Monday, June 22, 2009

Sweet n Sour

I understand that it is very scary to put a small child on an anti-psychiotic drug. If weight gain is the only side-effect, then it is a no-brainer. If the diagnosis fits and the medicine works, then these children should be on the correct medicine.

Antipsychotic drugs for kids raise hope, worry

(06-21) 19:38 PDT -- Increasingly powerful antipsychotic drugs available on the market, and growing evidence that starting these medications early can help children with conditions like bipolar disorder, is putting doctors under more pressure than ever to diagnose and treat young people with mental illnesses.

As a result, some doctors say, mental illness, especially bipolar disorder, has been overdiagnosed much the same way attention deficit hyperactivity disorder was in the 1980s.

"ADHD was the diagnosis du jour in the '80s. Now it's become bipolar disorder," said Dr. Andrew Giammona, who heads the psychiatry department at Children's Hospital Oakland. "We're in a quick-fix society, and parents want to believe that if we had this treatment, we can get it fixed and move on."

Before the 1990s, bipolar disorder was a rare diagnosis in children under age 19. By 1994, U.S. doctors were reporting about 25 cases per 100,000 young people, and by 2002 that number had jumped to 1,000 cases per 100,000, according to data from the National Center for Health Statistics.

Medication was prescribed for about two-thirds of those patients, according to the National Institute of Mental Health. Antipsychotic medications are among the most popular made by pharmaceutical companies. Earlier this month, a U.S. Food and Drug Administration panel recommended approval of three antipsychotic drugs for use in treating schizophrenia and bipolar disorder in children and teens. The FDA will make a final decision on Geodon, Seroquel and Zyprexa in the coming weeks.

While better drugs and increased diagnoses have been a blessing for many families, at FDA hearings in Washington, doctors and parents voiced concerns that the medication can cause long-term health problems - specifically, extreme weight gain that can lead to metabolic disorders like diabetes.
Not a trivial decision

"It would be controversial enough if it was just a diagnosis, but the diagnosis comes with these very potent medications," said Glen Elliot, chief psychiatrist and medical director of the Children's Health Council in Palo Alto. "My main message is parents need to be apprised that this is a cost-benefit analysis. You don't trivially put somebody on a medication."

As with ADHD, many thousands of children and teens really do have a mental illness that can be treated effectively with medication and therapy. Oakland parent Barbara Carlson said her son was 7 when he started having fits of violent rages, smashing windows and throwing chairs. After several days of testing, he was diagnosed with bipolar disorder - but she was reluctant to put him on medication. "He was just so young," Carlson said. "I thought, 'He has his whole life ahead of him, what if this is the wrong diagnosis?' It was very scary to put him on medications."

Seven years later, she said the drugs have improved his life dramatically. He's had weight problems, but he's excelling in school and is active in sports and making friends.

Many mental health experts said they've felt pressure from families with troubled children to make a diagnosis and start treatment - a reaction that's understandable if the child is clearly having problems. But if doctors don't have the proper training to accurately diagnose a mental illness, children may not get the right treatment, said Dr. Robin Dea, director of mental health services for Northern California Kaiser Permanente.
Depression and mania

"I tell doctors, 'You have to be honest with yourself about your own level of experience with this condition,' " Dey said. "We have to be honest with ourselves about whether the medications are working, and if they're not working you need to keep questioning the diagnosis."

Bipolar disorder is thought to affect about 1 percent of children, although studies vary and some experts believe it affects as many as 5 percent of children.

The disorder in adults is marked by extended cycles of depression and mania, although people can have long periods of time where they have no symptoms at all. During manic periods, adults may get grandiose ideas, feel euphoric and be impulsive and make poor decisions.

Children with bipolar disorder tend to cycle through moods faster than adults, and they are more likely to be extremely irritable than euphoric, said Dr. Kiki Chang, director of the Pediatric Bipolar Disorders Program at Stanford University School of Medicine. Experts note that these children are not just kids with behavior problems.

