psychiatrist on call- UUHHMMM

[klmno]

I called the psychiatrist's answering service to reach the on call doctor tonight because difficult child was raging and it started to get frightening- it went on about an hour instead of his normal 20 mins. - plus he has been exhibiting other manic symptoms and he has had the recent medication changes.

Well, I get a call back from therapist that difficult child saw 2 years ago (you know the kind- the whole problem was discipline). I guess the answering service sent the message to the therapist instead of the psychiatrist on call. Anyway, he did help in giving a pointer on how to get a difficult child (who's on probation) into psychiatric hospital. Then, said call again to get psychiatrist because the answering service had made a mistake by referring my call to him.

So, psychiatrist on duty calls. By this time, difficult child is calm and doing homework in his bedroom. psychiatrist asked for history so I tried to sum up 2 years worth in less than 5 mins. psychiatrist sounds like he questions diagnosis. I personally don't care what they call it- this kid is cycling.

Then he spends time telling me how psychiatrists do their best to diagnosis and choose medications but it isn't an exact science. I know that, but what do I do NOW? So we discuss medications and dosages and he mentions all the AP options. Fine, but what do I do NOW?

He says it sounds like I want difficult child in psychiatric hospital and they normally don't do that anymore because insurance will only pay for a few days, and that is when the kid is a danger to self or others. I know that, but... And, he proceeds to tell me, that sometimes they will do it when parent just needs some rest, but they don't like it because psychiatric hospital and insurance will require a complete medication change and they think that is stupid. (I'm thinking, oh really, well if they aren't working, why wouldn't you change them- and if the difficult child needs drastic medication changes with risks of mania, shouldn't they be in psychiatric hospital?)

Then, he asked who is here to help me- where is father. Father has never been in life. He says what about grandparent or uncle. (This makes me paranoid- difficult child only has a grandparent and uncle in his life- besides me. Grandparent is out of state, uncles tried to get custody last year- does this psychiatrist have access to difficult child's file if he's on call?) I explained that no one was in this state but me.

Now, difficult child has picked up extenssion and been listening to part of conversation about upping medications and psychiatric hospital and so forth. I don't know if psychiatrist picked up on that, but then he says, well, if you can't take anymore, just call social services and tell them (me- NOT!!!) So, difficult child flips, goes to counter and puts all medications in a bag and takes them too his bedroom. I tell psychiatrist that difficult child heard part of conversation and he is removing medications, now what do I do?

psychiatrist says, then he's not cooperating and doing what he should and he needs to be compliant or this just won't work. HELLO!!! So, I tried to explain that he has NEVER refused his medications and he normally is compliant and has had long periods of stability but right now, I believe he is manic and there is no rationalizing with him when he is manic.

psychiatrist says, then what do I plan on doing? I said my plan was to call them, so now what should I do. He said give max doses of medications that regular psychiatrist had suggested, (meaning include zyprexa tonight), then calll regular psychiatrist first thing tomorrow. So, why didn't he just say that to begin with?

Then, I spent another hour getting difficult child calmed down- no, I wasn't calling social services, etc., etc, get medications back from him, and he takes them, as normal- with zyprexa. Which of course means, he is out of it right now, but he'll be rapid cycling tomorrow.

Am I the only one that sees a problem here? My nerves are shot and I think it has as much to do with this psychiatrist as with my difficult child.

 

[smallworld]

I'm so sorry.

I feel very fortunate because all three of our psychiatrists have given us their cell phone numbers to use after office hours. But when they're out of town and arrange for coverage, I get very worried. Inevitably the covering psychiatrist just doesn't get the whole scenario and makes suggestions that don't make a whole lot of sense.

I guess you can heart in the fact that your difficult child's asleep for the night. And when you talk to the psychiatrist tomorrow, ask him what you should do after hours when there's a problem because the coverage just ain't cutting it.

Hope tomorrow is a better day.

 

[JJJ]

I love it. You call the professionals and they give you a difficult child answer. The APs are used to treat mania so the Zyprexa should help. I hope you get a better answer from your regular psychiatrist this morning.

 

[Baffled]

Wow! These people are supposed to be such professionals! I just don't get it sometimes. I've been through several therapists, but so far only 2 psychiatrists. In our area there is no one close that specializes in only children and adolescents. I'm in the process of changing p-docs (now going to be our third). We go next week to one that is a 2 1/2 hour drive away! But as far as therapists, they tell me things like--make him go to his room when he is raging. How do I get a 130 lb 14 1/2 year old boy to go to his room when he is enraged? Carry him? lol I have to give it to my last psychiatrist though. She was always reachable very quickly and gave good advice. I at least didn't get a psychiatric lecture.

