My daughter is 16 and has had an obvious anxiety problem that's been identifiable for at least 5 years. She was put on Zoloft at first and that did seem to help, but at the same time had been diagnosed with ADHD. She was failing all of her classes at the time, she was in 7th grade and by the next quarter of school was passing all of her classes and seemed like a much happier child. She did "ok" the rest of middle school and when she hit high school started having difficulties again.

It's a lot of information to go over, so I'll cut to the chase as to why I am most concerned now.

Background is that my mother has bipolar with rapid cycling which has become worse and worse over the years because she only takes the medications that she wants to take, she won't take the ones that do or that she thinks do cause her to gain weight. She also takes Adderal so that she can continue to lose weight, so you can imagine that she's a mess. She also abuses prescription drugs, which makes things even worse for her.

Given that my mother is that way, you can understand why my daughter has asked with fear in her eyes if SHE could be bipolar "too" like grandma. I have told her that even if it's possible...and it is...that grandma does not take care of herself and IF my daughter has BPD, we will get her the treatment that she needs and if she follows a plan of care, she will be okay.

She was seeing a therapist AND a psychiatrist in the past year and the psych was a child/adolescent psych. I feel like we wasted a lot of time there because he only switched her from Zoloft to Celexa and didn't spend much time talking with me about my concerns or us together and basically said that she was doing poorly in school partially because she doesn't WANT to do the work. He totally dismissed that the reason we were referred to him is that her anxiety level and sensory overload in school just hearing other kids talk in class was to the point where she told the school counselor that she thinks about hurting people and she elaborated to me that she had ideations at that time of even hurting her family. Well, when we talked to her therapist for advice, she did not feel like she needed "immediate" emergency help, but that we needed to tell the psych. She also has rapid mood swings and periods of what I can only describe as mania and will talk a lot, be happier, be productive in things she wants to do like writing stories, drawing, well, anything but school work, but then she'll crash and be depressed, moody, weepy. She is constantly yelling at her brother and me and her dad for making too much noise, certain kinds of noises, etc.

She also had to discontinue her ADHD meds last year because it became apparent that they were causing her anxiety to go through the roof.

She had chronic mono where the worst symptoms lasted for about a year and have been getting better for the past year, but she still has fatigue, sleeps a lot and now her teachers are asking her and us if she has depression, they are worried about her.

Allll of that to ask...would it be appropriate to take her to a good, somewhat local (hour away) psychiatric inpatient adolescent program for evaluation for intake? She approached me this evening and told me that another teacher asked her today if she's depressed, that she has too much anxiety in class and can't stand to be around her friends and is always yelling at them, etc. When I told her that I will see what I can do maybe getting her in with a new psych, also asking if maybe she would be open to going to a hospital for maybe a few days where they could evaluate and get her meds started and correct, she didn't hesitate and immediately said YES, I want to go away for a little bit, I think I need that.

I am concerned that just making appointments with a new psych and starting down that road is just going to be another time waster since it's not as intensive as I think she needs and we need everything evaluated at once to get her on track. She's failing every class and it's affecting her self esteem, but she can't seem to dig out of the hole. For instance, she has an 18% in English, her strongest subject. She cannot go on like this.

I need support. I will disclose that I was hospitalized as a pre-adolescent/adolescent from ages 12-14 at least four times because I was just a behavioral issue and my mom didn;t know how to deal with me, I had so many family problems and I was medicated improperly and I do carry some of that baggage with me, so I admit to being reluctant to just "put her somewhere", but I recognize that that's MY baggage and I am willing to do what it takes to get my girl better.

I wonder how she might do with an online school?
Would someone be home with her to supervise if that was an option?

If she is saying she thinks about hurting people or herself, I think the therapist /docs need to pay attention to that..

