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TOPIC TITLE: Manic episode - daughter
Created On 3/14/15 11:40 PM
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TBear
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3/14/15 11:40 PM
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Dr. Price,

One of my daughters in her late teens .... This past week however - is the third hospitalization after she went totally off .....still so hard to believe. We took her phone, cut her internet access, and curtailed her ability to go anywhere without direct supervision - which lead to further suicidal behavior and now she is hospitalized again. They have taken her off antidepressants (fluoxedine) completely and put her on lithium and risperdal saying she is bipolar. Possible comoribid borderline????

Her behavior is so impulsive and dangerous to herself, nothing like who she used to be - but then she suddenly sounds so reasonable....I spoke to her after Shabbos and she sounded more stable - but was pushing for me to take her out before Monday (when the doctor and case manager get back) They were talking about a longer term residential program for her .....

So my question - How long does it take to stabilize and do I give in to letting her come back home with outpatient stuff - we miss the girl she used to be.... so I do not trust myself , I want to give in to bringing her home. Yet wonder what is in her best interest

What is the treatment and prognosis for this diagnosis? How long does it take to bring stable controlled behavior?


Edited: 3/15/15 at 1:55 PM by TBear
 
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Dr. Price MD
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3/15/15 11:11 AM
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The Bipolar piece could take a couple weeks. The borderline piece requires intensive DBT treatment over several months.
Follow the doctors' orders in terms of discharge planning. Read the book, "Stop Walking on Eggshells" before she comes home.
Let me know how you make out.

Rabbi Price, M.D.
Www.RabbiMD.com
 
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TBear
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3/15/15 1:56 PM
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Thank you - I have ordered the book and will try to hold the line in getting her the help she needs.
 
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MoMo
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3/15/15 4:06 PM
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T bear I'm praying for you and your daughter!
 
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TBear
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Thank you MoMo.... feels so odd - the behavior was so far out of bounds that I still can barely wrap my mind around it.... like some nightmare I want to desperately wake up from.....

She has developed a side effect to the risperdal, so I think they are going to change her meds again......

Have to keep davening.
 
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keep climbing
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3/17/15 6:58 AM
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Thinking of you, Tbear. How are things?
 
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TBear
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3/17/15 10:33 PM
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The treating psychiatrist at the hospital in consultation with the psychiatrist and therapist who have been seeing her for several years decided that she needs long-term residential. The case worker has had it cleared from the insurance - but now we just have to wait for a bed to open up at one of the approved hospitals... feel like a hole has been torn in my heart

She was practically begging me to take her home on a "trial" rather than have her admitted to long-term, hurts - so hard.... I don't know how we are going to handle Pesach for her. What about the Seder?

Thanks for asking and davening .

Dr. Price,
Is it a harmful side effect from the Risperdal - the psychiatrist has not returned my call and i am worried for her because she has begun producing milk as a side effect - are there any long term problems from this? I guess they feel she really needs to stay on it....and they have her on "keep in sight" level of care still so even if she seems so much better in a short meeting with me - there is a reason they are still watching her so carefully.


Edited: 3/17/15 at 10:34 PM by TBear
 
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Dr. Price MD
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I would trust the doctors. That is a side effect from Risperdal which will go away once they switch the medication in the future as she stabilizes.
If she is still on constant observation then she is not ready for home. Residential is not forever but just until she is ready to move on to a less intensive
Level of care. Keep us posted.

Rabbi Price, M.D.
Www.RabbiMD.com
 
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TBear
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3/18/15 7:51 PM
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Thank you Dr. Price.... They are telling me she is still very labile and have begun her on seroquel....

Now can you put on your Rabbi hat and help me know how to maneuver Pesach and kosher food at a longer term facility far from anything Jewish.... this is not NY or anywhere that has a very large Jewish population.... and my Rabbi hasn't been able to call me back - I don't want them thinking when she insists on Kashrus that she is being oppositional - which is not beyond her at this time I can't bring her home this way - she can turn on a dime - in the middle of the seder if something set her off, G-d forbid.... On the other hand -how to handle..... she goes from wanting to daven and keep hilchos to angry and not wanting to observe anything ..... What is required of her so I can tell her in a clear manner - she has asked? So far they have authorized (wrote a prescription for) her diet and I bring in food for her - she has it when she wishes, and when angry they take her to eat in the cafeteria.....
 
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Dr. Price MD
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3/19/15 6:42 AM
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Contact the patient advocate at the facilities, the chaplains and the local Chabad Rabbis. Between these legal and Jewish
Resources you should be able to work everything out. If you run into any resistance, you may know a local frum civil rights
Attorney who would gladly take this case pro bono to assure everything is in order. Let us know how you make out.
(I successfully used Nat Lewin and Shelley Silver to help me move my national medical board exams to a day other than Shabbos or
Yom Tov and now the examination dates are forever changed for the rest of Klal Yisroel.)

