Please somebody direct me to some help

Discussion in 'General Parenting' started by klmno, May 25, 2008.

  1. klmno

    klmno Active Member

    This kid cheeked his medications tonight. I swear I don't know how he does it. I see him put it in his mouth- see it n his tongue, see him take a drink. Then I looked and found it later. I made him do it again. I think he took it but cr@@ I thought he took it before.

    Then, I smeeled smoke in his room when I went to tuck him in. He was in an attitude- which pretty much means that he did not take the medications. He was all over the place- setting a paper towel on fire on the deck in the grill. Tried to disconnect phone but I got it back. Then grabs a handful of his medications (mostly lithobid) puits them in his mouth- I don't play into it. He acts like he has taken them , then maybe 5 mins later I hear him in upstairs bathroom running water in sink. Somehow, I think he cheeked them.

    I could call police- based on all that is happened so far, the courts would probably send him to Fl to play at disneyworld. Yes, I'm sorry, I do think there are that many stupid, incompetent people involved here. People that don;'t really care what is in his best interest. I told the judge that things were amiss- our whole society is more interested in blaming the parents than they are in doing what is best for the child.

    I don't know what to do.
  2. flutterbee

    flutterbee Guest

    klmno -

    You do know that lithobid (Lithium) is toxic just beyond the therapeutic dose, right? Frankly, I wouldn't call the police. I'd call an ambulance for possible overdose.
  3. klmno

    klmno Active Member

    I think he held them in his mouth then spit them out- what signs should I look for if it is an OD? He is upstairs very quiet right now. This all took place about 15-20 mins ago.
  4. flutterbee

    flutterbee Guest

    Honestly, I wouldn't wait for signs. You can't be sure he did cheek them or how much got into his system. I call an ambulance for transport to the hospital. He needs to be admitted. This may or may not be a true suicide attempt, but a high number of suicides are impulsive acts as opposed to thought out processes as people believe.
  5. klmno

    klmno Active Member

    I just checked on him- he is eating cookies in his bed. He told me he spit the pills out- I really think he did- I think he did this more because he knows that I care more about him then he cares about himself. I told him that I would be reporting the incident to the PO.

    Of course, that isn't a long term solution either.
  6. flutterbee

    flutterbee Guest

    I don't understand...why would you tell the PO knowing what her take on all this is? I don't think this is a kid acting out because he's bad. He sounds like a kid that is destabilizing and struggling for some kind of control.
  7. klmno

    klmno Active Member

    I don't know Heather- I was just trying to think of something to get him to see that this isn't a good choice. We have an appointment with the family therapist on Tues.- quite frankly the tdocs seem like a waste of time. This is really where I think the problem lies. psychiatrist (and I agree) say that tdocs should be dealing with strategies. The problem is- NONE of them has done this.

    So I don't know what to do. I thought day treatment might be an answer. Maybe I should call for an ambulance anyway tonight- to teach him a lesson if nothing else. But I'm not so sure it would. I'm still wathcing him- one thing doesn't look right and I am calling an ambulance.
  8. flutterbee

    flutterbee Guest

    I'm not there of course, so I can only speak from my own experiences. But, I really wonder how much control he has when he does these things. I don't think it's an issue of being bad. It sounds like highly impulsive behavior and that comes with both unstable depression and bipolar. And that's what my thinking was on calling an ambulance. Whether or not he received a toxic dose, it was an impulsive act that could have had serious consequences. I don't think the PO or the police can help with that. That's when the doctors come into play.

    And I was thinking, too....if the medications are making him feel 'weird' and that's why he's cheeking them, I don't know how much of an effect the order from the PO/court is going to have. The medications make him feel weird right NOW, whereas the consequences for not taking them are down the road.

