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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by AnneL on April 3, 2001, at 0:03:50
My 13 year old daughter has been diagnosed with Panic disorder and OCD. She was started on Zoloft about 3 weeks ago. She has been living with my mother and sister for the past 7 weeks (that's another story) and
has seemingly made some progress, but remains very, very moody. Her therapist called me today and said that she needs to be hospitalized because she is expressing a desire to "jump out a window" or "drink something poisonous". She is on 24 hour watch by my Mom and sister while we find her an adolescent hospital program. She did express relief and requested hospitalization. She said she heard a "woman's voice" yesterday, which is something she experienced about 5 years ago and it lasted for about 1 month. With some counseling, it seemed to disappear as mysteriously as it came on. We are looking into a program at UCLA and hope they have a bed available. Her psychiatrist does not admit patients so I have no idea what I am doing. Please help! Thanks AnneL
Posted by Sulpicia on April 3, 2001, at 4:44:29
In reply to Panic Disorder/OCD/Suicidal Ideation HELP!, posted by AnneL on April 3, 2001, at 0:03:50
> Hi
I'm so sorry that your daughter is so ill. I have a 15 y/o who has
had some rough times too.
Clearly you need an expert diagnostician since neither panic disorders
nor OCD cause psychosis or suicidal ideation. I'm somewhat dismayed that
in view of her prior history she's still got this diagnosis.
One warning sign here for me at least is her reaction to the zoloft.
When I hear about a reaction like this, I immediately wonder about bipolar
disorder, which can be set off by anti depressant meds. Moody also makes me wonder.
I'm sure there is a longer history here but for the present probably
the best thing you can do is look on the web or in the phone book
for the local chapter of NAMI [national association for the mentally ill].
They can give you a ton of support and often have meetings or support people
available at the hospital.The other really helpful thing to do is get educated on the disorders
and their treatments. A good place to start are the links at this site.
About the adolescent bed -- great if you can find it but remember she
can also be admitted thru the emergency room and they often have better
connections. Suicidal ideation is a bona fide emergency and your mom
is not a professional. Trust me on this one, a single untrained person
cannot do a 24 hour suicide watch. Another possibility might be to get
round the clock help by asking her pdoc. I know that this sort of care
is available. Perhaps you could try to access it.Were I in your shoes [and I have been there] I would take her to the
emergency room and get her admitted. Let her wait for the bed in safety.
You actually do have an emergency on your hands.Let us know how things work out.
S.
Posted by AnneL on April 3, 2001, at 13:16:29
In reply to Re: Panic Disorder/OCD/Suicidal Ideation HELP! » AnneL, posted by Sulpicia on April 3, 2001, at 4:44:29
> > Hi
> I'm so sorry that your daughter is so ill. I have a 15 y/o who has
> had some rough times too.
> Clearly you need an expert diagnostician since neither panic disorders
> nor OCD cause psychosis or suicidal ideation. I'm somewhat dismayed that
> in view of her prior history she's still got this diagnosis.
> One warning sign here for me at least is her reaction to the zoloft.
> When I hear about a reaction like this, I immediately wonder about bipolar
> disorder, which can be set off by anti depressant meds. Moody also makes me wonder.
> I'm sure there is a longer history here but for the present probably
> the best thing you can do is look on the web or in the phone book
> for the local chapter of NAMI [national association for the mentally ill].
> They can give you a ton of support and often have meetings or support people
> available at the hospital.
>
> The other really helpful thing to do is get educated on the disorders
> and their treatments. A good place to start are the links at this site.
> About the adolescent bed -- great if you can find it but remember she
> can also be admitted thru the emergency room and they often have better
> connections. Suicidal ideation is a bona fide emergency and your mom
> is not a professional. Trust me on this one, a single untrained person
> cannot do a 24 hour suicide watch. Another possibility might be to get
> round the clock help by asking her pdoc. I know that this sort of care
> is available. Perhaps you could try to access it.
>
> Were I in your shoes [and I have been there] I would take her to the
> emergency room and get her admitted. Let her wait for the bed in safety.
> You actually do have an emergency on your hands.
>
> Let us know how things work out.