"An irritable kid is most likely not bipolar, he's probably just upset about something," Chang said. "Bipolar kids may be extremely explosive, extremely angry. But they have to have these other symptoms: they're not sleeping as much, their mind is going faster and they're making poor decisions."
Hard to tell the difference

It's not always easy for doctors to tell the difference between a kid with bipolar disorder and one who's dealing with teenage angst or has some other problem, like post-traumatic stress. Giammona at Oakland Children's Hospital said he once diagnosed a child with bipolar disorder only to discover later that the patient had a food allergy that was making him extremely irritable.

"There's a lot of overlap with other potential diagnoses," he said. "There can be lots of reasons for symptoms that look like bipolar disorder. Just because they have the symptoms of the disorder doesn't mean they have it."

Dale Milfay, vice president of the National Alliance on Mental Illness in San Francisco, said it's crucial that children with mental illness get a correct diagnosis as soon as possible and start treatment right away. There may be medical advantages to early treatment, she said, but children also benefit from staying in school and developing crucial relationships with friends and family.

"The earlier people are diagnosed, the better their chances," Milfay said. "But you wouldn't want these drugs to be overused. There needs to be some real criteria that this is not something a primary care doctor can just diagnose."

Wednesday, June 3, 2009


This sounds like a broken record, I see this almost every day in the world of Special Education. The parents take their children off the medicine and don't take them to their counselors. Here is a very true list of what we have seen in the last two weeks of school

1. "M"'s mom takes him off his meds. because we only have two weeks left and surely we don't need him to take his drugs, he is a 4th grader who then goes "poo" in his pants and spreads it around the school in little "poo" bombs.
2. "Z" is tired of working and when the teachers give him an assignment he says"I am not doing any more Effing work" His mothers solution was to have him write 100 times at home that he will not use the "F bomb" again. The next day he got into a fight and used the "F bomb" with the assistant principal which earned "Z" the right to have On Campus Suspension and miss his end of year party
3. "J" does not take his medicine and his mother says it won't hurt him to miss a few days, so he flies around the room, uses the F-bomb with a teacher, won't stay in his chair at all and can't focus, so he had a wasted learning day and the teachers had to send him to the principal where he was told if he did not take his meds. the next day he would join "Z" in OCS, he made the right choice the next day and took his meds.
4. "C" admits that his mother spreads his meds. on a half PBJ sandwich because he can't swallow the pill but he has actually been feeding it to the dog which explains why the teachers were puzzled when the mother said his meds had been increased in the last month and were perplexed as to why he can't pass the second round of State Mandated Tests and now has to attend summer school.

So you decide, is it important to take your prescribed meds.? absolutely "YES".

Youth with history of mental illness gets probation for break-in

BLOOMINGTON -- A 12-year-old Bloomington boy who broke into two homes in Normal last year was placed on 60 months probation Wednesday and ordered to cooperate with attempts to help him avoid future problems with the law.

McLean County Assistant State’s Attorney Aaron Hornsby described Sept. 18 as “a truly frightening day and what were truly frightening crimes.”

The youth and a second boy got off the school bus where they were scheduled to attend special education classes and instead broke into two homes, said Hornsby.

An 83-year-old resident of one of the homes saw the two as they left his property and called police. When the 12-year-old was stopped, he was waving two knives, said the prosecutor.

The youth’s background includes a history of mental illness and two suicide attempts, according to Hornsby.

The state asked that the minor be placed on probation until he is 21 years old.

In her remarks prior to her decision to place the youth on probation until he is 17, Judge Elizabeth Robb said she was troubled by reports indicating the child was taken off medication by his mother and missed counseling appointments.

Calling the mother’s decisions irresponsible, Robb told the parent, “he’s not going to function without medication.”

The mother was ordered to work with child welfare, school and court services staff assigned to the child’s case.

Defense lawyer Art Feldman agreed that the child’s mental health issues must be addressed.

“It’s clear to me that the minor has mental health issues. It’s a matter of how to deal with them,” he said.

An Aug. 3 hearing is scheduled to review the boy’s progress.