    Bipolar disorder is one of the hardest of these illnesses to properly medicate. It can take a long time and a lot of trial and error to get the combination that works. And you're absolutely right that the therapist needs to be working on strategies. One thought I had on that - because of my own experience with my daughter - is how delicate the therapist feels he has to be. My daughter's therapist recognized that her relationship with my daughter was volatile - and she got more out of difficult child than anyone else. But, she had to go very slowly and very gently. Of course, that does NOT excuse the drug/drinking thing.

    I posted on your day treatment thread that I literally stumbled across a place that when I read about it sounded like a really good fit for your son. Of course, the problem is that its here and you're there. But, I'm going to PM you the website with the thought that maybe they might have some information on resources in your area. It's worth a shot.
  9. klmno

    klmno Active Member

    Thanks, Heather- I PM'd a response back. I'm going to try to get some sleep now.
    I'll be waking up and checking on him through the night.

    I just ask that anyone who reads this send wishes that whatever higher power might exist, please send a message to this kid that he cannot survive this way.
  10. meowbunny

    meowbunny New Member

    I agree with Heather. I don't think he has a choice in his behavior. It may take some searching but you need to find a therapist you can trust. There are some good ones out there. Sometimes it just takes time to find one.

    I also agree that I wouldn't be getting up and checking on him. I would be taking him to the ER. Whether he actually spit them out or not is irrelevant. It was a suicidal act. He. needs. help. He is not doing this to spite you. He is not doing this because he has any control over his actions. He is completely unstable and needs more help than you can give him at home. I'm sorry, but that's the way I see it.
  11. DammitJanet

    DammitJanet Well-Known Member Staff Member

    K...look view may not be real popular here goes anyways.

    I dont think it really matters what diagnosis he has at this point, he needs treatment. Honestly, with as difficult as he has been in treating, he may be in the early stages of a budding personality disorder. I dont remember all the details about his early life but if it was traumatic at all then budding borderline personality disorder wouldnt surprise me in the least. It looks an awful lot like bipolar disorder but can be harder to treat. Good news is I have it and arent I a peach? LOL.

    Can you take him back to the psychiatric hospital he was just in? Can you access any of their psychiatrists as discharge planning...can you ask to be referred to either Richmond or Chesterfield mental health services? Heck if you have to give them my dads address as your address. Say you are moving there and want to start the services and not be up in the air...whatever.

    Or...move down and here and use my therapist and psychiatrist...I swear they are good.
  12. Wiped Out

    Wiped Out Well-Known Member Staff Member

    I'm sorry. Too watch our kids struggling is so hard and scary. He doesn't sound stable from what you are describing. This time he spit them out but he sounds like he needs more help. I've always been terrified of the thought that my difficult child would learn to cheek his medications. I agree with the others about the ER. Gentle hugs-I hate mental illness.
  13. Marguerite

    Marguerite Active Member

    He's got you running round after him, checking up on him and worrying. This is wrong. It puts you on the back foot, him in the driver's seat.

    I agree he's acting impulsively (to a certain extent) and it's dangerous. However, I think he needs to get the message somehow that this is NOT acceptable and he has to take personal responsibility for managing his own illness, and not turn treatment into a game, or tug of war with you.

    So what I recommend - talk to his doctor (or whoever you need to regarding his medications) but you've got to come down heavy and firm on this, using the medical system on your side. (I agree - forget relying on the legal system, especially if you've lost faith with them). See if you can organise blood levels to be done to determine if he's actually taking his medications or not. If this means inconvenient and painful daily blood tests, well whose fault is that? Certainly not yours.