Rabbi Price, M.D.
Www.RabbiMD.com
 
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MoMo
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3/19/15 9:26 PM
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(Wow)

T-bear I'm still praying for you!!!
 
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TBear
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3/19/15 11:16 PM
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Thank you Rabbi Price for your advice, expertise, and mostly for your care and responsiveness

Thank you MoMo for your prayers... they are truly needed

I was discussing with my therapist today - and he said with all I have been through just this past year even someone "normal" would be having high-stress, difficulty and sadness To which I responded then it has to be really bad for someone who isn't normal like me .... so we could laugh a little - to help relieve the pressure. In reality I feel such a loss for the daughter she was and the knowledge that this is going to be a long road.... she is different, the manic stuff....and I feel helpless to do anything.

The "crazy" that I am is trauma induced defense - as my therapist said - without the trauma I would not have the DID. But my daughter (and evidently my ex-husband) has a chemical disorder - something - that effects the workings of the brain - it can be made worse or better by environment etc... but it would always have been. Like the difference between being born with a deformed leg and having a leg shattered in an accident. What difference if the leg still is weakened - means you have to try harder to accomplish what those with a healthy leg do without even thinking about it.

Either way - we did not choose the parents we had, their abusiveness or their genes - that was pre-ordained, all that is left to us is to do our best, to choose a Torah way of life - I just don't understand how that is possible for my daughter - this seems to have really "taken her over". Where did my little girl go? Hashem Yerachem

Thank you for the support - this is something that can't be made public - so I have to try to function as if all is fine... but it is not - and here I can get help anonymously.

Means a great deal.
 
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Dr. Price MD
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3/20/15 5:43 AM
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It is possible that she can come back to the person you always knew with some time to heal. I see these kind of recoveries all the time.
So many are suffering, often alone. Nice to have this forum to share. We need to expand this to so many others who need this support, guidance,
And encouragement.

Rabbi Price, M.D.
Www.RabbiMD.com
 
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Teddybear
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3/22/15 3:09 PM
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That sounds really tough.
I am davening for you, T-Bear.
 
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mouse
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Just got on for first time in a while. Davening for you and your daughter. Hoping this whole thing will be a distant memory in a few years (or less.)


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All the king's horses and all the king's men couldn't put Humpty Dumpty together again.
 
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TBear
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3/26/15 10:44 PM
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Thanks for the responses...
she is in a residential care facility at this point.... beginning to stabilize...they are allowing me to bring in pre-plated meals - labeled for which meal, and I wrote up some guidelines for them - and explanations.... one battle won, B"H!

another daughter of mine (22) is now in and out of crisis - her therapist says she needs more care than she can give ...is terminating/ trying to transfer - but my daughter is not handling it well - been seeing her for 6 years... she has extreme social anxiety and depression - barely will leave the house unless she is with family.... They are telling me complex PTSD.... maybe borderline - that she needs someone good - with DBT training..... can't find one who is affordable...her therapist told me to watch her carefully and take her into the hospital if she gets to crisis.....

I feel like the whole world is closing in - and then there is Pesach prep for the family: seder for 14 (my oldest son leading)- but all of our Pesach stuff (dishes, pots & pans, etc.)was destroyed by the fire last year and I still have to work full time - no more days left to take off..... My therapist has basically said I have to get my sleep with all this pressure - I know that the DID co-consciousness disintegrates into problematic stuff if I don't take care of myself.....How can we get this done? and also, I keep thinking, how can we have a Seder with my daughter in that residential facility? I just wish I could go to sleep and not wake up, life is just too hard.

I know this is the result of extreme abuse from first my father and then my ex-husband/ father of my kids..... It ends now! but it is taking so much - like the slaves leaving Egypt....I need Hashem to split this sea of tears for me

Dr. Price - my therapist has suggested that I might consider anti depressants to get me through this time - I took St John's Wort in the past and it helped.... how long wold it take to have an effect? Can't afford any more medical costs - a Psychiatrist for me isn't happening - hard enough to cover the kids and therapy, besides I couldn't get the time from work for an appt...

Sorry about the complaining rant...


Edited: 3/26/15 at 10:52 PM by TBear
 
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Dr. Price MD
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St. John's Wort like antidepressants can take a few weeks to work. Sounds like you definitely need more support. There may be free services available to you through your county such as case management, free psychiatric/psychotherapy, help in the home etc.

Rabbi Price, M.D.
www.RabbiMD.com
 
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keep climbing
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Tbear, we're thinking about you and davening for you(((.(HUGS))))
 
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TBear
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3/30/15 7:00 AM
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There is no help except from Hashem - and after all He encompasses all.... and we just have to do the best we can

thank you for responding and davening

chag kasher v'sameach is a very real bracha - do we even think about the words we say -

how it is a major struggle for some to achieve....the effort and resources necessary to make it kosher and the inner resources to draw on for simcha.......

