New psychiatrist visit and diagnosis

[AllStressedOut]

We visited with the new psychiatrist today. He thinks all 3 difficult children are bipolar. He had an awkward moment chuckled under his breath, then said "You're going to think I'm a proponent of bipolar and this medication."

I'm a little surprised he thinks middle difficult child has this. I guess it's always a possibility with bio-mom having this diagnosis, I just don't see much depression in him. He is over the top happy when he's happy, but I don't see sadness often. psychiatrist asked him some questions and every answer was yes. I think this is just my difficult children personality to say what he thinks you want to hear.

He wants them all to try out respiradol (sp?) for now and come back in 2 weeks for a check up.

I'm not sure if its my own allergy medications, but today I just feel like I'm not on my game. I am at a loss as to what questions I should have asked, really if I did anything right in this meeting. He asked my opinion and I told him I didn't see it in middle difficult child, but he said that even if he had a mild form of it, if we didn't treat it first, the ADHD medications were just going to make it worse.

He recommended I read "The Bipolar Child" LOL...I found that funny. Maybe he comes on this board and reads what ya'll say? LOL

Any thoughts on trying this medication on middle difficult child? I do agree with him that oldest and youngest difficult child seem to have many BiPolar (BP) traits, but I'm really not certain on middle difficult child.

They need a smiley face up there that looks like its in a cloud. Cuz my brain is hazey today.

 

[smallworld]

Didn't the neuropsychologist say Aspergers? What did the psychiatrist think about that?

 

[AllStressedOut]

Yes he did. The psychiatrist barely made mention of it. I think he mentioned it when going over youngest difficult children info.

The only thing that may apply to why he didn't mention it further was him saying that you have to get the boys to a "base" line of behavior with their BiPolar (BP) before determining other problems. He did not say this around the same time as mentioning the asperger's, but he said it later.

 

[busywend]

ASO, keep in mind it really does not matter the diagnosis. You are treating the symptoms. If risperdal (sorry not familiar with it) is meant to treat a symptom your difficult children have then it is worth a shot. If it does not match a symptom, then you need to question the thought process of the psychiatrist. Perhaps a 2nd opinion.

 

[AllStressedOut]

He said its very similar to seroquel, an anti-psychotic that he says he uses as a mood stabilizer. Is that normal? I've never dealt with mood stabilizers, although all 3 difficult children were on seroquel last year to help them sleep.

 

[timer lady]

I agree with Busy - many psychiatrists treat the symptoms. So very often, a difficult child goes through several diagnosis's before hitting on the "right" one. Often, the addition of a medication will confirm or rule out a disorder. This is a fine art & your difficult children are still quite young in this process.

Keep in mind, that you might have 2 different disorders at the same time.

Many times I've told our psychiatrist, call it pregnancy if you have to, just treat it! I didn't care the diagnosis - I wanted the symptoms treated.

Good luck with the new medications - hope they work for your boys.

 

[Steely]

Well.......hmpfff. Not sure what to say. I guess I will just go with what my gut is saying, and you can take it or leave it.

A) I disagree with treating the 3 of them as a unit. They each need to be treated individually, and for their own specific sets of weaknesses and strengths. To blanketly XR one medication for all three sounds a little negligent. A little - not a lot - but it does not sound like a lot of thought went into it.

B) Does difficult child 2 have specific behavior problems that need to be addressed in your opinion? Do you think that in your heart of hearts medication would help? If so, than accept his diagnosis for now.

C) Risperdal is not a mood stab, but an anti-psychotic, and similar to Seroquel. It can be used to treat major manic episodes of bi-polar and it can also help with severe aggression. It will not even out the ups and downs of the mood swings, but only quell the intensity of the mood swing. If your kids are experiencing major mood swings, than a mood stabilizer should also be considered. Many times, bi-polar patients use both a mood stabilizer and an anti-psychotic.

D) psychiatrist is right on about the ADHD medications making things worse if they really are bi-polar. There are many, many varieties and aspects to bi-polar, and each child is different in the way they manifest the disease. My son, is what they call hypo-manic.....which mean that primarily he manifests more mania than depression. So, your difficult child 2 never feeling depressed is not exactly relevant. The Bi-Polar child is THE best book on the market for this type of info - and they also have a website if you want to check that out as well.
http://www.bipolarchild.com/

I hope this helps at least clear some of the haze! :crazy: Feel better!

 

[mrscatinthehat]

Do your kids all go in together? I am a little confused. Did he talk to them alone (with-you) or was it all of you in the appointment? I would question why they aren't treated as individuals. Maybe I misunderstood and if so I am sorry. This just struck me as odd.

