Who's In Charge Anyway???

[Haunted]

I am really concerned.... see " My son tried to kill himself tonight" thread. He is not progressing very well, is still placing blame on others, expressing feelings of revenge, stated to me the other nite that he feels "he is the last person he can trust" and is concerned over his "lack of coping skills" when he get's out.

Really does not feel that he can resist going back to drugs and the people who that entails. He has been treated for the past week by a very insightful MD, great follow up with her, she really seemed to connect to him. Very supportive of his care, our concerns over discharge, skills and resources for when he comes home. She feels like he has a form of anti social personality disorder and ordered Risperdol and a Minnesota "mini" psych eval as of last Friday, to which I agreed. Then she told me she was going out of town and transferring his care to another MD.

I had a great visit with him Sunday evening and felt like he was starting to express some hope for the future, I actually got a big hug and he told me he loved me!!! I was on a cloud driving home.

Monday morning I got a call from a woman who was scheduling a follow up appointment for this friday to see him. She is a Psychiatrist who had been contacted by the hospital and she informs me he is being discharged WEDNESDAY!!!!! ***???? I "finally" got in contact with his new Doc who also told me that she started him on COGENTIN!!!!! I told her I was not cool with that since it can act as a depressant, and also requested that she taper his Risperdol level. She agreed and said she would have the case manager contact me to discuss his DC plans. I also have been asking to review his chart at the nurses station, I primarily want to read his H & P, progress notes and CM notes. She told me I could not review the chart until he had been discharged and then I would have to go to medical records.

Last nite my son was EVEN WORSE then when he was brought in. Sleepy, poor grooming, just sat with his head on the table during visiting hour. The PM shift said that he was pretty much like that all day and commented that he had been "brighter" and more social the past few days. They again denied my request to review his chart and didn't have any info on his DC. I also discovered that his Psych eval had NOT been done, even though I had to pay 350.00 up front for it and it had been ordered last Friday.

Today I spoke with my son's nurse and asked that MD or CM contact me. Also asked about DC date. The nurse replied "I am not sure, I would ask your son since he has daily contact with the Doctor and would know more about that". WHAT???? Now I have to get DC info from my adolescent drug abuser?

I just want to know guys, I have worked Psych for YEARS and never heard of anything like this. I have allowed parents to review the chart, I have always followed up on discharge plans, I cannot understand how he is falling thru the cracks like this! He will be 18 in a few weeks and by my estimation will be deemed "gravely disabled" and on SSI within 6 months.

What can I do to push for more help for him? Is it possible that there is also an organic component for his decline in mental status? His handwriting is like a 3 year old, he can't concentrate, is even more spaced out and disorganized than before. How am I supposed to care for him at home? How can I work and not worry that he is degrading further, being afraid of what I may come home to? I'm not getting any answers and last but not least the new Doc had mentioned that we were considering the military as a furture option for him. I pointed out that no branch of the military is going to consider enlisting him while he is on ANTI DEPRESSANTS !!! "Here's your SSRI's and an AK47 soldier, have a nice day !" She replied "Oh, I never thought of that! "

Sorry for the rant but grateful for your opinions. He is on Effexor and I am wondering in Wellbutrin might be a better choice for him based on his addictive past. Whew, I feel better, scared but better.

[P_RN, ADN, RN]

Bless you and your son. Where is his medical doctor in all this? It would seem the shrinks would benefit from someone who recognises symptoms that aren't necessessarily psych. I suggest a medical consult now.

[Thunderwolf, MSN, RN]

you have my hugs. this is is a very rough path that a parent takes. he will be 18 in a few weeks. you feel he is not ready. decline to accept him home at this point in order to obtain additional time for med adjustment, psych eval, and doc-parent discussion. you as a parent have a right to speak to the physician. schedule an appointment. bring your list of questions. you are his guardian...until he is 18...then the whole thing changes...he becomes his own guardian (bad choices or not...you mentioned, antisocial personality). folks do not get prescribed major meds such as these unless there are significant axis i and/or significant axis ii symptoms/disorders present. you need to discuss with the doc about what significant symptoms are present in order to understand the rationale for each of his meds. this is a doc-parent discussion. if he is on an antipsychotic, what is the rationale by the doc for the cogentin? i am not surprised or against its use....he is on an antipsychotic and is prone to the side effects. young males on antipsychotic meds are a risk for eps (like dystonias and pseudoparkinsonism)...so, it is not unusual as a preventative measure, especially if he has had some early eps on the antipsychotic med during his stay there. you mention the drowsiness/sedation...it's the meds. may need time to adjust to them or may need adjusted....something again to talk to the doc about as you review the chart with him/her. definately, i believe counseling is in order during and after the inpt stay. and when we speak of adolescents or a young man like your son staying with you at home (s/p trashing your place and drug use), family counseling is in order. you can medicate the person...but, you can't medicate the environment. the environment (home, friends, work, internal stuff, etc) need to be addressed or you will be walking down this road again. as a soon to be adult, your son needs to know he has the support of his family to help him get through this, but he will need to be held more accountable for himself and for his behavior...especially around his friends (who also like to drug). this may be tough for you, but is a necessary step. what does this mean (accountable)?....it is a counseling issue. a medication will not instill this in him. so, if he needs the meds, he needs the meds. if he/family needs counseling, it needs to be there. often, meds and counseling together initially is the way to go. as a psych nurse, you know this. as a mom, you know this as well. my heart goes out to you. this is a very difficult moment for you. and, i am truly sorry this has happened. also, counseling for yourself, if needed, is something to keep in mind too...to help you as well to get through this rough time. i hope for the best...for your son, yourself, and for the rest of your family. you have our support.

and don't forget....take care of yourself during this.

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