I hope you can find a good resource to guide you.

bipolar useful sticky threads-
http://neurotalk.psychcentral.com/thread3275.html
http://neurotalk.psychcentral.com/thread302.html

Hi,
It is important for her to have some say so in her treatment. If she agreed to go to a new psychiatrist, take her.

Can you take her out of school? I would hate to be sixteen and miserable and have to go to school as well.

Getting a diagnosis and the right treatment sometimes takes many months. She will need a good psychologist with lots of experience in bipolar to help support her lifestyle and medication changes.

M

I could take her out of school, and I know that alone will be hard for her because it was such a big deal for her to get in to this school because it's a visual artsy early college program and she's such a gifted visual artist. The thing is that she will lose that, BUT she's already losing it because she is failing.

I absolutely have asked her what she wants to do because I agree that with her age, she should have a good amount of input and choice in her diagnosis and treatment. She is open to seeing a new psych or short term hospitalization.

I wish she had the motivation and focus to commit to an online school, but unless I hold her hand every step, at THIs time c I don't know if she can/will with her focus issues. But again, she's already doing poorly in school. We are currently about two months, maybe a little less? From the end of the school year and my hope (I realize this sounds selfish, but I assure you it's love) is that if we use the steps the teachers gave us in the parent teacher conference they insisted on this week, maybe she can pull it out and at least finish the semester with SOME credit since she's not going to get ANY for her time the way things are going.

It's really hard, I admit to be mom AND advocate because I really don't know what will help and what will hurt as far as trying to tie up ends.

So...now I have to decide, how will I find a good psych? The ones we've been to over the years have been unable to help in any significant way and they were referrals from current care providers.

Honestly,I'm feeling like these child psychiatrists that we've been dealing with aren't equipped and I just honestly worry we'll just spin our wheels even trying to FiND an outpatient diagnosis and treatment plan.

No, he has not been diagnosed and honestly, given how sick my mom stays from denial of treatment and added drug abuse, I WISH I were off base, but even he seems to be convinced she is bipolar or something very similar.

I have told her not to be afraid, she does NOT have to stay sick "like grandma" if we get her dx and tx early and well.

Anyway, I may try to look at options for outpatient before seriously considering impatient if possible. We really are very close and besides her not feeling well, having her issues, things are good at home and I don't want her to HAVE to be gone if its not necessary.

The harm to others has not come up since we addressed it with the psych and therapist about a year ago and I've asked get abOut it. If she's being straight up, which she usually is, she's not having those thoughts at this point, but who knows when/if that comes up again??

Sigh. As her mother, I SO want to do what it takes. Where is the parenting manual I was promised?? Especially the one for special needs children???

Hi,

How far are you from a major teaching hospital -- one usually associated with a university?
Psychiatrists there are often up to date on the latest research and protocols. Also, they can deal with people with complicated cases who are not properly treated in their communities.

I completely understand about the noise issue. Even those of us who are properly medicated have difficulty with sensory overload.

Possibly consider getting her some noise canceling headphones: http://en.wikipedia.org/wiki/Noise-c...ing_headphones
While you are waiting for an appropriate diagnosis and possible medication/s, you can do things to reduce her sensory overload.
Also, help her get enough sleep. Sleep is an important part of staying stable. Does she get some regular exercise like walking to the same time everyday?

If you have not done so, get a major blood work up from her family medical doctor: thyroid, other hormones, and so on. Check Vit D, . . .

Some people have found the book Bipolar for Dummies to be useful. It has a section on impact on friends and families.

M

Well, unfortunately we went to the nearest teaching hospital after calling and they told me I should bring her in through their ER. This is sort of the mac daddy of teaching hospitals in our area within about two hours from us...it's 40 minutes, nothing again for 2.5 hours from us. They said she's "not even close to meeting criteria for inpatient" and you could tell she was really frustrated at that point, since we went, she's been kicking herself that she didn't tell them what she should have because she really wanted to get IN somewhere and start feeling better. Makes me feel sad that I couldn't do that for her. The referrals they gave me were totally useless, they were to the local mental health crisis line, which was another dead end. I called her psych and her pediatrician to see if there's any way we can work out maybe a direct admit, but no one has called me.

