Hospitalization for mental illness

[Anonymous]

I did a search for CR2 and found this thread. Does anyone have any recent reviews of inpatient options. OP, if you are still around, how did your son do?

[Anonymous]

Anonymous wrote:OP here. The psychiatrist has a long term plan (a 2-3 year plan), but nothing seems to be getting better, and these rages are destroying our other kids (and us, but whatever). They pop up at random times and there is no stopping them until they run their course. And in the meantime, he's not going to school and is not functioning in society. And we have less than a year until he's 18 and we lose some levers to get him care. I'm just at a loss.

This is tough. I'm so sorry. Have you considered partial day hospitalization?

[Anonymous]

This is an old thread that PP bumped for more info, but I hope OP's ds is doing much better also.

[Anonymous]

Anonymous wrote:I did a search for CR2 and found this thread. Does anyone have any recent reviews of inpatient options. OP, if you are still around, how did your son do?

NP. I liked Adventist Behavioral Health. Medstar Montgomery was also fine. The problem with I patient was what people said a few years back. You get short term stabilization and maybe started on a trial of medication or a medication change. What I found worked best (after trying multiple rounds of inpatient t, partial and intensive outpatient) was residential treatment.

[Anonymous]

Could you recommend your residential treatment? Please’d child went to Barry Robinson but my understanding is that’s for military families only....

[Anonymous]

Anonymous wrote:Could you recommend your residential treatment? Please’d child went to Barry Robinson but my understanding is that’s for military families only....

Elk River Treatment Program.

I’ve heard some kids had success at Rogers.

[Anonymous]

I just wanted to echo that the genetic swab profiles for drug interaction are invaluable for anyone needing medication treatments. So many of the challenges with mental health treatment come from experimenting with a medication, seeing if it works, seeing if it needs to be stronger, and then when you need to try an alternative, tapering down in one before gearing up in another. It’s a hard, rocky process for the patient and their families as they go through that, sometimes over and over. The genetic profile takes away almost all of that experimentation and helps the doctors prescribe the most potentially successful, least problematic medication right away at the most likely to be successful dose. It can be expensive...it cost us $300 and that was with the insurance company covering the rest. But it has been invaluable, and will be useful for medication prescriptions their whole life. It covers a large number of drug families, particularly those covering mental health.

[Anonymous]

No advice, but just offering support and hoping it all goes smoothly OP!!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

OP - So sorry your son and your famly are going through this. I can only relate that our oldest daughter was a very, very hard case to identify in terms of medications and she was not identified as having a mental health issue until she went away to college and it reached the point that she hospitalized herself. It was a very, very hard time for all as on paper she was just what every parent would want in a daughter, student, community member etc. She had to withdraw from a top tier college, came home and fortunately found a good psychiatrist here to work with though as you have seen there were ups and downs over her college and grad school years. Since you seem so at the end of your rope, I will share some of the things that may be considered:

- She was very hard to diagnose, beyond the anxiety - but probably was a derivative of the bi-polar family. But with not classic it was hard to say if meds dealing with that would help. Ativan was med given to her to help keep mood stabilized, but more to take when in a panic or escalating situation. As an adult she still uses it today when she knows she will be in overtly stressful environment.

- She could get started on something and have her anxiety and her "acting out" escalate which for her was calling others on the phone or when home being in your face and unable to sleep. And I mean she could go without sleep or much for days even taking meds. I would definitely say this is not the med to start with if it can be avoided at all, but she was put on Klonopin at least for a time. It was the severe lack of sleep, fueled by anxiety that could escalate though not in dangerous behavior, but still very debilitating such as no concentration etc.

- Inability to sleep runs in the family and when my husband had an adjustment to retirement a few years ago, the same psychiatrist helped him to get his system righted, BUT the key was finding a sleep medicine. What finally worked was an older medication called Doxepin. For him the fact that it also seems to deal with allergies was also very helpful as that had been the start of a physical downturn at the same time.

- For her anxiety/depression she, too, went through several medications while in college and then grad school, and it was very frustrating because one would work for even a couple of years and then seem not to. And you probably due know that to really try a new one or mix means coming off for a period of time. I know at one time she was on Lithium, which while scary to think of, really did work in bringing her system into balance. Eventually she found Lexapro to work.