Beth

 

[AllStressedOut]

We all went in together. He spoke with each one of them individually, but mostly observed them and spoke with me. We went in 3-4 weeks ago and spoke with a therapist in his office who went through an extensive computer program and asked me tons of questions. Each answer I had to provide several examples to before she marked the answer in the program. He basically went over the answers while asking some additional questions and watching the boys.

While in the office youngest difficult child was entertaining himself by beating the tar out of middle difficult child. At one point he threw a highlighter at him hoping to hit him in the head. He was disappointed he missed. I'm sure much of the evaluation was just him watching the two boys with eachother. Their behavior was attrocious (sp?) and if it wasn't for the fact I wanted him to see the true behavior, I would have nipped it in the bud immediately. But this is how they act for other people, so I thought it best that he see it first hand.

 

[neednewtechnique]

You got lucky on that one, in a way.... So many times, we can take difficult child somewhere, like a doctor, and we WANT the doctor to be able to see the behavior we are trying to desperately to describe, and they sit there like little angels and they simply cannot believe that there are really that many problems. So being that the psychiatrist got to see it firsthand, I would agree that it was a good thing for this time.

As for the hypomania, as you mentioned your middle child noticing the mania more than any depression, the risperadol is supposed to help lessen the mania, so maybe this won't be a bad medication for him. As for the two you notice the mood swings in, as someone else mentioned adding the mood stabilizer, it might not be a bad idea. The mood stabilizer has been working so well for my difficult child that we have not even needed to add the "risperadol" type medication to go along with it.

One good thing about them all starting out on the same medications is that, over the course of the next few weeks, you can make notes about what behaviors are improving in each individual child, and what each child is still going through or if anything is getting worse, and it might help YOU distinguish the different changes in behavior of each kid so you can communicate that to him and he can adjust each child according to new observations.

 

[susiestar]

Umm, I hate to be dense, but...

If HE has read The Bipolar Child why is he encouraging you to try an antipsychotic with little PROVEN track record as a mood stabilizer when there are several mood stabilizers to choose from? Some children (and adults) even need 2 mood stabilizers at the right levels to stabilize thier moods?

Bipolar Child does advise ruling bipolar out BEFORE trialing any ADHD or SSRI/SNRI medications. But the book very clearly stated that mood stabilizers are not antipsychotics, or the version I read made that point.

Can you ask him for a trial of a mood stabilizre for a month or so BEFORE any antipsychotics? Ripserdal requires a baseline EKG, or a blood draw, not sure which, before starting. OR at least I was told that eons ago. Blood draws are not fun, but get him to prescribe EMLA cream if your kids can tolerate lidocaine cream on their arm or wherever. Put it on 15 minutes before the blood draw and it will take lots of the awfulness away.

I would be asking him soem careful questions and for some well respected sources naming seroquel or risperdal as also being used to stabilize moods before I gave the medications to my kids. (all medications are serious, but if the mood stabilizers are not FIRST you may never get a clear picture. OR at least not without the agony of coming completely off all medications to try it.)

Hugs,

Susie

 

[BusynMember]

I can only speak from my experiences. The neuropsychologist who saw and actually tested my son extensively (twelve hours in all) was right about my son being Autism Spectrum Disorders (ASD) and the Child Psychiatrist was wrong that my son had bipolar. My son had no crazy moodswings, but the psychiatrist still insisted he had bipolar so I put him on BiPolar (BP) medications. Should have trusted my own gut because it said "AUTISM" lol. We went to a meeting for parents of bipolar kids and their kids. My son was nothing like them, far more at peace with himself, but far less social and spacey, and several moms asked about the diagnosis. and mentioned the high end of the spectrum. Seeing the other kids made me really understand that this psychiatrist, with a great reputation, was not correct about my son, and we took him to the neuropsychologist. Four years later off medications and obviously on the Spectrum, my own gut instincts were obviously right. He's a teen and still not your typical moody teen! He does do weird things, like talk to himself, but it was explained to me that many Autism Spectrum Disorders (ASD) kids process their thoughts better when they talk out loud. He is very cognizant of reality. Am I mad? I'm made at MYSELF. This kid had been on TONS of medications he didn't need. Should have followed my gut.
Be aware that many kids on the spectrum also rage when frustrated and can be defiant, especially before getting the proper Autism Spectrum Disorders (ASD) interventions. Is bipolar in your family? psychiatrists often know little about Autism Spectrum Disorders (ASD). Ours didn't. It's not a psychaitric problem, it's neurological. At any rate, you may want to calm down and go slow--and another neuropsychologist evaluation can't hurt either. If it doesn't feel right to you, don't do anything until you see if other professionals agree with his diagnosis. As an aside, RIsperdal is often prescribed for Autism Spectrum Disorders (ASD) kids with good results. I don't think just observing and talking to kids is a good way to diagnose. There is a way to do a better evaluation. Good luck, whatever you decide to do.

