Tag Archives: bipolar

Weekend Review

A nice long weekend.   The Captain was mostly good, handling change / transitions / disruptions (not getting his way) well for the most part.   Sunday night he got the Melatonin about an hour before actual bedtime and for the first time in weeks, he went right to sleep without any tantrum or complaint.

Aha!  We had discovered the key.   Previously, we had given him the Melatonin about 20 minutes prior to bedtime (per the bottle’s instruction).   Perhaps he needed to be really tired before it would kick in so smoothly.

We tried this method again last night, but it failed.   It may have worked though, if he hadn’t received a call from Grandma last night, and wanted to spend the night at their house.  His tantrum last night was over not being able to go.   He blamed his brother because his brother didn’t want to go.

This morning, he woke up early again, before 5am, and quietly had breakfast, took a shower, and started being helpful, cleaning.  He’s a different person in the morning.

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An Apology

At The Captain’s appointment last night with the psychiatrist, The Doctor told him that he needed to apologize to his brother about having attacked him with a piece of wood.

Inwardly, I rolled my eyes.  We have had this conversation with this boy.  It does not work.  He does not apologize, or if he does, it is never, ever heartfelt.

The Captain responded with obligatory answers and nods.

The Doctor said he needed to buy a card for his brother, and write his apology in it.  He said that would be a big deal and that we would all be very proud of him for doing it.  He told us to make it a HUGE deal, and celebrate the moment with cake.

Eyes still inwardly rolling, we left and stopped at the store on the way home for the card.   He picked out a blank card with cats on it, and wrote “I’m sorry for hitting you” on the inside, and drew a picture of a person crying a lot.

When we got home, he gave the card to his brother and watched him open it.   His brother smiled and The Captain wrapped his arms around his brother, without prompting, and said “I’m sorry” and “I love you.”

We were amazed.  And The Captain noted that the cake was indeed, not a lie.

Afterwards, we had cake, and he was really, actually, very proud of himself.

New Research in Juvenile Bipolar

I’m reading about new research regarding childhood bipolar, which includes changing the way they categorize the disorder into a dimensional approach, because of the frequent overlap (comorbidity) of other disorders.

Other symptoms of juvenile bipolar disorder (all of which are true for The Captain except the nightmares):

  • deflects blame
  • suffers horrendous nightmares
  • antagonizes siblings
  • excessively craves sweets and carbohydrates
  • functions in mission mode
  • wets the bed
  • sleeps hot
  • takes excessive risks
  • hoards food
  • has many ideas at once
  • interrupts or intrudes on others
  • experiences periods of self-doubt and poor self-esteem

One of the phenotypes they’ve identified is the “Fear of Harm” phenotype (The Captain’s matches in bold and red).

Territorial Aggression

  • is willful or refuses to be subordinated by others
  • argues with adults
  • defies or refuses to comply with rules
  • is easily angered in response to limit setting
  • is bossy towards others
  • relentlessly pursues own needs and is demanding of others
  • blames others for his/her mistakes
  • has protracted, explosive temper tantrums
  • displays aggressive behavior towards others
  • has irritable mood states
  • lies to avoid consequences of his/her actions
  • is intolerant of delays
  • has difficulty maintaining friendships

Attention / Executive Function

  • has difficulty organizing tasks
  • demonstrates inability to concentrate at school
  • is easily distracted during repetitive chores and tasks
  • attempts to avoid homework assignments
  • has poor handwriting
  • is easily distracted by external stimuli
  • has difficulty estimating time
  • able to focus intensely on subjects of interest and yet at times is easily distractible
  • has auditory processing or short-term memory deficit
  • has difficulty making transitions

Mania

  • has periods of high, frenetic energy and motor activation
  • has period of excessive and rapid speech
  • has many ideas at once
  • has elated or giddy, goofy, silly mood states
  • is easily excitable
  • interrupts or intrudes on others
  • is hyperactive or easily excited in the PM
  • displays abrupt, rapid mood swings
  • fidgets with hands or feet
  • is very intuitive and/or creative
  • tells tall tales; embellishes or exaggerates
  • has exaggerated ideas about self or abilities

Harm To Self Or Others

  • Makes clear threats of violence to others or self
  • Makes moderate threats of violence to others or self
  • Has made clear threats of suicide
  • Curses violently, uses foul language in anger
  • Has destroyed property intentionally
  • Is fascinated with gore, blood, or violent imagery

Self-Esteem

  • feels easily criticized and/or rejected
  • feels easily humiliated or shamed
  • experiences periods of self doubt and poor self-esteem
  • complains of being bored
  • has periods of low energy and/or withdrawals or isolates self
  • has decreased initiative

Sleep/Arousal

  • has difficulty getting to sleep
  • has difficulty settling at night
  • sleeps fitfully or wakes in the middle of the night
  • has difficulty rising in the AM

Sensory

  • is extremely sensitive to the textures of clothes, labels, and tightness of fit or socks and shores
  • exhibits extreme sensitivity to sound and noise
  • complains of body temperature extremes or feeling hot despite neutral ambient temperature

Hypersexuality

  • displays precocious sexual curiosity
  • exhibits inappropriate sexual behaviors (openly touches self or others’ private parts)

PPSO

  • wets bed
  • has night terrors and/or nightmares
  • hoards or avidly seeks to collect objects or foods
  • has acknowledged experiencing auditory and/or visual hallucinations
  • craves sweet tasting food
  • has concerns with dirt, germs, or contamination

Anxiety

  • displays excessive distress when separated from family
  • exhibits excessive anxiety or worry

…  and what does that all mean?

