of the night. He met with a different "therapist" every day but did nothing more than go over his whole story with each of them. Group was just him for half the time. The other two days it was him and the girl who seemed to be there only because her parents wanted to go to the shore for the holiday. I don't know what I expected would happen while he was there, but after that experience I never bothered to have him admitted again. In fact, I actively fought to prevent it. Didn't see the point. They clearly had nothing to offer.
  7. neednewtechnique

    neednewtechnique New Member

    Well, I would not be so worried about the Seroquel, except that last time she took it, there were TONS of side-effects, and she didn't really get any BENEFIT from it. It was not helping with her mood swings and she was tired all the time, which only made things worse, becuase she tends to rage easier when she is tired because she's cranky. Like I said before, the Seroquel she used to take, but it was before she came to us. But I have heard the HORROR stories from her Bio mom about the nightmares of the time she spent on that medication, and it was bad enough that DCFS would not even approve her to take it, which was the biggest reason that she was not on it when we got her.

    I am also curious to find out why he chose an AP over a plain mood-stabilizer. Is there an actual reasoning behind which TYPE of medication they use, or are they all grouped together in a bank of different ones they can pull out based on personal psychiatrist preference???
  8. klmno

    klmno Active Member

    Those sound like very valid concerns and questions to discuss with the psychiatrist to me. It is my understanding that there are "base-line" mood stabilizers, then there are the AP's. Why he would choose to take the course he did is beyond me- unless he is just thinking the seroquel might address the specific symptoms that he saw but he still isn't sure that she has BiPolar (BP) or typical mood cycling- these are just my thoughts- obviously, I'm not a psychiatrist and sure can't speak for one. I would definitely put a call into him though to express concern and discuss these things.

    Seroquel is a popular medication right now- I take that to have advantages and disadvantages. For one thing, maybe then that means it often does wonders for a kid (and sometimes, as kids grow up, the effects of a medication can be different). on the other hand, when a drug is "popular" with the psychiatrists, it can lead to being over-prescribed, in my humble opinion.
  9. neednewtechnique

    neednewtechnique New Member

    I have been thinking about it, honestly, ever since I left the hospital, and although my conern for the medication issue still exists, I am kind of going to take a "wait and see" approach to the whole concern about the group therapy. I know that it is important, but there has to be more to it than that.

    Also, we don't have a psychiatrist here in our new state yet, since we moved things have been going great for difficult child, and so we have not had to worry about it. I have concerns because there are not many psychiatristS in our new town, and the one everyone seems to take their kids to is not really my style. He likes to TREAT with medication instead of using medication as a supplement to a proper and appropriate therapy program, and I know this from experience, not just based on what people have said.
  10. klmno

    klmno Active Member

    Can you refresh my memory as to why difficult child was admitted? Is this an acute psychiatric hospital? Did you see mood cycling yourself?
  11. smallworld

    smallworld Moderator

    I've read anecdotally that Seroquel can be helpful with cutting behaviors. That may be why it was chosen for your difficult child.

    According to my son's psychiatrist, the sedation associated with Seroquel is actually worse at lower doses than at mid to higher doses. Furthermore, it can take a while for the body to adjust to the sedating effects. What dose was your difficult child taking when she was living with biomom?

    I happen to be a huge fan of Serqouel because it was the first medication in 4 years of trials that actually addressed my son's anxiety and lifted his depression. He's been on it since December and has continued to do very well. I hope the same holds true for your difficult child.

    Hang in there.
  12. neednewtechnique

    neednewtechnique New Member

    Well, difficult child has a very long psychiatric history, we have talked about her mood issues several times before, and I don't believe that her psychiatrist at the hospital is even questioning any of her diagnoses...he just didn't like her medication for some reason. Yes, she is in acute care at a psychiatric hospital, one that apparently has a great reputation.

    difficult child was admitted in the middle of the night on Wednesday Night/Thursday Morning. When I came home from work on Wednesday, difficult child was very ungracefully recovering from a major meltdown that she had sometime that afternoon while we were gone to work. She took one of my steak knives out of my kitchen and cut herself up pretty bad. She was not trying to kill herself, she was just cutting, but she threw herself into a frenzy and really messed up her arms badly. Nothing deep enough to need stitches or anything, it wasnt the severity of the cuts that was causing a problem, it was the NUMBER of cuts she put on herself. There were hundreds of them, they completely covered the insides of both of her arms from her elbows to her wrists. Sorry, I know this is a bit graphic, but I don't know how else to explain it. Since she was not in real 911 emergency of bleeding to death or anything, we didn't rush to the ER right away, because I had my other small children home and needed to make arrangements for them before I could leave. So I just made sure she stayed right with me so that I could keep an eye on her until we could get to the hospital. Once we got to the ER, they had to get someone to come and evaluate her, and even though the psychiatric hospital she went to is an hour and a half away, they have a "sattelite office" in our town with a few psychiatric staff that can do evaluations for them, and they called one of them to come in and meet with our difficult child. They determined that she needed to be admitted to the psychiatric hospital, so they transported her straight from the ER to the hospital.