 

[AllStressedOut]

Bipolar is in their family, their bio mom was diagnosed with it about 6 years ago.

I haven't read The Bipolar Child fully, so I need to check it out again and read. The only one who could start on medications lastnight was oldest difficult child. Middle difficult child goes to camp Monday and didn't get his medications in time to take them with him, so we're choosing to wait to give them to him. Youngest difficult child has another blood glucose test today for the reactive hypoglycemia diagnosis to be re-evaluated so he couldn't start it until tonight.

They're supposed to have their blood drawn prior to taking this medication? The psychiatrist didn't mention a word about this. He did say it is similar to seroquel with blood sugar and that this happens in rare cases.

I'm not on medications yet this morning so I'm going to start researching while my brain is still functioning. My allergy medications really put me in a fog.

 

[smallworld]

Risperdal, like Seroquel (and the other atypical antipsychotics), can increase glucose levels and cause diabetes. It can also cause weight gain, which then affects cholesterol and triglycerides. My daughter is on Zyprexa, another atypical antipsychotic, and we have her blood monitored every six months. We also had an EKG administered because APs can prolong the QTc interval.

Once you know what's going on with youngest difficult child's reactive hypoglycemia, you may want to reconsider this medication because it can mess with glucose levels.

Risperdal is prescribed both for raging associated with Autism Spectrum Disorders (ASD) and bipolar disorder.

 

[AllStressedOut]

This is why we took them off of seroquel, blood glucose. It didn't make sense to me why he would be put on an extremely strict diet and then be given a medication that messes with his blood sugar. He was on seroquel for about 9 months and never tested for blood glucose after the initial test.

I just read up on risperdal and it does sound like the type of medication that would help them, with Autism Spectrum Disorders (ASD) or bipolar. Maybe this is what the psychiatrist was thinking?

I don't think we'll have results for youngest difficult children blood glucose test until Friday or later.

Another thing this psychiatrist said is that he has never heard of "reactive" hypoglycemia. This is what the nurse at our old school said too when she heard of the diagnosis. I'm at a loss as to how some of these people know about it and others don't. Wouldn't this be part of their annual training, new DXs and such? Or am I kidding myself that these professions get annual training updates?

 

[Stella Johnson]

Risperdal worked well for my difficult child for a couple of years. She developed a rapid heart rate and they took her off of it.
She did start to gain weight toward the end. Make sure you read all the side effects on this one. Kids on the board have had a wide array of reactions to this drug and some can be serious.

So he didn't prescribe any other mood stabilizer along with it?

Steph

 

[smallworld]

What kind of doctor diagnosed his reactive hypoglycemia? Has he ever seen a pediatric endocrinologist? If not, I'd strongly recommend it.

 

[3sacharm]

So just this past Monday we went to the psychiatrist for the routine visit. My son who is Bipolar (and never sad or depressed) has been treated with Lithium (mood stabilzer) for almost 2 years. Recently, he has had some struggles with frustration and rageing outboursts at school ( a new school) and the director asked me to ask the psychiatrist about Risperadol. He takes Metadate (stimulant) in addition to the lithium. We went through almost every stimulant before we found Metadate. Anyway, my point... The psychiatrist felt that Riperadol was one of the last things she wanted to try, instead she upped the metadate with a mid day booster. She told me she she would rather try clonodine or tenex before going to the antisphychiotc class. Every kid is different and the issues are different as well, but that was her take on risperadol for my son. Good luck.

 

[AllStressedOut]

He wants them on this until 10/9 for their follow up appointment. He said at that point, we'd see how it was working and adjust medications then as needed unless problems came up between now and then with this medication.

How long does it take to start working? I can't give middle difficult child any until he gets back from camp 9/26. If it takes 3 or more weeks to start showing any affects, we won't see it in him yet.

I want to say the teacher who recommended this psychiatrist said his son was on this medication too, he is also bipolar, but he is on additional medications as well.

Our old psychiatrist diagnosed the reactive hypoglycemia. He is doing a new blood glucose test today to have this reevaluated.

 

[AllStressedOut]

I find it very interesting how different docs have different preferred medications. They always seem to have plenty of samples in their preferred medication too. Strange coincidence?