 

[gcvmom]

So how's he doing today? That psychiatrist who called you was useless!

Could you take him to the ER next time he starts getting violent? Or call an ambulance/paramedic?

 

[Star*]

klmno -

Okay - maybe I'm not getting this right - BUT I see something in this that no one else commented on. So I'm asking you based on my observation from your post.

First of all = you say he is cycling, and manic.
Then you call the doctor and he's now calm
In the middle of all this - he's so manic he thinks to pick up the phone and eaves drop?
THEN when the thought of Social services or outside agency getting involved is brought up =he flips and begins outrageous controlling behaviors???

Is this typical of manic behavior? (I am asking) Because for someone who is depressed he certainly had a lot of thought processes going into picking up the phone, spying on you, and then acting out when other people were going to be involved.

I only know that when the people I know who when manic are manic - they couldn't think like that -mostly they couldn't think period, just sit there and stare off somewhere - like the snap snap of fingers in front of their face and they had no clue. So I guess I'm asking more than observing. And certainly not making any suggestions that he is or isn't cycling..

Just trying to understand where your fella is coming from.

And....IF (HUGE IF HERE BECAUSE I KNOW HOW I FELT ABOUT IT PERSONALLY) it is - a behavioral thing - Did you ask where you can get classes for parenting? When this was suggested about Dude I nearly died. I thought "YOU HAVE NO idea what it's like to live with this kid." and then it hit me that if it was all behavioral I needed to KNOW how to deal with it - and if it wasn't behavioral at all - would additional counseling and parenting classes hurt or help? - I admit with some shame - they were right - and it helped.

I dont' know what Dude's problem is - I have been told that it is NOT organic. We had an MRI done on his brain and had the results read by a top notch neuro- and the all said - he's behaved like this for so long - it's habit. And you have let it happen so long that it is habit. BECAUSE I had not a clue.

I've had so many false diagnosis about him - that I figured what harm could taking classes and reading about how to communicate with him, what his triggers were and how to avoid them - and now at 17 - 12 years AFTER our first outburst - he's matured some, and a lot of his anger, hitting, frustration, yelling, have diminished greatly due to being talk how to self-stimulant and coping techniques like walking away and all the science that went behind that logic. It did help him. More than medications, more than Residential Treatment Center (RTC)'s. But he is still who he is. Manipulative with those that allow him to maniuplate, sticky fingers - from those who don't lock their stuff up. Still get's angry, still gets depressed about stuff - still refuses medications...but he's slowed down considerably....and stopped all the screaming and yelling, and pooping pants, and threats.

Is he still sneaky? You bet. Will he still do whatever if he is sure he can get away with it? YOU BET. Is that part of his emerging BiPolar (BP)? NO WAY. That is behavior - and all kids who have mental illness WILL have behavior problems BECAUSE they don't have good self-taught coping skills.

Dont' take offense to it when someone says it's behavioral - it's still no ones fault - it just means now you get a different set of books and tools to help you communicate with your kid - who more than likely is suffering from cycling.

But my thought at this stage in my life - if he is cycling - wouldn't it be nice to have an outlet? How does he KNOW what to do for HIMSELF when he's cycling? Someone has to teach him - that's how. And it sure isn't a parent - it's a behavioral specialist. Having a self-stimming calming technique can go a long way to stopping the yelling, arguing, and "fits". But if you don't know HOW - how are you going to calm yourself. THAT to me is what "behavioral" problems are. If there is a problem there should be a solution, and if I don't know the solution - I want someone to teach it to me.

Know what I mean??

Hugs - Sounds like you had a rough night. (throws more hugs and more hugs) - I had the same "support" system you do when I started to try to makes sense of Dude - NO ONE.

Can you ask the school if there is a group in your state that would help you and your son afford the services that he needs? Like pay for therapy, give you a weekend of respite?

If you don't know where to go - PM me and I'll see if I can help you do research so you can both get a break.

 

[smallworld]

Star, I can't tell you whether klmno's difficult child is manic or depressed or cycling between the two, but I can describe mania and depression as I've seen it in my children.

Depression can be: sad, withdrawn, quiet, unresponsive or monosyllabic responses, motionless, feeling worthless

Mania can be: loud, giddy, constant on-the-go movement, aggressive, violent, goal-directed behavior, grandiose thinking, impulsive

According to my son's psychiatrist at his day treatment program, the only way to treat mania and cycling is with mood stabilizers and atypical antipsychotics. Depression can be treated with medications and therapy.

