Friday, November 12, 2010

Mania

I’ve been looking forward to this post because I have a heavy heart and I hope that after blogging I’ll feel a little better.

This week my son had his therapy appointment. It was disappointing on several levels, but after the appointment, as we were walking to our parked car, my son ran off. He started darting between parked cars and running between buildings while my youngest cried, afraid his brother was gone forever.

The entire time he had a smile on his face and an impulsive energy about him.

I knew from past experience that if I chased him things would escalate, so I tried to keep a distance. At one point, I had to move our car to another lot to keep him in our sights. Once closer, he started attacking the car with his fists. I coached his brothers to keep their eyes forward, to not look at him since it was obvious that my son was trying to scare them. Then my son started climbing onto the hood of my car and started beating the glass.

When I got out of the car and asked him calmly what he was doing, he said, “I don’t know”, with a smile spread across his face.

I asked him if he was having fun scaring his brothers and he said, “yes”.

He then ran around the car and grabbed an umbrella and tried to stab his brother with it, all the while I was throwing myself across the van to protect my little ones. This struggle went on for moments. It was all so fast, it’s like a blur now. I remember there was a lot of screaming, in a panic I was yelling for him to stop, while his brothers were crying in the car, terrified.

I screamed at my little ones to run out of the car into an office building while I kept his brother at a distance. With all the commotion, I wasn’t surprised when a man approached and asked if he could help.

YES! I was so relieved to have assistance. With the little ones safe inside an office, the man and I approached my son.

At first my son looked confused, he started slowing down and continued to walk away from us, but the man began talking. I was so impressed, he talked and talked, about being a soccer coach, about his daughter wanting to marry a rock star, he went on and on.

And it worked! With a look of total confusion on his face, my son calmed down, I was able to take his hand and lead him back to the therapist’s office.

Once there, our therapist got a first hand look at my son’s transformation. He went from being a sweet boy, full of life and anticipation for the weekend, to a scowling child tipping a table over in the lobby.

His brothers confirm to our therapist that my son wasn’t angry outside, but had too much energy and was having fun.

Once my son had calmed down, he explained that it felt fun and he felt powerful when he was scaring his brothers, like he was big and they were very tiny. He also felt like he could do anything. But he wasn’t able to determine what triggered it all.

The next day our therapist called and asked if this type of thing had happened before. “Yes!” I said. He asked a few other questions, then when he was done he said, “It appears your son was experiencing mania”. He said he wasn’t surprised that the episodes weren’t very long since he was so young and they’re new to his illness, only being present this year.

Inside, I had two distinct feelings that were crashing together. The first, I felt such relief that our doctor was now verbalizing something I always believed to be true. My son has been manic.

Second, I felt a sick feeling in my stomach and a deep pain in my heart.

If my son has mania, things are going to get worse.

When I asked if this now appears to be a case of childhood bipolar. He responded that they don’t want to label kids this young, but he did feel that what we were seeing in my son yesterday looked very different than a kid with typical anger problems.

As he finished the call he said that we should expect a lot of med changes in the coming years and be prepared to add a second mood stabilizer soon. In the meantime, he told me, “We need to hope for the best, but treat aggressively.”

Hmmm... after all that blogging, I still have a sick feeling in my gut.


18 comments:

  1. Wow. Our boys could be twins. My boy is 9 and my husband and I and whole family walk on eggshells it seems. I never know what the trigger will be, or what I can say no to or not. Sometimes it seems like he is waiting for a trigger, pushing the envelope to get me to say no so he can explode with rage and foul language and throwing anything insight, biting, pinching... you name it. But when this is not the case he is the sweetest boy you could meet. I came across your blog out of desperation when I typed in "my son is dr. Jekyll and Mr. Hyde" and I am so thankful. For years it has seemed that we were alone in our quest to help our son and save our family. Thank you for sharing already it has helped me. Just today we are trying to switch meds due to side effects from Seroquel which is the only thing that has enabled our boy to sleep and control his rages. I am sure he also has mania, but no one outside of the home has seen it. Anyway, Thank you.

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  2. Me again, I just saw the meds you are using. We are trying trileptal starting tomorrow and my son has been taking tennex for quite some time already. Before the tennex he could stay awake for 3 days and nights full of energy and even bouncy, then sleep for a few hours and do it all again.

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  3. Hi Anonymous! I’ve the seen the same thing with my son, pushing the limits so he can explode. It's like they know that they need to explode to feel better, so they seek out conflict sometimes to relieve their suffering.

    By the way, we may live near one another, you can reach me through the email listed above if you ever want to discuss doctors and such privately. I'm currently looking for a new therapist, but need some recommendations.

