ANTIPSYCHOTIC MEDICATIONS AND THE DISORDERS THEY TREAT

April 10th, 2014

I want to address in my latest series the antipsychotic medications and the disorders they treat. Of all the drug classifications, antipsychotics sounds the scariest to parents. They assume that by prescribing them, the doctor is saying their child is psychotic. It is essential to understand that this class of drug – in spite of its name – has many uses and has helped countless children with different disorders. Unlike stimulants, which essentially treat one mental disorder – ADD – antipsychotics are used in the treatment of not only psychoses (disorders that include the loss of touch with reality), as their name implies, but for many behavioral problems in children and teens.

These drugs are called antipsychotics because upon their introduction into mainstream psychiatry they were used primarily for the psychoses. However as time has passed, this has been greatly overshadowed by their widespread use treating a myriad of other conditions. Unfortunately, the name has stuck and thus the immediate anxiety parents and teens experience when they are suggested. Many parents simply won’t give it to their children just because of the label. Until someone comes up with a more suitable name, parents need to be educated and reassured.

In my next few blogs I will address the disorders and the use of these drugs for treating Schizophrenia, Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), Stimulant-Resistant Attention Deficit Hyperactivity Disorder (ADHD), Tics (Tourette’s syndrome), Childhood Bipolar Disorder, and some other trends in the use of the antipsychotics.

DISCLAIMER

Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

WHEN IS IT SERIOUS?

November 12th, 2013

In my last blog I described quite serious calls I receive on a regular basis. But for the most part the calls I receive are from parents who are worried and really not sure if their child has a serious problem. I can categorically say that most calls are about children who do not have a serious problem. But are there some guidelines that we can use to know when it is serious?

We have to remember that a parent remains the best diagnostician of her child. No one knows the temperament, behavior patterns and moods of their child better than a concerned parent. So when a child has a change in thinking, mood or behavior most parents should assume that it is probably one of those ever present times when a developing child is changing and showing the enormously wide variations in the normal cycle of growing up. So an upsurge of anxiety, a sad mood, or a disruptive bout of behavior is no cause for great concern. It will probably pass as development proceeds and will soon be forgotten.

But there is cause for concern in the following circumstances:

The change does not return to usual after a few weeks and especially after you have tried to help.
If you have tried to understand the cause for the change and have failed to get a handle on it.
The change is getting worse despite concerned parental intervention.
The child seems to be suffering in his everyday ability to feel good and function in and out of the home.

In the above circumstances a consultation with a mental health professional might go a long way in helping you understand, intervene and possibly get you and your child professional help.

But there are certain circumstances that demand immediate professional intervention:

Suicidal behavior including talk, threats, gestures, notes, plans, diary or internet postings or attempts.
Violent behavior or threats including verbal threats and of course the involvement of weapons in any way.
Bizarre or psychotic behavior including hearing voices, strange thoughts, suspicious paranoid behaviors or other out of control actions.
Substance intoxication especially with any out of control activities.

In summary most children act in new and sometimes anxiety-provoking ways but these are usually normal events involved in growing up. But when the problem hangs on, does not respond to your curious exploration and support and especially if it is getting worse and affecting her life more and more then it would be wise to get help. It still might not be too serious but a bit of education and guidance can go a long way.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

THERE IS SOMETHING WRONG WITH MY CHILD

November 7th, 2013

These are three phone calls that I received in one week:

(Steven)
“The school principal just called and said our son Steven, a fourth grader, was overheard talking with some friends about bringing a knife to school. He has a history of misbehavior, but recently he has gotten worse. He has been fighting a lot, not following rules, talking back, leaving the classroom without permission, and now this. I’m freaking out. When can we see you?”

(Jessica)
“Our fourteen-year-old daughter, Jessica, has been sad since her grandma died six months ago. She’s been withdrawn, sleeping a lot, and hardly eats. At first we sympathized with her and gave her space. But this morning I looked in her diary and read a note in which she talked about yearning to be dead and join her grandma in heaven. I think this is much worse than just grieving. What should we do?”

(Marty)
“Marty, our eleven-year-old son, has always been shy. Ever since we can remember, he was scared to do anything new. We would have to accompany him everywhere — school, camp, after school activities, and the like. He could never go on a play date without great fear. He never made close friends. But now he is beginning to act really strange. He talks to himself, he is over-involved on strange websites, he smiles about things we can’t understand, and yesterday said something about being connected to other people through mind reading. I read something about psychosis on the Internet and he seems to fit the bill. I’m terrified something really serious is wrong with him.”

I get calls like these almost every day. Realizing that your child may have a problem is really scary. It can be devastating to learn that your child is physically sick, but discovering that your child suffers from a mental disorder adds another layer of confusion and anxiety. Mental disorders are not as well understood as physical disorders, and it is only recently that they have begun to be talked about openly. Add the fact that new diagnoses come up seemingly weekly, along with all the misinformation in the media about the medications used to treat mental disorders, and you have some very confused and worried parents. Through my blog I want to address your questions, fears, and worries about treating your child. I want you to ask me questions and I want to hear your concerns.

MY CHILD IS BEING BULLIED!

November 1st, 2013

In the last blog we discussed what to do if you think your child is a bully. Now, let’s discuss what to do if you think your child is being bullied.

First, help him or her to talk about it – establish an atmosphere conducive to talking about the feelings of shame and humiliation he/she may feel. Don’t leap in with suggestions or quick judgments; such attempts to help are often experienced by the child as a kind of psychic bullying. Encourage your child to speak directly with the authority figure responsible for harmony and safety (teacher, principal, swimming pool director, etc.) to give your child an active, assertive role in resolving the problem.
For many parents, the first thing to do seems to be to call the parents of the other child, but rushing into fix it for your child (i.e. contacting the bullying child’s parents and demanding an apology) may ultimately worsen the situation; at the very least, you and your child should work together to deal with the bully.
If your child is being bullied you also should notify the organization or place where the bullying is taking place, such as the school, camp, or venue for an after-school activity.
Your child will need some experience of “fighting back” so that he or she does not simply feel further victimized. It helps to have your child understand the psychology of the bully, that he or she is “egged” on by overly passive or insecure behaviors and that some amount of confident and even humorous self-assertion can often help your child to get through the next ominous encounter.
Never encourage your child to fight physically because it can just escalate the violence (possibly with significant danger to your child) and reinforce fighting as a solution.
If your child cannot overcome his or her fear and anxiety about a bully, it is wise to seek outside help, especially if fear, anxiety, and depression are interfering with day-to-day life.
Support your child’s friendships and social network throughout the ordeal of dealing with a bully; this is the time when your child most needs to feel he or she is not ostracized because of being the bully’s victim.

The key issue in bullying is that intimidation occurs repeatedly and becomes a form of harassment and abuse of other children. It is important for parents to become active in their community in order to avoid bullying issues. For instance: there are effective intervention programs across the country that parents should get involved with in their children’s schools. Schools should be encouraged to create and enforce anti-bullying policies and to have class discussions about bullies. Conflict resolution classes can also be very helpful.

Dr. Henry Paul, MD

Psychiatrist, Author and Educator