    He needs a good talking-to, to give him every chance to tell you if the medications make him feel weird, or if he has some other problem with them. He needs to know that if he has a genuine problem, he CAN talk to you about it to see if there is some other way around a problem. Maybe there's a liquid form he can take (harder to cheek) or some other form he can't weasel out of so easily. Or maybe a different form that doesn't make him feel weird, or doesn't taste so awful. We went through similar things with difficult child 1 when he was about this age - he wanted to be 'normal' and was skipping his medications to see if he could cope without them. He was trying to say, "I'm normal, I don't need these medications, I've grown out of it, I'm fine. It's everybody else who has a problem." He needed to find out that the medications WERE beneficial, even if he couldn't notice any difference in himself. What we finally got through to him was - off his medications, we wanted to wring his neck. Off his medications, he was angry with everyone because everyone was nagging him or being mean. A videotape would have been useful, I wish we'd had that option. But he finally understood that people were nicer to him when he was medicated, and this wasn't entirely his perception. Because he was not aggressive when medicated, people were less inclined to get angry with him.
    After that, we made a point of calling him on it whenever we felt he was unmedicated, so he would realise that WE DID notice, even if he didn't. He needed to know that it made a big difference. Until a kid understands and accepts personal responsibility for taking medications, you will have this struggle. While some kids may simply forget, if a kid is deliberately missing his medications then you have a problem that MUST be addressed.

    And I know he's impulsive, and maybe faking the overdose was an impulsive act, but faking taking your medications is not an impulsive act, it's deliberate and premeditated. THAT needs to be addressed. Ask him why, then work on finding a solution to whatever problem he presents. And if there isn't a solution satisfactory to him, then work with whoever you can (medically speaking) to get the message through to him - however inconvenient/unpleasant taking medications may be, it's far worse FOR HIM to not take his medications.

    On the subject of medications tasting bitter (or horrible in some other way) - difficult child 1 has got into the habit of taking his medications (which taste very bitter) with neat cordial extract (like Kool-Aid concentrate). If this is a genuine problem, go through as many ideas as possible to find a way of coping. However, I don't think that could be the reason because cheeking it would only make the taste problem worse.

    Next, even if you think you've got through to him about being responsible, begin to ensure TIGHT supervision of him to make sure he's actually swallowing his medication. Also keep watch to make sure he doesn't go off somewhere to throw up. Talk to local drug counsellors on what sort of tricks to watch for and how to catch him; also how to make sure the medications are taken. And if he complains at your lack of trust, remind him that his recent behaviour is the reason you've lost trust, and that trust must be earned back. TRUST IS NOT A RIGHT.

    Finally, if he ever again pulls a stunt like pretending to take an overdose, then get him to hospital to get his stomach pumped. It's not pleasant, but it is the right course to take for a suspected overdose. Let him live with the consequences of his actions. And if he complains and says you over-reacted, point out that if you had failed to take him to hospital and he HAD taken an overdose, you could have been in legal hot water if you had not covered all bases. Don't make a big song and dance about "I could have lost you," because that's only feeding into the drama he's trying to create. Frankly, this is not about, "Oh dear, he is trying to hurt himself, he must feel terrible," it's far more about getting him away from histrionics and back to practicality and common sense. After the crisis is over, THEN you are more free to discuss any problems he may have about the medications. The right way for him to behave is to tell someone if he has a problem. The wrong way is deceptive and cannot be tolerated or excused for any reason.

    How do you react if he falls and gashes his leg? Do you cope, or do you need someone else to step in? Whichever it is, you need to approach this sneakiness over medications in a similar way. Take sensible, commonsense but serious action. Get someone else to take over at that point if you need them to. Always err on the side of caution. It's like living with the boy who cried wolf, only in your case you ALWAYS have to respond even if you're fairly certain it's another false alarm. If he has unpleasant but logical consequences (ie stomach pump; blood tests) every time he "cries wolf", then surely he's going to get the message that this is stupid and irresponsible.

    You need to take control back, and not let him keep you on the back foot like this. So from here, you need to make some plans. Work out, either on your own or in conjunction with his doctors/therapists/whoever, exactly what you are going to do in each scenario you have presented here, when it happens again.
    For example, write down what you will do if he has apparently taken his medications and yet presents as unmedicated (tell him you have to talk to the doctor about drastically increasing his medications, since they don't seem to be working?)
    Then write down what you will do/who you will ring if he apparently takes an overdose.
    Keep going with the list, even if you have to put down some fairly unlikely possibilities. Then tuck the list somewhere where you can get at it quickly but of course he can't - never let him see anything like this, it will only give him ideas. You need to seem relaxed, well-prepared, in control.