    All of the diagnosis's listed on my profile for her are old, meaning that they did not get assigned to her in the psychiatric hospital. The only thing they have been talking about at the psychiatric hospital that is new is a possible Reactive Attachment Disorder. They were informed in advance that her normal psychiatrist has concerns about her showing several signs of Borderline Personality Disorder, even though they don't diagnose it in kids, they still watch for the signs. But even with a warning about it, they seem VERY surprised by how STRONGLY she exhibits those symptoms.
  13. klmno

    klmno Active Member

    This has obviously been a very traumatic and stressful week for you- HUGS!!

    Now, I'm wondering if psychiatrist took her off lamictol and is using seroquel to help stabilizer her and possibly intends to switch her to a different mood stabilizer at some point. Really, I think the only way for you to get some comfort is to talk to psychiatrist about his decisions. He might have felt strongly that she was suicidal and temporarily wanted to have her somewhat sedated on something that could also address mood issues- I just don't know how they look at these things.

    difficult child had a therapist once- early on- that said difficult child wasn't responding enough and opening up in counseling and was showing disruptive behavior so "maybe psychiatrist should medicate him to the point of being in a stupor" until difficult child could be "reached". difficult child had just turned 11 yo, was exhibiting suicidal behaviors (several signs plus self-injurious behavior) but had recently escalated to the point of illegal behaviors. I was appalled that the therapist said that to me- and still think it was absurd. But, now, I do think there are times when it is best to really medicate them, temporarily (as in very short term) if it prevents injury to self or others.

    But, again, who knows what she has said up there or what psychiatrist's intent is at this point. Keep us posted- talk to psychiatrist- I think you will feel a lot better, or at least have info enough to decide if you agree or if you want to pull her out of there.
  14. smallworld

    smallworld Moderator

    I didn't mention in my post above that Seroquel has been FDA approved as monotherapy for the treatment of bipolar disorder (although most psychiatrists do prescribe it in conjunction with a mood stabilizer). It is a very helpful medication because it treats anxiety, depression, mania and mood swings. And again, it is more sedating at lower doses than higher doses.
  15. neednewtechnique

    neednewtechnique New Member

    Well, when she took Seroquel before, she was on 150mg of it...and she was still having problems with the sedating. But, again, it was not being used by itself at that point. She was taking Concerta with it, Reperidol, Colodine, and another one I don't recall the exact name of right off the top of my head, zepam something?? As soon as we got her, she was already off the Seroquel and the first thing we did was start working on straightening out her medication because I was trying to figure out why she was on 2-3 different AP's at the same time.

    So, maybe once they are able to tirate up to the therapeutic dose, since it is by itself, maybe we won't have those problems. I just want to make sure that they have a good plan for the management of her medications before they send her home, because like I said before, when she is "sedated" or "tired" she rages MORE because she is cranky!
  16. smallworld

    smallworld Moderator

    Risperdal, Clonidine and Seroquel are all sedating. Given all together, you'd have one pretty tired kid.

    A dose of 150 mg is still considered on the low end. Mania and bipolar disorder are treated anywhere from 300 mg to 800 mg (and sometimes even higher). My son's dose has ranged from 400 mg to 800 mg.
  17. Sara PA

    Sara PA New Member

    Clonazepam? Generic Klonopin? A benzodiazepine which is in the class of minor tranquilizers (the antipsychotics being the major tranquilizers).

    IIRC, Seroquel is sedating up to about 250 mg/day. The dose range for the medication is between 75 and 800 mg. Quite a dose range spread.
  18. neednewtechnique

    neednewtechnique New Member

    Clonazepam, yes I think that was it. This was prescribed off-label for Panic Disorder, but is an anti-seizure medication.

    Totally off topic, has anyone ever NOTICED how the anti-seizure medications have a whole different ability to control all sorts of different emotional and behavioral issues. Who would have thought that panic disorder and bipolar disorder would be treatable by seizure medications????
  19. Sara PA

    Sara PA New Member

    Clonazepam is an benzo which is also used as an anticonvulsant. My understanding is that it is used in emergency situations to bring convulsing patients out of seizures. I've heard of it mostly used to bring people out of seizures related to alcohol withdrawal. It isn't generally used for the long term because people develop a tolerance and it is highly addictive. Most clonazapam is prescribed for anxiety and panic attacks which are not off-label uses.

    Dilantin was the first anticonvulsant used to treat behavioral issues. There were a lot of small studies on it as far back as the late 1940's. But then, behavior issues all became psychological, not neurological, problems in the 60's and people tossed aside what was learned about Dilantin.
  20. slsh

    slsh member since 1999

    In my experience with- thank you and hospitals, he usually had a individual sessions a couple of times a week with a social worker/therapist. Most of the hospitals he's been in really focused on group therapy and aside from organized group therapy a couple times a day, there's a therapeutic component to almost every aspect of the day.

    The point of hospitalization is strictly to stabilize, not to "cure". It's a very different mindset as opposed to a medical hospitalization where the point *is* to solve the problem. The cure for our kids hopefully comes through ongoing outpatient treatment after they've been stabilized in the hospital.

    I'm sorry. I've always found it incredibly frustrating that hospitalization doesn't usually mean (in thank you's case anyway) significant progress. It's been a way to keep him safe, tweak medications, and get him to a point where we can continue onward in the outpatient setting.

    Hang in there.