> S.Thank you very much for responding. I agree with you entirely and I have questioned her diagnosis and response to the Zoloft as well. We are taking her to Northridge Medical Center to the ER for psychiatric evaluation and admission to their adolescent inpatient program. Our first choice is UCLA, but there are no beds, and time does not permit. I agree that this is a bona fide emergency and know that even though she is calm right now, that could mean that she is actually plotting her suicide. I will keep all posted and hope that the admission process goes as smooth as possible. And I pray for an accurate diagnosis and proper medical treatment. I will be researching all that I can on various mental disorders so I can be armed with knowledge. Thank you again for alll your help. AnneL
Posted by Sulpicia on April 3, 2001, at 19:31:48
In reply to Re: Panic Disorder/OCD/Suicidal Ideation HELP! » Sulpicia, posted by AnneL on April 3, 2001, at 13:16:29
> > Excellent that you're moving quickly here.
At some point find out the law in CA on voluntary/involuntary
admissions and age. I suggest this bcuz in my state if they are
over 14 they can refuse to sign in, in which case you have to file a
petition and do it involuntarily. It's a bit unnerving at first in terms
of paper work and rules. I've found it's best to be prepared.
Try to grab as many phone numbers of people on the unit as possible,
like her nurse, unit manager, therapist etc.
Visit if you can and be prepared for the possibility of her being *really*
mad at you. One last suggestion: your child will seem extremely normal to you
and you will probably witness some nasty acting out [normal for kids w/out
visitors in a psych hospital] but don't let her convince you that she doesn't
need to be there.
I'll keep checking back here. Depending on diagnosis I may be able to offer some
great on-line support communities in addition to this one.
And remember: you're doing the right thing, you're keeping her alive, and don't
let her play on you so you feel otherwise.
Best,
S.
Posted by AnneL on April 4, 2001, at 1:14:46
In reply to Re: Panic Disorder/OCD/Suicidal Ideation HELP! » AnneL, posted by Sulpicia on April 3, 2001, at 19:31:48
> > > Excellent that you're moving quickly here.
> At some point find out the law in CA on voluntary/involuntary
> admissions and age. I suggest this bcuz in my state if they are
> over 14 they can refuse to sign in, in which case you have to file a
> petition and do it involuntarily. It's a bit unnerving at first in terms
> of paper work and rules. I've found it's best to be prepared.
> Try to grab as many phone numbers of people on the unit as possible,
> like her nurse, unit manager, therapist etc.
> Visit if you can and be prepared for the possibility of her being *really*
> mad at you. One last suggestion: your child will seem extremely normal to you
> and you will probably witness some nasty acting out [normal for kids w/out
> visitors in a psych hospital] but don't let her convince you that she doesn't
> need to be there.
> I'll keep checking back here. Depending on diagnosis I may be able to offer some
> great on-line support communities in addition to this one.
> And remember: you're doing the right thing, you're keeping her alive, and don't
> let her play on you so you feel otherwise.
> Best,
> S.Hi,
We made it! Got to the ER at 1:00 PM and we were on the adolescent unit by 6:00 PM! Long wait, first had to go through triage, social worker, medical exam and wait for insurance clearance, but somehow it did go smoothly. Even though my daughter requested to be hospitalized, she freaked when the reality hit her. They asked her to remove the shoelaces from her shoes, checked her bra and panties and everything she brought with her, urine specimen, etc. She cried and cried and cried and although I was very stoic through the entire scene, my mother and sister who have tried to be therapist, pdoc and substitute mom for the last 7 weeks were quite shaken, but they held up. She will see the attending pdoc tomorrow morning for eval. The one thing that really hurts is that since she left our home 7 weeks ago for some space between her and I (it was only supposed to be a week cooling down period), she told all the nurses on the unit that she dosen't want to see me! I know that her illness (whatever her diagnosis turns out to be) is adding to her inability to handle conflict and confrontation, but it just kills me that she has become so attached to my sister and practically ignores me. I know, I have to be the adult in this and as my sister puts it, Holly (my daughter) feels like a "bad kid" and if I reject her than it makes it true. I know this is rambling and thank you for "listening". I've never experienced this before in my life. Thanks, AnneL
Posted by Sulpicia on April 4, 2001, at 17:18:30
In reply to Re: Panic Disorder/OCD/Suicidal Ideation HELP! » Sulpicia, posted by AnneL on April 4, 2001, at 1:14:46
> > Oh god have I been there. My daughter actually hit me when we came to visit
the day after her admission. Just be stoic and matter-of-fact and realize that it
will get better. This is just about the only thing she can control right now, so I
bet you can guess how she is feeling. I managed to cheer mine up on the second day
with food -- perhaps a favorite treat? She will also get a bit more cheerful once she
starts to earn privileges. When they're first admitted they have none and are subject
to a ton of restrictions. Absent active psychosis or violence or suicidal stuff, they
usually get privileges fairly quickly. It sounds awful that I know this system so well.
