I'm no Dr. but what is your opinion ??

In my experience, Medicaid will only pay for Abilify when other traditional antipsychotics (with generics) have been trialed and failed. I actually think his dose of Abilify is high, combined with a high scheduled dose of Thorazine (has a short half-life but is more used on a prn basis than scheduled, but that doesn't necessarily mean it's contraindicated) I would worry about EPS and/or weight gain. Has he tried Guanfacine (tenex)? Seroquel?

I guess the real question is: Is it working? Is he less aggressive on all these meds? For an 11 y/o, I would expect him to be snowed on this but, if he's a big boy and/or if it's working, the benefits would outweigh the risks. We rarely combine antipsychotics but when we do, they need to do a MD to MD review with the insurance company. So I would expect that to happen here.

At some point, he may have to do a drug holiday and start fresh. We do that a fair amount when there is polypharmacy to see what is really underneath. It's a nightmare for staff but can be helpful for treatment.

Good luck. Does this kid have intensive in home therapy? It sounds like he needs it in addition to the behavioral school. What happens after school can carry over easily into the class. If they are not working with the family, any gains he may have will be quickly lost. A good in home therapist can do wonders for a chaotic home life. The sick kid tends to hold the rest of the family "hostage" by his moods and they forget how to parent and interact in a healthy way.

Hope he gets the help he needs!

I'm no Dr. and I really don't like to question the docs in what they do...but please give me your honest psychiatric nursing opinion on this.

11 yo boy with a diagnosis of Oppositional Defiance DO, Impulse Control, Major Depression DO, ADHD (combined type) Mood DO NOS.

Mom and Dad have been divorced since 2000, mom has had numerous live-in boyfriends/fiances the most recent boyfriend has been since 06. There is no abuse of any kind noted. Boy has 2 half brothers that lives with him and 3 half sisters that live with dad. Boy has anger outburst, some physical violence with fighting at school and attacking teachers, was kicked out of school and placed in an alternative behavioral school where he got physically violent with a teacher there also. He was hospitalized and discharged with these meds.

Abilify 10mg BID

Clonidine HCL .1mg BID

Celexa 20mg 1 1/2 daily

Melatonin 3 mg HS PRN

Benadryl 50mg HS PRN

He is now in outpatient therapy and med management.

Doc that he see's for med management started him on

Focalin XR 20mg daily

Thorazine 50mg TID

in addition to the meds listed above.

Kid is on mediciad. I was asked to do the prior auth because medicaid would not pay for the Abilify. When I called to get the PA. Medicaid said they would not approve Abilify with Thorazine. They would need a letter of medical necessity for that to be approved. Apparently there are interactions.

My question to you all is. Is this too much for an 11 yo ???

Abilify 20mg daily and Thorazine 150mg daily are adult doses right ??

I'm not really questioning the doc. but everytime I am asked to do a Prior Authorization for one of his patients because Medicaid won't pay for it is because of something like this. Medicaid thinks he is over medicating.

What do you think ??

11 yo boy with a diagnosis of Oppositional Defiance DO, Impulse Control, Major Depression DO, ADHD (combined type) Mood DO NOS.

Mom and Dad have been divorced since 2000, mom has had numerous live-in boyfriends/fiances the most recent boyfriend has been since 06. There is no abuse of any kind noted. Boy has 2 half brothers that lives with him and 3 half sisters that live with dad. Boy has anger outburst, some physical violence with fighting at school and attacking teachers, was kicked out of school and placed in an alternative behavioral school where he got physically violent with a teacher there also. He was hospitalized and discharged with these meds.

Abilify 10mg BID

Clonidine HCL .1mg BID

Celexa 20mg 1 1/2 daily

Melatonin 3 mg HS PRN

Benadryl 50mg HS PRN

What do you think ??

i think the kid is way overdiagnosed/overscripted and has every right to be angry and occasionally violently expressive, but then, i'm old school. look at how he got to where he is. split parents and 5 new siblings? multiple trust objects lost in the maternal home in the formative years? talk about abandonment issues. a sociopath in the making.

too late for his parents to keep their pants up, so lets trank the kid and move on. no need for re-parenting here.

i think the kid is way overdiagnosed/overscripted and has every right to be angry and occasionally violently expressive, but then, i'm old school. look at how he got to where he is. split parents and 5 new siblings? multiple trust objects lost in the maternal home in the formative years? talk about abandonment issues. a sociopath in the making.

too late for his parents to keep their pants up, so lets trank the kid and move on. no need for re-parenting here.

I was hoping someone else would say that. I think he is over medicated as well. When you have parents like that who keep putting men/women before their kids, it's just gonna make things soo much harder for that kid.

In my experience, Medicaid will only pay for Abilify when other traditional antipsychotics (with generics) have been trialed and failed. I actually think his dose of Abilify is high, combined with a high scheduled dose of Thorazine (has a short half-life but is more used on a prn basis than scheduled, but that doesn't necessarily mean it's contraindicated) I would worry about EPS and/or weight gain. Has he tried Guanfacine (tenex)? Seroquel?

I guess the real question is: Is it working? Is he less aggressive on all these meds? For an 11 y/o, I would expect him to be snowed on this but, if he's a big boy and/or if it's working, the benefits would outweigh the risks. We rarely combine antipsychotics but when we do, they need to do a MD to MD review with the insurance company. So I would expect that to happen here.

At some point, he may have to do a drug holiday and start fresh. We do that a fair amount when there is polypharmacy to see what is really underneath. It's a nightmare for staff but can be helpful for treatment.

Good luck. Does this kid have intensive in home therapy? It sounds like he needs it in addition to the behavioral school. What happens after school can carry over easily into the class. If they are not working with the family, any gains he may have will be quickly lost. A good in home therapist can do wonders for a chaotic home life. The sick kid tends to hold the rest of the family "hostage" by his moods and they forget how to parent and interact in a healthy way.

Hope he gets the help he needs!

I don't know what all has been tried on this kid. He is a new pt and came with the meds he left the hosp with. I don't know a whole lot about his prognosis as he is not my patient and this particular doc only works on Saturdays and there is usually a different nurse working with him on those days. I do a lot of the PA's for this doc tho. And it seems like everytime I am asked to do a PA it's for a med in addition to thorazine. Since the doc doesn't want to go thru the red tape with medicaid he will prescribe them something from the $4 list at Wal mart or one of those pharmacy deals.

It just seems like thorazine is his drug of choice for kids. And they are really high doses. I don't really like to question it but when all the PA's are denied because of thorazine won't medicaid get suspicious ??

So....the Thorazine is prescribed because it's cheap? I've seen oodles of EPS in patients who take Thorazine, as well as tardive dyskinesia from it. I wouldn't give it to a child and would try to avoid it in an adult unless it's only going to be used for a short time.

Personally I would never let my own kid be on Thorazine. I say Thorazine is too high risk for kids #1. and #2- I agree, how about increasing the kids therapy.

My opinion is: Yes. If you admit that you're no doctor, then that's the first step in recognizing your problem and dealing with your delusions of grandeur.