There is another hospital in the other direction about an hour, not a teaching hospital, but has a large psych unit. They said they have about 4-6 hour ER wait time and they don't even have any beds open right now anyway.

Honestly, I'm just trying to keep her content and have the least stress right now because she's in such a "fragile" state right now as far as anxiety goes.

We've gotten regular bloodwork for her since she had a chronic immune issue for over a year and we still get it, but she seems to be "normal", although we're trying to get in with a new integrative psychiatrist and maybe they'll know which tests to definitely get which will show us what might be going on.

Hi,

In most states the ERs only admit due to 1) danger to self, or 2) danger to others. A few have a third criterion: 3) unable to care for self.

I found my amazing psychiatrist through the medical school in my city. I called and made an appointment. He was brilliant and he took good care of me.
Outpatient sounds like a good idea. You have to get that set up through a psychiatrist or a hospital. Check your insurance. Policies vary as to what is covered and how the outpatient program effects the number of visits she is allowed for the year.

That is a good plan.

Stretching the truth to get admitted is only good short term. She is doing a good job now of being clear and honest about what is going on and will get a good psychiatrist who is right for her.

I really hope that you get a call back from those folks Monday. If you do not, call them and push them some more.

If it helps, some teenagers sort of "out grow" these diagnoses. Or at least as they get older they learn to handle the diagnosis. She is lucky to have you close with her during this time.

M

Hi emom - I feel some of your pain. I have had my daughter in acute care facility 3 times now and a long term treatment facility once in the last 2 yrs. It is a difficult decision but I do not regret the decision I made because it was appropriate for my child. I think finding a new psychiatrist is warranted since the current one is not listening to you and your daughter. My daughter is newly diagnosed bipolar, with a previous MDD diagnosis for 2 yrs. Many times she gets completely out of control and is a danger to herself. These are the times I have had to hospitalize her. It was a relief to me knowing that she was somewhere safe. Good luck to you.

Hi Emom. Welcome to Neuro Talk. I am sorry your family is going through these issues. If your child is talking about hurting someone, or herself or family, this is something to pay attention to. I would indeed have her evaluated and go down any road you have to, to get her the help she needs. If one road doesn't work, you find one that will. An in hospital stay can somtimes do wonders. This can be a good experience for her, and maybe get her on a better track. You are doing great, by wanting the best for her. ginnie

[QUOTE=emom;860779]My daughter is 16 and has had an obvious anxiety problem that's been identifiable for at least 5 years. She was put on Zoloft at first and that did seem to help, but at the same time had been diagnosed with ADHD.
She also had to discontinue her ADHD meds last year because it became apparent that they were causing her anxiety to go through the roof.

Hi emom,
My daughter is also 16 and just diagnosed with bipolar II disorder, after 2 1/2 years of new issues constantly arising. My daughter was also told at first that she had depression/anxiety issues (rather than BPD) and ADD.
I am still learning myself, but wanted to let you know one thing I've learned that can help you. Antidepressants, as well as stimulants used to treat ADHD can trigger manic or depressive symptoms (or both) in BPD people, as well as make the condition permanently worse. (Which may be why your daughter had the reaction she did to her ADHD medicine)
I would seek another psychiatrist, and before making an appointment, ask them if they regularly see/treat patients with bipolar disorder. I am reading a very helpful book I also highly suggest (super easy to read and understand, written by a Doctor) called "The Bipolar Handbook for Children, Teens, and Families" by Wes Burgess. I'm only on chapter 5, but its really helping me understand and (hopefully better prepared). I don't know about you, but I feel totally isolated by this, and by the constant crisis', and the trouble my daughter gets in and its resulting consequences; I'm hoping understanding will help...
Prayers for you both,
MK