    Also, we too had a bad reaction to Seroquel. My son became very depressed, impulsive and saw people that weren't there while on seroquel. It made him very dangerous to himself. You can read about that here:
    http://mysonhas2brains.blogspot.com/2010/03/things-are-getting-worse.html

    I'm glad you found my blog, I hope you know that you’re not alone!

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  4. We've seen a lot more stability with the Trileptal. But we are still increasing his doses, starting today, we increased again. We are still under the dose limit, so hopeful he'll reach a long stretch of stability once we reach the limit for his body.

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  5. Oh, I'm sorry you are going through this. My son is having issues with mania right now too. It's very tiring. We are using Seroquel but I am hoping to get a med change soon as Seroquel is a mixed bag for us as well. What did they give you for when he gets like this?

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  6. They do have PRN's for when they go psychotic. Mania's are very scary, but with the right drugs, you can maintain long stable periods. My girl went three years without a psychotic episode, until we had to change her meds because of severe side effects. Hang in there!

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  7. I have had a similar experience with my daughter in parking lots before. It is very scary and I am so sorry you have had to go through that. One thing that our pdoc has done for us (since we drew lots of attention and I was concerned about someone calling child protective services on us) is that she wrote a letter on her letterhead. The letter contains just some good information stating that the child is under doctor supervision, what her diagnosis is, and that we have been trained to help her through this. It opens the door for the person to call her office if there are any concerns. We have the original at home and I reduced and laminated several copies that I keep with me all over. One in my purse, a couple in the cars, etc. It makes it easier to give someone information without being distracted from keeping your child safe. I hope that it gets better for you soon!

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  8. Wow. I know exactly how your son feels, which has happened quite a few times on the blog. It's pretty crazy how much we have in common but I guess that's how it goes sometimes.

    I think part of my motivation for soccer practice partly mania, or mostly mania.

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  9. It seems that from your blog posts that this is not a new symptom at all, it is just new to your therapist. Just because he labeled it as manic doesn't mean it is something different than you have been dealing with. It has happened in your home, it but it is scarier and more dangereous out in public.

    You HAVE been treating the sypmtoms all along, but it is tricky, as you know. But you will continute to figure out what meds work for your son, and eventually the symptoms will decrease and things will get better. It's a long road, but you ARE getting somewhere. Just because a therapist has an aha moment doesn't really change anything.

    One of the most affirming thing that has happened to us in our journey with our son (who is now almost 12) is when we finally got a psychiatrist for him who said to us "I believe you." Unfortunately until you find a therapist who REALLY understands child mood disorders, you will have to trust yourself as the expert on your son.

    Hang in there
    Betsy

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  10. I don't know what to say, so I am just going to send you hugs and strength from above. You are amazing, mama. Exceptional. Don't forget it.

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  11. Wow. That is so scary!

    First of all, WHO was this amazing stranger that helped you through this in the parking lot? Was he a therapist? Someone with experience with mental illness? The guy needs a medal or something. Most people wouldn't stop to help.

    Second, I'm glad that this happened at the therapist's office. This gives him first-hand evidence of what you're dealing with and I think that's the most positive thing that could happen. Otherwise, they may or may now believe us and never seem as truly concerned.

    Is your psychiatrist recommending adding risperdal? We have so far seen great results from it, but we're not perfect either. The MadMan had two huge rages this week, both resulting in stuff getting smashed/broken/ruined. I hate this. :(

    Hang in there!

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  12. Thanks everyone for the great feedback!

    Meg- Right now my son is increasing his Trileptal, I believe we have one more increase left before we hit the max dose. Once there, they will move on to a second med. Right now, I have no idea what she will tell us to do. What are you considering for your son?

    Kelly- I love the idea about the prepared note to explain things. I’ve never thought about people on the outside mistaking our situation as one that would require CPS. I think that is a brilliant idea!

    Hayden- So does soccer (exercise) help prevent mania for you?

    Betsy- You are so right! I think it's been so confusing because our doctors have been telling us that it wasn't mania in the past, but now that he got a picture of it, I hope they have a better understanding, and now I have confirmation on what was always a gut feeling. Looking over the past few weeks, I would describe the school parking lot incident as mania too. Especially when he took off on his bike after attacking the car from the outside and scaring the kids.

    Gina- I know what you mean about the amazing stranger. When I look back on the incident, I like to think of him as an angel (not real) just an amazing person who rushed in to help, then left as soon as I had it under control, without waiting for praises. It's nice to know these people are around. He was helpful without making me feel more uncomfortable than I already was.