 

[klmno]

Thanks,all! I think there is some good advice here, in every post. Oddly enough, as much as that psychiatrist annoyed me last night (and he REALLY did), he might have found an answer. psychiatrist (the regular one) had said reduce lithobid when I started difficult child on the zyprexa (due to lithobid causing some twinging of muscles and being jittery). So, I did, then when I stopped the zyprexa, I increased the lithobid back, thinking difficult child would just have to live with side effects until I got a better answer from psychiatrist. The psychiatrist last night said give the higher dose of lithobid (that I had already raised difficult child up to again) plus the zyprexa. (Actually, I think a wise parent here suggested that last week too- I should have addressed it then!) I was going to call the regular psychiatrist this afternoon, but I am going to wait now because if today is any indicator- this is great! difficult child barely fussed when getting up for school and came home with a great attitude and seems happy (in a normal range) right now. I'll just have to see if it stays that way through the entire evening. Of course, there is still the issue of the lithobid side effects- I don't see how we can ever get him switched from that medication. Maybe we'll just have to wait until mid-summer, when it is apparently difficult child's most stable period.

As far as behavioral management- Oh, I'm sure there are times when difficult child manipulates me. Last night he was raging and acting somewhat manic (I'm not sure where the line is between mania and hypomania) before I called the psychiatrist. I called more because of what I was afraid it was leading to and due to increase in frequqency of these episodes and being afraid to wait until next psychiatrist appointment. Anyway, he had calmed down by the time several phone calls were made and I finally had psychiatrist on phone. The picking up extension and other stuff- I agree- bad behavior. difficult child has some issues that may or may not be related to mood cycling, and he heard some things that hit raw nerves to him. Anyway, after we discussed those things, he seemed to be ok and took his medications just fine last night and this morning.

When difficult child started exhibiting problems (over 2 years ago), we spent over 6 mos on the behavior management road and it just made things worse- and I mean more than a little worse. When those strategies stopped and I started dealing with him differently and we thought the prozac he'd been started on helped, anyway, he really changed and was fine for 8-10 mos. Then it all went haywire again. The profs who know all the details and actually saw a lot of this with their own eyes say he is definitely cycling and he was manic (which followed his first major depression) when all this started 2 years ago. Still, there are strategies I can use to help keep things on an even keel most times and strategies he can learn to help himself- we are working through some of those currently. But this behavior management technique is much different than the conventional ones they tried before when they thought the diagnosis was dpression and something conduct related (like ODD or Disruptive Behavior), even though those still "fit in" with BiPolar (BP) not otherwise specified. The MDE psychiatrist doesn't think it is true BiPolar (BP) (she does see he is cycling though) because she thinks the adequate therapy to deal with underlyying issues and learning these strategies and hormones balancing out after puberty will probably stop the mood cycling. We'll just have to wait and see on that one, but I do believe there is cycling going on now because the treatment for cycling (both medications and strategies are effective- at least most of the time) and the treatment for CD related problems made things worse. And when I read the list of symptoms for BiPolar (BP)- if there are 20 things listed, my difficult child exhibits 18 of them, seriously, i was amazed to see how much it fit him like a hand in a glove, as far as what he has exhibited over the last 2+ years- but, he hasn't exhibited these symptoms all his life.

Still, Star, you bet there are times when difficult child is pushing limits with me and with rules and plucking every nerve and it is not BiPolar (BP)- it's obnoxious teen boy!!

I have to go now- I have to start a thread on my issue for today about job and insurance problems......ARGH!!!

 

[Star*]

Well thanks so much SW and klmno for straightening me out on that. After I wrote what I did I thought - OMG she may just think I'm trying to say he doesn't have BiPolar (BP) not otherwise specified. Maybe I should start off my curious notes with Inquiring minds.

I guess another thing that gets me is that for years Dude has had a lot of BiPolar (BP) symptoms and 2 psychiatrists have told me that he's emerging or will be in his 20's. I found that almost acceptable considering his therapist says he's an emerging anti-social. The only people he's anti-social with is me and DF. I wonder - if that is typical teen.

klmno - I am so happy that you are so intuituve to your son and figured out what amount of medications to give and hold. It sounds like maybe you just needed a hug. So = HUG. You've really got it together more than you realize I think.

How are YOU feeling? Now that you've gotten him squared away?

HUGE HUGS
Star

 

[klmno]

LOL, Star! really, it is difficult many times to distinguish intentional misbehavior and disorder or medication-related behavior.

Anyway, I am hanging in there - thanks to the board! Thanks for asking!

by the way, from your posts that I have read about Dude, I wouldn't have thought anti-social personality.