- In terms of treatment she always had a team of a psychiatrist and a psychologist, who worked together though not in the same practice group. While in graduate school after two years of great stability, things came apart again and at that time, it was recommended she go to a day treatment program so she could also pick up her school program as soon as possible because it was important that she reestablish a routine.

- The impact on the siblings as well as parents is real, and you can't isolate one from the other. About the best you can do is to try and spend special time with the other siblings and let them know they are loved and that the one in turmoil is due to an illness.

- Are there no options in the DC area for a hospital based day program with an educational component once the teen is stabilized? Or it would seem if you get your son into a hospital for stabilization that he would need to be released to a therapeutic day treatment program to start with.

Not sure any of this will apply, but thought I would share.

I am very sympathetic to how hard it is to diagnose kids and adolescents with mental illness. No one wants to mistakenly label a child. Behaviors which in other populations would be considered diagnostic symptoms are often problematic, but dismissed as "within the range of normal" for an adolescent (i.e. because parents and doctors refer to adolescent hormone swings, risk-taking behavior, and moodiness as normal).

BUT, I just want to point out that there are a few key clues that seem to have been overlooked in your situation, which, when properly considered, point convincingly to a bipolar spectrum diagnosis. Your description of talking on the phone a lot, being in your face and being unable to sleep are pretty much hallmarks of hypomania. There are 2 variations on mania -- the one most people recognize is "frank" mania which is pretty much so manic so as to be disconnected from reality w/ paranoia, delusions of grandeur or extreme hyperactivity. But, hypomania, is a sort of "lower degree" of mania, and it is often misattributed by doctors and family members as behavior that is normal or the result of choice.

Also, the problems with sleep that run int he family is a clue that points heavily to bipolar. Sleep disturbance is a prime component of bipolar and people often mis-attribute the cause of sleep disturbance to anxiety, when both the anxiety and lack of sleep are caused by the underlying bipolar.

Cyclicity is hinted at when you mention that medication that coincided with a regular downturn that occurs with seasonal allergies is also common with bipolar.

Finally, the fact that Lithium worked so well, is a fact weighing in favor of bipolar diagnosis.

A lot of times, bipolar goes undiagnosed while doctors try anti-anxiety meds, sleep medications and/or depressants, either alone or in combination. When one of these medications is tried, they will often seem to work for awhile until the patient cycles either up or down. The doctor and patient think the medication has "stopped working" when really the problem is the wrong diagnosis and wrong class of medications.

All of this is why it's really, really critical to be working with a highly experienced psychiatrist who isn't just doing 15 minute medication checks, and who has a lot of experience depressive disorders so that a proper diagnosis can be made.

There are many good books that describe bipolar, but I really like Frances Mondimore's Bipolar Disorder: Guide for Families and Patients (or something like that). It has a really good overview of symptoms, variations, medications, psychotherapy, etc.

I was diagnosed as a late teen with bipolar and had these symptoms. Lithium calmed me down. And made me gain 60 pounds in 4 months. Within 5 years other MDs said I’m definitely not bipolar. 20 years later I was diagnosed with ADHD. ADHD meds turned my life around, plus trauma therapy for going a lifetime with undiagnosed ADHD.

Always get a neuropsychological exam from a reputable NEUROpsychologist. I wasted 30 years leaning on psychiatrists, each who has their own “speciality”/POV. As I understand it, psychiatrists get just a couple of days in med school on ADHD and I have yet to find one that understands ADHD and autism very well. Nor do they understand trauma very well. One psychiatrist told me, “As well meaning as we are, we are drug pushers. We don’t have the time to listen.” I would say that I’ve had great therapists, but until I got a specifically trauma-centric therapists, I could not heal fully.