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  13. Mama Bear- It can sometimes. When I was with my dad and step mom, it was mostly mania because I had so many mixed up emotions. Now, it's a release, you know? Instead of doing bodily harm, I go outside and run or do drills. I still get caught up in self harm sometimes but G and my foster parents can see the changes in me and my mood (like you can with your son). There are still times when I am very manic, but I try to find ways to get it out without violence or yelling or anything. We're going to the store this afternoon to get some paint, paper and stuff like that. I painted in Kindergarten but not much after and my Counselor suggested it.

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  14. What is mania? My daughter has done all of the above. She has left a hotel room and wandered around all by herself. She has left a friends'house and gone to a park, she has left our house, she has taken off from outside our school because she doesn't want o go...all of these aren't mania according to a psychiatrist in the hospital. My daughter has been in the hospital for 6 days, she has had 2 rages but right now they think she has Intermittent Explosive Disorder. I agreed that she has rages but I also pointed out that she can get very silly, depressed, have impulsive behaviour, manipulates, irritability...you get the picture. Also they keep focusing on the fact that she only does this at home/ not school..even though she has them in parks, museums, in public washrooms,in our front yard, on our driveway etc...She also rages, acts out in front of her grandparents, aunts, uncles. I feel very frustrated because I sense that they think this is controllable...so why is she doing it at home mostly. The finger is pointed at us, we are and have always been supportive, loving. They ask my husband and I if we fight a lot in the house- NO. They ask if we feel she's been abused- NO. They ask if she is bullied- NO. I told them I read this blog- My Son Has Two Brains and I it was exactly what is happening with my daughter. I told them I read a book on BI - Polar and it fits my daughter. They say, No because she doesn't meet the Mania criteria. So needless to day I feel that 6 days in the hospital hasn't really helped us, actually my daughter is in heaven because the play WI, do art, watch TV,she doesn't want to leave! It hurts because everyone says, she is so sweet, we can't imagine these problems at home, she is wonderful here. So....finally what do your therapists consider mania to be because supposedly my daughter doesn't have it!?

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    1. That's a very good question!

      Here is a link to what the DSM guide says about what Manic behavior is:
      http://www.mental-health-today.com/bp/man.htm

      The fact that my son took off wasn't the indicator for him possibly being manic, it was the behavior that he presented during this episode, excessive energy, engaging in dangerous activities, he afterward shared how he felt big and powerful and we were small, our therapist said this could've been grandiosity.

      But because his episode didn't last long, he doesn't meet the criteria for Bipolar disorder. In fact all of his "manic" suspicious behavior has been short lasting so that has kept him from the official diagnosis. Though our psychiatrist states that his irritability and impulsive actions may also be a symptom of mania but to qualify for the diagnosis it needs to have 4 other symptoms from the DSM list. He’ll need to be evaluated to see where he falls with that.

      I can understand your frustration, we are all feeling it. As for the "temper" diagnosis, I was told by Stanford that this diagnosis is only going to complicate things further. But many of us parents will probably see this label now placed on our kids, even though they don't perfectly fit into the "temper" diagnosis.

      I understand how frustrated you must feel that you are being blamed for your child's illness. I know that like us, this is not your fault, it is not a parenting thing, only an illness our kids have inherited that the doctors can't figure out. If you look back on schizophrenia, the parents in the beginning were also blamed for this illness, it wasn't until the parents fought back and demanded that more research be done that it was finally recognized as an illness. We may be years away from experiencing the same respect, but I hope it happens someday.

      You may want to get a second opinion if you feel the blame is landing on you as a parent. There are many doctors that recognize that our kids are suffering from a real illness.

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    2. If you haven't read them already, you might be interested in the following links. They are previous posts related to possible mania:

      http://mysonhas2brains.blogspot.com/2011/08/could-this-be-hypomania.html

      http://mysonhas2brains.blogspot.com/2011/08/bipolar-1-disorder.html

      My son has also come to me with an excited expression saying that he felt like he wanted to fly. He started to cry saying that he couldn't look out the windows because it made him want to fly. This really scared him.

      Another time he went into a compulsive episode of cleaning the house at 10 pm at night. He looked like he was in pain wanting to stop, but couldn't until this energy burned out. His movements were excessive and rushed, at one point he begged for help to stop.

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  15. Thanks for the response. Yes, your son does sound like what they describe. The only thing our daughter does is wake up in the night, wide awake an ask to go downstairs.

    As of today we have entered a day program, she will go to the hospital for school/assessment/therapy. Still the diagnosis is unknown...now they are saying she suffers from anxiety/panic attacks!?. The Intermittent Explosive Disorder has just been ruled out because she hasn't raged at school. She does rage in public and in our house( strangers and family/close friends she rages).
    We will do behaviour therapy. No medication.

    Thanks for your input.
    It is much appreciated.

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  16. Hmm. that is interesting, our son got the label of intermittent explosive disorder and he never raged at school either. Only at home.

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