May everyone here be blessed with a Chag Kasher V'Sameach
 
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mouse
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4/11/15 10:12 PM
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Tbear, how'd things work out over Pesach???



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All the king's horses and all the king's men couldn't put Humpty Dumpty together again.
 
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TBear
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4/12/15 11:32 PM
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Thank you for asking Mouse...

Married children came in, nice to see them - daughter was in the residential psychiatric hospital....she did the first Seder alone - didn't do the second..... so angry at me for having her there - was not recommended / etc... for her to leave the hospital at that time - not stable... we missed her...but walked over to visit both days 8-9 miles

she turned 18 this past week and signed herself out against medical advice.... was home for the last days.... left today in a rage because i did not agree to have her inviting men to the house for her to sleep with (she said it was her lifestyle choice)... would not give her a cell phone or internet access/ laptop in my home to contact them.... now she is gone - on foot - no ID, no money, no cell phone.....been gone 7 hours - scared for her....

Her mood when home was fluctuating from OK in the morning to really down/ depressed/ suicidal early afternoon to agitated and anxious late afternoon - to really irrational, impulsive and opposition - to wanting to explode/ hurt others/ herself - to back again.... that pattern held for three and a half days until she left this afternoon...

on lithium 300 mg 3x/day and Seroquel at night (25mg?) .... she did not take her meds with her - she hates taking any medications..... I had to practically force her to take them - she kept cheeking them when at the hospital.

feeling hopeless - she can control to some extent when there is something she wants - she didn't show this extreme fluctuation at the hospital.... it only "leaked out" from time to time..... but she wanted out and so showed no "immediate" risk to her life or "imminent" danger to self or others.....

Tying to balance - my youngest was crying herself to sleep tonight with me holding her, my teenagers are angry, as is one married child - the other married child is sad..... We are all in shock and grieving who she used to be.... I am numb and feel like collapsing - my Rav told me to do nothing - she was just trying to bring about some drama and would be back.... I don't think he is taking it seriously enough - the therapists have not returned calls but were warning and cautious in their responses to me earlier when she was so oppositional - The hospital had us sign papers saying we would not press charges against them if she came to harm as a result of her leaving....I made a police report soon after she left, but since she is 18 - they cannot pick her up unless she is doing something illegal.... but at least they have her description... sent out a report to all precincts...

Rabbi Dr. Price.... What options are there - if she is not willing to do the work? I thought Bipolar didn't cycle so quickly..... or am I misreading what it means to be manic?


Edited: 4/12/15 at 11:37 PM by TBear
 
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Dr. Price MD
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There is AOT (assertive outpatient treatment) where people are court mandated to take their medication and attend appointments. There are mood stabilizers that can be given once a month instead of daily.

Rabbi Price, M.D.
Www.RabbiMD.com
 
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mouse
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Tbear....so sad to read above....did things get better??? How is your daughter? I don't know how you cope with it. My daughter may be manic depressive and we alrready have a hard time with her so reading this scares me. My daughter is not in school currently due to the probs she had while in school. I keep telling myself I'm a good mom, as you are, and genetics get the better of kids sometimes, but at other times, I just get scared. I hope you're ok. I hope she's ok. Sad.


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All the king's horses and all the king's men couldn't put Humpty Dumpty together again.
 
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TBear
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They do not have AOT in this state.... can't get her to a doctor to get anything done...

She has contacted me from time to time to say she is OK - got kicked out of the homeless shelter and came home saying she missed Shabbos and wanted to be here Shavuos.... stayed 6 days then left without a goodbye again Friday after saying she hated Shabbos Thursday night (the opposite of what she said 6 days before).... She is still refusing medications or any help at all - her mental capacity varies from fine to total illogic or almost delusional/ paranoid - so strange. She said she thought that people being medicated was a government plan to have control over people so she won't be controlled with meds..... It is hard to take what she says as truth when it gets so twisted - she now says she had to leave where she was because they told her she was a "demon".....and she had to leave home to help rescue a friend she met at the homeless shelter from the "crack-heads" - as if she is able to rescue anyone?!?!?

I am in shock - like this is all a bad dream.... makes no sense whatsoever..... and there really is nowhere in the frum world to turn without it hurting my family - people already know too much though... I give up
 
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toy123
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Tbear sorry things are so hard for you. I'm davening hard that all should work out okay. Make sure to take care of yourself and so nice things for yourself so u don't end up crashing. Your other children need you!!!


-------------------------
Sometimes you need to run away just to see who will follow you.

Sometimes when I say "I'm okay", I want someone to look me in the eyes, hug me tight and say "I know you are not".

Just because I'm smiling doesn't mean I'm happy.
 
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TBear
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Thank u Toy
 
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mouse
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Sounds rough. I daven that she has a refuah soon.

I don't know what to say. I wish there was something that could be done. It sounds really scary to be you at the moment. .


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All the king's horses and all the king's men couldn't put Humpty Dumpty together again.
 
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