The expectation is that, when we identify the causative genes for bipolar disorder, we will be able to point to a network of signaling pathways in the brain that regulate specific behaviors associated with the condition. Once researchers are able to isolate the genes involved and understand their functions, the development of more targeted treatments becomes a real possibility.

Bipolar Mission Mode

When I read in The Bipolar Child about “Mission Mode,” it really hit home.  The Captain at least once a day finds an unreasonable request that he must continually ask for every five minutes.

Mission Mode is the bipolar child’s intense need to do something, where no amount of reasoning or discussion can deter them.

Their sheer persistence is all-encompassing and they become very adept at blocking out any agenda but their own (which they are feeling very intently and very urgently)

They are inflexible–they perseverate or can’t move off a topic, they can’t anticipate that this kind of behavior will bring negative reactions from those under assault by their perseverative plans, and they have impulse control problems and cannot wait for something. (They may also be anxious that they will forget what it is they want; or they may be using this sudden gusto about a project or new idea to focus their thinking.) The new idea may be a stabilizing force that supplies an external structure because deep down inside they are afraid they are disappearing down the rabbit hole. They experience their need as an emergency situation, and so urgent that it is as if their very survival depends on their getting whatever it is they think they have to have. Any refusal on the parent’s part seems to make them feel unprotected and unloved.

From what I gather, once a child is stabilized with medication (which I am not sure yet if The Captain can be described as such), ignoring him and repeating your response, and using cognitive mediators is the solution to this.  (see links above)

Early Onset Bipolar Red Flag Symptoms

IN reviewing the “red flag symptoms” of bipolar in children, here’s how The Captain stacks up (ones that match are bolded and red):

Very Common Symptoms of Early-Onset Bipolar Disorder

  • Separation anxiety
  • Rages & explosive temper tantrums (lasting up to several hours)
  • Marked irritability
  • Oppositional behavior
  • Frequent mood swings
  • Distractibility
  • Hyperactivity
  • Impulsivity
  • Restlessness/ fidgetiness
  • Silliness, goofiness, giddiness
  • Racing thoughts
  • Aggressive behavior
  • Grandiosity
  • Carbohydrate cravings
  • Risk-taking behaviors
  • Depressed mood
  • Lethargy
  • Low self-esteem
  • Difficulty getting up in the morning
  • Social anxiety
  • Oversensitivity to emotional or environmental triggers

Common Symptoms of Early-Onset Bipolar Disorder

  • Bed-wetting (especially in boys)
  • Night terrors
  • Rapid or pressured speech
  • Obsessional behavior
  • Excessive daydreaming
  • Compulsive behavior
  • Motor & vocal tics
  • Learning disabilities
  • Poor short-term memory
  • Lack of organization
  • Fascination with gore or morbid topics
  • Hypersexuality
  • Manipulative behavior
  • Bossiness
  • Lying
  • Suicidal thoughts
  • Destruction of property
  • Paranoia
  • Hallucinations & delusions

Less Common Symptoms of Early-Onset Bipolar Disorder

  • Migraine headaches
  • Binging
  • Self-mutilating behaviors
  • Cruelty to animals

New Tools Discovered

I’ve been doing more research on early onset bipolar disorder, via internet searches and books.  I’ve read quite a bit even previous to The Captain’s diagnosis, having suspected for years that there was more going on in his head than ADHD.

One interest resource I came across was PsychEducation.org, where I first learned about how bipolar relates to the Circadian rhythm and about light and dark therapy.   I ran out and purchased some yellow bug lights from Ace Hardware and installed F.lux on all of the computers.  I’m not sure if the yellow lights in The Captain’s room have had any effect, or if the software is working, but it’s certainly worth a try.

Yesterday, I started reading The Bipolar Child by Demetri & Janice Papolos.  Much of it was information I had already run across, but it too discussed light therapy and Circadian rhythms.

It also suggested the use of Melatonin to aid in restorative sleep and the use of Omega 3’s or fish oil which may be able to act as a mood stabilizer themselves.   I didn’t have time to absorb all of the Omega 3 section, but I got the part about the melatonin, so while we were out yesterday, I got some melatonin supplements from Walgreen’s, at about $8 for a bottle of 5mg.