My daughter was most interested in change for the vending machines -- a most coveted
thing!Two things to keep in mind at this point, aside from keeping your own head together
[keep repeating "this is not my fault", because it isn't], 1]don't bring a ton of her
stuff to the unit. It will get lost, stolen, destroyed, or argued over.
2]Unless you are totally blessed, the staff will start discharge planning immediately.
Do not allow yourself to be bullied or coerced. It took us 4 admissions until they did\
the right thing -- which was to send her to a longer-term facility that specialized in
treatment of dual-diagnosis. I'm sure this won't happen to you but I mention it only f
from bitter experience -- the bottom line is that you can refuse to take her home if you
believe it's inappropriate. The staff will threaten to call child welfare and prosecute
on charges of abandonment, but the reality is they won't. It does help if you can have
the pdoc who was treating her as an outpatient speak to the unit pdoc. Don't assume that
they would contact each other.Make sure the unit pdoc communicates with you personally -- as in in person, rather than
some silly telephone tag game. Bring paper and pencil, write things down, ask questions,
and get phone numbers so you can follow up when the inevitable questions come to you later.While I remember this, regarding your insurance, they will more than likely act like jerks
at some point. Check out the appeals process NOW, just in case so you know time limits and
process. Also, little known trick: if you feel your child must stay inpatient and the insurance
denies it, you can pay the per-diem rate at the hospital at the capitated rate -- i.e. the same
discounted rate that the insurance co. would pay to the hospital IF YOU ASK FOR IT. YOu can
go after compensation later and your child will still be in treatment.Take care of yourself and I hope you get a good clear diagnosis.
I'll check back later.
Best,
Liz
Posted by AnneL on April 4, 2001, at 18:55:21
In reply to Re: Panic Disorder/OCD/Suicidal Ideation HELP! » AnneL, posted by Sulpicia on April 4, 2001, at 17:18:30
> > > > > Hi Liz,
Thanks for responding to my rambling thoughts, its so great to have someone who understands and has been there! We are ready for the discharge planner! I have already called UCLA Child and Adolescent Anxiety Program and have been financially cleared. The intake coordinator will be calling me for initiating the assessment process. My plan is for Holly to go from inpatient when appropriate to d/c her (Now I know not to let myself get pushed around!) to either an inpatient our partial outpatient program (8:30 to 3:30) everyday. Evidently UCLA is well-known for their excellent testing and diagnosis as well as their multidisciplinary approach. I spoke to Holly this morning during her phone privilege time and she sounded quite pleasant (she must be so relieved to be getting away from it all) and said she would like to see her Aunt Julie on visiting days and would like to see me on Family group/process days (Mon, Thur, & Sat). It's kind of funny because in all actuality she has no choice about me being there on group days because its mandatory! But, I took it as a positive step in the right direction. I have no faith that any of this immediate inpatient business will lead to a correct diagnosis or medication plan, but she is safe and her anxiety level is coming down and my major goal is to get her to what I consider to be one of the better chances of getting an appropriate diagnosis and treatment. Thanks again for listening and keep the good advice coming, its so much appreciated. Anne
Posted by Sulpicia on April 4, 2001, at 22:57:36
In reply to Re: Panic Disorder/OCD/Suicidal Ideation HELP! » Sulpicia, posted by AnneL on April 4, 2001, at 18:55:21
> >Sounds good so far. I realize that our kids are totally different but we did the
partial hospitalization program and there are some issues you may wish to consider.
I'm not clear about where she would be living, but if there is stress or issues about
this, perhaps this might be a strike against the partial program.
Please make sure *exactly* what the partial program is. Ours was the same unit as the
inpatient, and yes they have groups and such, but it really boiled down to being confined
to an acute adolescent unit for 8 hrs a day. It wasn't much of a theraputic mileux [sp?] and
it was damn expensive. That said, it's not a bad way to step down after a longish stay
inpatient -- sort of like readjustment.
Also consider that she may be on meds that make getting up in the morning VERY difficult.
It may be more trouble than it's worth to get a kid adjusting to meds up and dressed and
there by 8:30.Depending on diagnosis and medication, it will take at the very least 7 days for the
quickest of the AD meds to show any effect. Often it will take longer, or she will need
to try several different meds before something is achieved. Ideally we'd love for the kid
to be inpatient until the med situation is perfect but these days it more than likely won't
happen. Fight like a tiger to avoid bringing her home if:
she can't sleep
she can't eat, or has side effects to the extent that you think she can't wait them out.
is very sedated -- like falling down.
is agitated, hyper, extremely happy, or still severely depressed so you're afraid of suicide.