[Anonymous]

It’s important to understand “adverse effects” of pharmaceuticals. If a person has tried a series of drugs in one area (antipsychotics, SSRIs) and they aren’t getting better, researchers say it’s because the patient does not have that particular problem. ADHD meds won’t help a bipolar and bipolar meds won’t help anxiety or neurodiversity.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP here. The psychiatrist has a long term plan (a 2-3 year plan), but nothing seems to be getting better, and these rages are destroying our other kids (and us, but whatever). They pop up at random times and there is no stopping them until they run their course. And in the meantime, he's not going to school and is not functioning in society. And we have less than a year until he's 18 and we lose some levers to get him care. I'm just at a loss.

I am concerned that the doctor cannot control the outbursts with meds. This alone is a good reason to hospitalize and tweek meds under 24 hour supervision. Have you seeked a second opinion?

OP here. This is his fourth psychiatrist, although the first since he had a real breakdown in his ability to deal with anxiety at all. The biggest problem is his lack of sleep. The doc keeps tinkering with his meds, but nothing seems to enable him to sleep at night and function during the day (the meds that make him sleep render him totally nonfunctional).

My DS has psychosis and takes chlorpromazine. It makes him fall asleep within 60-90 mins.

[Anonymous]

Anonymous wrote:So far docs have been unanimous that he is not schizophrenic or bipolar--so not sure abilify is the right thing yet. Too soon to tell yet if last night changes that view.
I think perhaps based on what I'm hearing here is that what he needs is a residential program, rather than crisis hospitalization. Any suggestions as to how to begin that process? I do not want to warehouse him--I contine to have hope that he can get through this. But he will fight it every step of the way.

Meds like Abilify, Seroquel and Latuda are mood stabilizers and can also help with rage. They are not just for bipolar or schitzophrenia. Our DD who had major depression and anxiety has tried each and is currently on Latuda. It definitely helps her bring down her anger surges.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP here. The psychiatrist has a long term plan (a 2-3 year plan), but nothing seems to be getting better, and these rages are destroying our other kids (and us, but whatever). They pop up at random times and there is no stopping them until they run their course. And in the meantime, he's not going to school and is not functioning in society. And we have less than a year until he's 18 and we lose some levers to get him care. I'm just at a loss.

I am concerned that the doctor cannot control the outbursts with meds. This alone is a good reason to hospitalize and tweek meds under 24 hour supervision. Have you seeked a second opinion?

OP here. This is his fourth psychiatrist, although the first since he had a real breakdown in his ability to deal with anxiety at all. The biggest problem is his lack of sleep. The doc keeps tinkering with his meds, but nothing seems to enable him to sleep at night and function during the day (the meds that make him sleep render him totally nonfunctional).

Have you talked to the doc about the big guns, like Abilify? Have you done a genetic test for med absorbtion (genesight)?

Was going to suggest something similar. My DD had SSRI-resistant anxiety and was put on Zyprexa, an anti-psychotic. While I am not a fan of this class of drugs (and have written here before about that, extreme caution is required), Zyprexa has helped a lot and she is now on a quite low dose doing fine. Her anxiety attacks were terrible and very destructive. Not rage exactly but she would scream hateful things and would systematically and almost robotically trash everything around her as though she were in a trance.

Sorry but that is NOT anxiety.

[Anonymous]

Call your insurance and find an in patient treatment facility with beds. Sometimes the hospitalization is so you can get prioritized in a facility besides the stabilization part.

[Anonymous]

With kids it isn't exactly the same "danger to self or others" that it might be with adults. Like if the kid can't function in school at all. The first time for us it was partial hospitalization (grade 2), second time inpatient (grade 4, dx was a psychotic disorder at that point in time), third time inpatient at age 14.

But it's mostly to figure out how to stabilize on meds. Inpatient in our case was a few weeks both times. Kid was already involved with a psychologist the first time and psychiatrists the subsequent times. I suppose I kind of thought this would result in greater insight or something (for us, at least) but not really.

When he was hospitalized at 14 I wrote my own summary covering the past several years as well as what had been going on more recently. I was very pleased that the attending psychiatrist (not the same person as his outpatient, and that was when I first learn that in any kind of hospital there generally isn't involvement with outpatient providers) read it and told me that he appreciated having that info. We were also having some issues with a couple of the staff in the unit and the psychiatrist allowed our son more passes than said staff would have liked.