    It's not easy when they're like this - they're cunning as sewer rats sometimes, especially when they turn their little minds towards devious ways to drive us crazy. If you can plan to block off every escape tunnel of his, maybe he'll eventually get the message?

  14. Sara PA

    Sara PA New Member

    Many of the articles I was looking at last night indicated there was an association with akathisia and suicidal ideation.

    Based on my own experiences, my son's and what I've read about this suicide-medication connection, I have to say that attempting suicide is often a impulsive, compulsive act....there is no true choice in the matter. The idea that everyone who attempts or thinks about suicide is overwhelmed by depression is simply false. Truth be told, it is entirely possible to feel the compulsion to attempt suicide without there being any depression present at all.

    Your son is telling you that the drugs he is taking are making him feel strange. He has confided to you that he has suicidal thoughts and that he is craving substances he knows he shouldn't use. He is desperately seeking your help to make him feel better -- think better -- because he wants those thoughts to stop. They aren't really him. You have one scared kid there. Telling him to make better choices or your further involving the juvenile justice system isn't the answer.
  15. smallworld

    smallworld Moderator

    I agree that your son is not stable and can't control what is going on with him. I know it's a holiday, but in your shoes, I would call the psychiatrist's office and tell the covering psychician what happened. Ask him what you should do. Whenever my son's tells us his medications make him feel strange, we listen and make changes to help him.
  16. klmno

    klmno Active Member

    Thanks, everyone for all the responses. Each post here has some good advice and points well taken. I need to review them all more carefully.

    Things spiraled so fast last night and he knew he had me worked up. It seemed like if I called for an ambulance that it would start a habit of giving him more drama that he is looking for at times like this. I need to prepare myself for this and if (when) it happens again, remain as calm as I can and just call the ambulance very quickly and matter-of-factly.

    No, he isn't stable. Part of it is impulsive and part of it is not, but when he is stable, he doesn't lie like this and take such irrational action. Not that he is ever perfect- but he thinks pretty rational when he is stable.

    We will defintely be talking tp psychiatrist about how he feels on these medications. I would call today except I have doone that several times in the past and no medication changes are ever made over the phone and I am never told anything any different from what I already was told. I think they do that to make sure no one gets in the habit of calling. My "threat" to him about the PO was a desparate attempt to get him to take the medications that I am holding in my hand. I do want him to discuss any side effects or bad feelings and anything else pertaining to his treatment, but he cannot live here and simply refuse to follow any treatment plan. Even if he refused to take the AP that just recently got added on would not be as bad as cheeking all of them- like the lithobid- which he has been taking for over six months. Of course, that would be a rational approach and he isn't capable of rational decisions right now. But, if he took the lithobid regularly, he would be making more rational decisions, in my humble opinion, even if it doesn't make him completely stable by itself.

    I wish I could videotape one of his rages- to show him (not to publicize on youtube) what happens when he doesn't take the lithobid. This kid is bigger than me and there is NO WAY that I could stand there with a camera in my hand and him ignore it while he is raging.

    We have an appointment. tomorrow with the other therapist- not the individual one, but the family one that is supposed to be helping with strategies, but says he can't do much until difficult child is more stable. Well, I think I will discuss with him that even if he can't help difficult child much right now, he can help me with parental strategies. If he can't do that whethere difficult child is stable or not, then I don't think he could teach me much. What I'm trying to say is that if a therapist can only help when things are completely stable, then how can they teach me what to do when things are not stable. If things were stable all the time, I wouldn't need a therapist. Ok, this is one of those times that I am frustrated about the whole thing and tend to blame them because I am still sitting here, a year later, without them providing me with any answers or strategies.