Side effects like these are unlikely but don't let the staff brush you off if you see something
you don't like or understand.
This sounds terrible but get rid of any tylenol or products containing it. The odds are she'll
be fine but you want to avoid having anything around that might be used in an impulsive moment.
Tylenol can destroy your liver from a relatively mild overdose.
Good luck with the diagnosis, and by the way, you're doing great!
Best,
Liz
Posted by AnneL on April 7, 2001, at 21:21:41
In reply to Re: Panic Disorder/OCD/Suicidal Ideation HELP! » AnneL, posted by Sulpicia on April 4, 2001, at 22:57:36
> > >Hi Liz.
Just wanted to update you on my daughter's progress and get some things off my chest. Actually hospitalization has been the best thing to help get rid of what I call the "logjam" for my daughter. Besides starting on Effexor XR (I also take it with very good results and her pdoc thought we might as well give it a try), the parent group and family group meetings have been very, very helpful in getting our daughter to express herself. Although I intellectually realize that my daughter was genetically programed from the start for a mental illness (depression and OCD along with panic disorder does run in both sides of the family), I am experiencing the usual mom-guilt of wishing I had done this or that differently. I'am working out this stuff as best I can. I came to the realization yesterday that my daughter's conflict of where she lives and reluctance to come home not only stems from her dislike of her step-dad and some disappointments in me, but probably more importantly she has reached that developmental age where she really needs her father. Discharge is around the corner and her Dad and I decided that we will give her a "trial" 90 day time in which to connect and get some daddy-love in Tucson. We have stressed to her that this is open-ended, in other words, my front door is always open should she choose to come back to live with me. This is the short version and you might imagine how difficult it is to do the "right" thing even when it means letting go. . . the grief process is horrible, but necessary and I realize that it is very difficult for my daughter as well. She can't live with me at this point in her life and she can't live without me. Her Dad and I will be putting together a "contract" so that contact between her and I will be expected so that we can both go through the process of healing our relationship in time and when the universe sees fit (and her meds kick in!) Thank you for listening. I really needed to "tell" you this. Thanks, Laurie
(as in Laurie Anne)
Posted by Sulpicia on April 8, 2001, at 14:01:22
In reply to Re: Panic Disorder/OCD/Suicidal Ideation HELP! » Sulpicia, posted by AnneL on April 7, 2001, at 21:21:41
>Hi Laurie --
I'm so glad your daughter is getting good help. It also sounds like she has a *very* special
mom, and an insightful one too. I went thru much of the same stuff when my daughter was diagnosed.
I *should* have recognized the symptoms. For me, at the time of diagnosis, and currently, a real
issue is that I'm in graduate school. The *clever* deans mandate on-campus residency. This, combined
with a staggering work load, means that I don't see my family for weeks at a time. My daughter of course
resents this like mad and it's been and continues to be, a huge issue.
I can well imagine the grief of letting her go to live with her father. Ideally it should help her to realize
that both parents love her -- and possibly that life with Dad is not the bed of roses she imagined.I've never come up with a way to deal with the familial component of mental illness. I suffer from depression
and ADD, and have over a decade of sobriety. My daughter got all the crap I had to deal with, and bipolar too.
In my more rational moments, I can see that she also got the humor, intelligence, and compassion that comes with
this inheritance, but it still makes me feel horrible.Probably for now, as you deal with this, two things might be useful. First, make sure her dad is *very* clear
about her diagnosis, it's severity, treatment, and any warning signs. It's easy to brush off indications of serious
trouble if you're unfamiliar with this sort of thing. The other thing that will help both you and your daughter is
to set up a relatively hassle-free way of communication. Make sure she either has email or perhaps a pre-paid phone
card or a pre-paid cell phone. And you may have to take the initiative too. I'm sure it will help her to know that
she hasn't closed the door to you -- a concern which would upset her tremendously I suspect.The last thing is to find some support for yourself. Perhaps a parents group thru NAMI? Can you ask at the hospital?
I think it's really important that you are validated and supported for making such a selfless decision to help your
daughter.
Your daughter is very lucky to have a mom like you, and tho she may not demonstrate any awareness, I very much suspect
that she knows it, and in time, will come to respect and love you all the more.
I check this board regularly so please keep in touch.
Best,
Liz
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