Last night, I gave The Captain a pill just before quiet time, and he calmly, quietly went to his room, and very soon after was sound asleep.   I’ll have to wait to hear how his day went, but the rest of my evening was wonderful.

The Emergency Room Visit

A few weeks later, we still did not see improvements, and The Captain had a Very Bad Day.  He got into an argument with his brother and hit him in the back with a large piece of wood from the deck.  Afterward, he was uncontrollable as he banged his head into the floor and the wall and destroyed anything he could reach.  Our stress level was as high as it had ever been.

The Doctor had said in the event of him attempting to harm himself or others, we should go directly to the emergency room or call 911.   So, we did.

We managed to get him to the car with no issue.  He screamed and cried along the way but did not actually resist.  His crying fell to a whisper by the time we reached the hospital.

While in the waiting room, The Captain chewed his hospital wristband off.   After a short wait, we were brought in and he had his vitals checked.  We were escorted to a far away hallway in the emergency section with several rooms that had nothing in them but the hospital bed.  No sharp corners.

They handed us a gown and said he needed to change into it.  He did not like this at all and screamed and cried over it for quite a while before we were able to convince him that it was better if he undressed himself than if someone had to do it for him.

He lay on the hospital bed while The Admiral and I stood beside him, waiting.   The Explorer was left at home and we checked in about once an hour.

Overall, we were there for about 4 hours, with intermittent visits from nurses or doctors doing routine things like registration and blood/urine tests.   In the end, The Captain fell asleep in the bed, and we decided to leave.

The day after, we met with the therapist and psychiatrist.   He doubled his dosage of the guanfacine from 1mg to 2mg, actually giving him a meltaway 2mg in the office.  He had us wait there for 20-30 minutes to see how it would affect him.

He was remarkably more playful and less impatient in the waiting area, and this impressed the doctor.   He said we could dose him additionally as needed in .5 mg increments, 40 minutes apart.  We’ve done this once or twice since then and it may or may not have been effective.

Since then, he has seemed better during the day, though still very irritable, but bedtime is still a recurring problem.

The New Doctor

After leaving the in-patient program, we had an introductory session with his new local therapist, followed by an appointment with the new psychiatrist the next day.  The new diagnosis left off the anxiety disorder bit and focused more on the moods and the pervasive development disorder, thus his current diagnosis is ADHD, bipolar, and high-functioning autism.

The Doctor reviewed what the hospital had prescribed (prozac, focaline, guanfacine, and desmopressin) and could not believe it.  Apparently some of these medications could interact with each other in dangerous ways, and some would not show improvement for a month.   He took him off everything, and switched him to just use Abilify.

Within days, he was back to “normal” and the chaos had returned.   At one point, he actually asked for his old medicine back.  The Doctor had said we should start low and move up, though, and that the mood and autism needed to be treated before the ADHD.

The In-Patient Program

The Captain’s hormones finally kicked in full force this spring, when his days and nights became a constant struggle, and his rages became completely uncontrollable.   Up until then, we had been able to “handle” him.  He has been homeschooled/unschooled and unmedicated since second grade.

The current state of the home is unbelievable.    We could no longer let his older brother, The Explorer, share a room with him, because all of The Explorer’s possessions would become destroyed just like The Captain’s.   We moved The Explorer and his stuff into our bedroom, and The Admiral and I out into the living room.   That’s right, we now sleep in the living room.   We are working on renovations to the rest of the house to allow us to be in another space, but until then, we are at the mercy of the living room and its lack of privacy.

Still, his behavior persisted and his rages over any little thing escalated, and his violence towards his brother exploded.   He punched, hit, and slammed The Explorer’s head into a desk.   We were at our wit’s end.

Finally, we made an appointment and took him to a local (but not close by) hospital’s adolescent behavior wing.  Security guards nearly had to drag him in.  After some hours of waiting and little feedback, we had to wait a few days until they decided to accept him into the in-patient program.

For three weeks, he spent his days at the in-patient day program and his nights at home.     He never displayed his rages or aggressive behavior while at the hospital, but based on our reports, the psychiatrist still diagnosed him as having a mood disorder, though he would not specify.   In the end, he was diagnosed as having ADHD, a mood disorder, an anxiety disorder, and pervasive development disorder.

Immediately, they started him on Prozac (for the anxiety) along with Desmopressin (for his enuresis).   His hyperactivity was still in high gear, and perhaps worsened, so they added Focaline to the mix.  Doses were changed, timings of medications were changed, but nothing seemed to help.   Nights at home were better some nights but chaotic on others.

In the last week, they added Tenex (guanfacine) to the mix, and at last, this seemed to normalize him.   He was able to attend homeschool group without throwing tantrums or attacking other kids.  He was able to focus and seemed genuinely happy.  He also learned a few “coping techniques” that he talked about (mostly things to do with his hands when fidgety).  He even stopped wetting the bed some nights (but not every night).

He was good enough to come home, they decided, and we were to meet with a new, local psychiatrist and therapist duo in a few weeks.