    You might be right, Janet. I don't really know where all this is leading. But, as others have said, one more time of this and I will call an ambulance for suicide attempt whether I believe he swallowed or not and when they get finished with him at ER, I will be pushing for admittance right back into psychiatric hospital. I realize I probably should have done that last night. I need to get over my tendency to resist making quick decisions when things catch me off-guard.

    These "episodes" happen quite often on Sundays. I have no idea why.
  17. susiestar

    susiestar Roll With It


    I agree he is unstable, and very scared, but also loving the drama. I think you may end up looking into Residential Treatment Center (RTC) or a longer term psychiatric hospital than the 3-5 day one.

    For cheeking, go get some tongue depressors AND a pill crusher. CRUSH any and all medications that are not time release. Mix them in something and then ahve him swallow that. For time-release medications, make him open his mouth nd let you fish around with the tongue depressor. It isn't perfect, but it is a beginning strategy.

    I also think you need a crisis plan. A "What to do if" plan set up for times like this.

    You might look on the archives or FAQ part of hte board for Crisis plan or emergency plan.
  18. klmno

    klmno Active Member

    Thanks, Susie! I will do a little research and see if I can develop a "plan" on my own. Unfortunately, both the lithobid and depakote are extended release. I'm starting to see a little pattern- first, there is a little hypomania, so he wants to keep it going and stay up all (or half) the night to be on the computer or play games. So, he cheeks the medications, if he is caught, there is raging. If he is not caught, he sets himself up for going into mania. I think it might be worse on the days that he realizes are at the end of "his time off" from school and he is "trying to make the most of it". I'm going to talk to him later today about what each medication is doing for him- it might not help, but I don't think it will hurt.

    Oh- and I think (not positive) that the hypomania follows depression. Or- the nagging doubt- depression leads to an "I don't care about anything" attitude that spirals out of control until his actions are more of an "indirect suicide" attempt.

    Yep- we very well are looking at more than typical outpatient maintenance. The question is what is available, how do we get it, who's going to pay for it, how far away is it (in this state or out), and is it a place where he will learn how to do more wrong than right. This is part of the reason I wanted to try partial hospitalization first. But, none of it can be gauged accurately if he is cheeking medications. If he went to day treatment, maybe they could give him the medications there.
  19. Tiapet

    Tiapet Old Hand

    K, I'm actually with Janet on this one. Your next plan of action is a wise one. Be calm and call. I think you will have more access to other docs and you can do it by choice. State simply and clearly that you no longer "want" to work with those you've been working with when they ask who the docs were (you DO have a choice I learned years ago with my oldest difficult child when she was inpatient). In doing this maybe you will have a fighting chance and help him in the ways you want and need to. Beyond that I don't know what else to offer you other then moving if all else fails and that IS a big proposition. One I did myself in the long run and very glad I did.
  20. timer lady

    timer lady Queen of Hearts


    I remember being in your position - do I dial 911? Do I ignore this "attention seeking" behavior? Question after question.

    We came up with a crisis plan - had to happen. In the midst of chaos isn't the time to figure this out.

    Any hint of self harming or aggressive actions toward others was a call to 911 for help in transporting a mentally ill child to ER. I never had a clue if my child(ren) would be admitted or not - that was our course of action.

    Behaviors to a lesser (but not much) degree promises(ed) a call to crisis team. Many times they come out & calm the situation; if not they would decide on the next step.

    In our home, the line in the sand is medications & safety issues. If kt isn't compliant in those 2 areas help is brought in. Other issues are negotiable, however husband, myself & tdocs have worked out plans for various & sundry situations.

    I'm sorry that your difficult child is so unstable. I'm sorry that you don't have a clear diagnosis. We didn't for a very long time. In the meantime, we had to treat/take action on the symptoms. Many times, the medications (which were effective, which weren't) answered our diagnosis dilemma.

    Do you have access to a crisis team? Have you applied with county mental health for a mental health case manager? I can't remember if you've had recent testing for difficult child - neurophych & others.

    I hope you have a calmer day today.