Today I am in a "don't mess with me" mood. Update on our difficult child 2 in psychiatric hospital

Discussion in 'General Parenting' started by seriously, Jun 19, 2011.

  1. seriously

    seriously New Member

    Went to see difficult child 2 in psychiatric hospital yesterday afternoon. We played a little cards and then he quit. Said he'd been playing cards all day. We asked him where he put the knives that are missing and he told us where to find one but didn't know where the other one might be. (We still can't find the second one.)

    Then he announced that the new psychiatrist told him he "just" needs therapy and she's going to take him off the Geodon and just have him on Zoloft which she started him on yesterday. He said this with a gloating look and the clear intention of putting us in our place.


    Then he left abruptly in another power play gesture saying he was done and we could leave now.

    I went straight to the social worker and asked her to meet with us. We spent an hour talking about difficult child 2 and this BS. She doesn't know what the psychiatrist really said to him - neither do we of course. He may have completely twisted her words around. But we have had this problem before with the psychiatrists at this psychiatric hospital. They tell him stuff that completely undermines our authority at home without even talking to us first and then he uses it to triangulate us with the doctors.

    She brought up all these things he had told them that are half-truths or distortions. We knocked every one down for her with specific examples. Ok she says and sits back looking very thoughtful. She asked if he had been tested for language problems and I said yes and his 2008 speech assessment showed that he is unable to take another person's perspective, is very concrete (she nods her head), and cannot tell when his communication is clear and when he really understands what someone else is telling him.

    Social worker is like - that explains some things.

    Uh huh.

    Apparently he tried to explain to her about why his sleep is so messed up and why he's been taking Klonopin. Made NO sense at all. He couldn't answer her questions in a way that made any sense to her and she said she finally gave up. and in group that day he had taken something she said and completely misinterpreted it. she tried repeatedly to clarify and again finally gave up because he was insistent he was right and she was wrong.

    I told her - Welcome to our world. He thinks he understands you and that you understand him, you think you understand him and that he understands you. Neither one is true. And once he's decided something you cannot successfully challenge his version - when he is unstable. When he's stable sometimes you can reason with him pretty well. But when he's not - it all goes out the window.

    She said she would talk to the psychiatrist and caution her that she couldn't rely on what he tells her to be accurate. I told her that I had thought the psychiatrist understood that the day he was admitted because I told her then that he was really out of touch with reality and she said she could tell that from talking to him. SW said she'd remind her.

    I also told her that he was not stable when they discharged him last time and that was how we got into giving him so much Klonopin. I told her the night nurse said he had trouble going to sleep and trouble getting up when he was there in May but that the psychiatrist told us he wasn't having any trouble. She looked kind of alarmed by that and we discussed it in more detail. She said she was going to look into that because it was really important that the psychiatrists got accurate information from the staff. I said - well what the night nurse might consider "trouble" could be different than what the psychiatrist considered trouble I didn't know. All I know is that I called her and asked for advice about how to get him to sleep and that's when she said he had had trouble there. Hope I don't get that person in hot water but it was disconcerting to have the night nurse tell me that at 2 am when I can't get him to sleep and he's been discharged "stable".

    Anyway, today I am just mad at him and all the BS. If that psychiatrist calls me and tells me he just needs therapy and she's taking him off the Geodon, etc. I am pulling him out of there and bringing him home before she completely destabilizes him. If he gets violent again he will just have to go to juvenile hall.

    Because if the only reason he assaulted me and wife, hid knives and trashed our house was because he needs "therapy" then he can go to juvenile hall and get some "therapy" courtesy of the judge.

    Last edited: Jun 19, 2011
  2. zoo_keeper

    zoo_keeper Member

    Hi. I just wanted to say I know what you're going through and how frustrating it is. My difficult child was recently discharged from a psychiatric hospital after deemed 'stable.' I was able to delay his discharge for 5 days by refusing to take him home for fear of the welfare of my other children. CPS eventually got involved and threatned child abandonment tho. It might be worth a shot if they try to discharge him when he's not ready again.

    I would be very weary of this psychiatrist starting zoloft and dropping the geodon. It's my understanding that most bipolar children should be stable with the help of mood stabilizers and anti-phychotics before beginning other medications. It might be different for your difficult child tho. Hang in there
  3. pepperidge

    pepperidge New Member

    I'm so sorry. Sounds totally frustrating. At least you should be on the same page as the psychiatrists.

    Remind me--sorry--has he been in a Residential Treatment Center (RTC) or have you/would you consider one? It sounds like not only does he need a major medication upgrade but that he also needs intensive therapy in a very structured and safe setting. Hopefully not your local juvenile justice place.
    hugs to you.
  4. seriously

    seriously New Member

    Yes Residential Treatment Center (RTC) is probably where we are headed fast if this continues. but we have no $$ for it and he's "fine" at school (when he's there that is) so it is unlikely to come through his IEP. I was really, really hoping we were not going to get to this point.

    We have in home support services (so far that means we see the family therapist at home 1 x week and difficult child 2 sees his facilitator 1x week outside of home) that haven't been very helpful so far. but I think this has galvanized some action on that front.

    spent 1 1/2 hours talking to our family therapist about the situation on Friday. THANK GOD we have someone who is experienced - both with staffing residential treatment and with serving families of juvenile offenders.

    she said he is not like the juvie kids she has worked with - it's clear there's mental health issues complicating the "usual" way they would proceed with a kid from juvie. she and I talked about why we can't make our home an Residential Treatment Center (RTC) and she was telling me all the ways an Residential Treatment Center (RTC) could handle him that we cannot. I think she nearly talked herself into saying he needs to go to Residential Treatment Center (RTC) not home.

    But I don't think we have jumped through enough hoops yet for that. I'm not sure.

    We'll see how he is tomorrow. He'll have 3 days on the Zoloft under his belt. I am considering telling the psychiatrist I've changed my mind about that - spent some time reading up on it today and there's some pretty suggestive evidence that AD's in people with bipolar lead to long term mood instability which is worse overall than trying to use just the mood stabilizers and AA's.

    I'll probably have to track down the references and print them out to take over there.

    Thanks for the good thoughts.
  5. pepperidge

    pepperidge New Member

    Hi Seriously--

    My experience with the otherwise very good board certified child psychiatrists we have had is that they totally tend to discount any disinhibition type of responses of kids to SSRIs. We've seen it in both of our kids, who don't meet the diagnosis criteria for BiPolar (BP). One is depressed, the other ADHD and a some other stuff. Our youngest trialed Zoloft in December. It didn't have any obvious on off type of reactions, but after about a week he was doing more crazy stuff (trying to swing off the rood on a rope tied to a pine tree for ex), more aggressive, etc. We took him off after a few weeks, and it took about two-three weeks to get him calmed down. The dreppsed son who has had a very positive reaction to Lamictal was originally trialed on Prozac and Lexapro (separately). Both had disinhibiting effects (stealing, totally losing it in the classroom, extremely silly behavior). The psychiatrists just didn't want to believe that SSRIs were having those effects. Now we have trialed some 10-15 medications for each of them in very controlled ways under psychiatrist supervision. Very few had really negative effects, but the SSRIs were pretty clear.

    The only reason I am going through this is to say that I am glad that you are researching the effects and going to talk to the psychiatrist. Even if you decide to keep him on it, be really vigilant about watching for disinhibition, more rages. The hard part will be to figure out what is the effect of the medications.

    HOpe you have a good conversation with the psychiatrist.