<p>Take her to a different psychiatrist for a second opinion: bipolar runs in my family and this is pretty much exactly how it plays out. Lexapro could very possibly make her worse - be careful with that.</p>
<p>I mentioned in an earlier post that this is not the type of thing that just goes away in a few weeks like the flu. Your daughter is ill and your job at this point is to offer any help and support to help her. You are frustrated already but you have not even seen the hard stuff yet. I hope that does not scare you but the reality is that mental health issues do not just go away. There will be times when this is bearable but there will be times when you will not believe that this could be your daughter. </p>
<p>I still have not heard you talk about the rape…do you beleive your daughter was raped? I am somehow getting some mixed messages and maybe you are just too angry to acknowledge what you really think or believe. Has the boy involved been brought up on charges and will your daughter need to testify? Is it bothering you that she is looking to boys when she just experienced a terrible trauma? I hope you and your wife are talking to someone who is really experienced because the road ahead is not going to look green for a while.</p>
<p>This CHILD needs unconditional love, consistency and structure- but what she is getting is validation that she is F*&ked up , with little indication that her parents see her any other way.</p>
<p>I sooo wish it were true, but “unconditional love, consistency and structure” won’t cure bipolar disorder if she has it. :(</p>
<p>Apologies that I haven’t read all the posts, but I did catch that your insu co is threatening to not authorize continued covered days. That should be a first priority-- to get the Utilization Review person at the facility to immediately appeal any potential denial of covered days. She is clearly NOT ready to come home, and while she may not be actively at risk of harming herself/others (a common justification for hospitalization) her behavior, including her resistance to treatment/noncompliance/nonchalance is clearly self-destructive. I agree from listening to some of the behaviors you describe that she sounds like she may have a Borderline Personality Disorder. They often have comorbid Axis I diagnoses (depression, bipolar disorder, substance abuse, etc) and they are tough to treat. Consider reading “I Hate You: Don’t Leave Me” by Kreisman and Straus. Its a great book about Borderline personality disorder.</p>
<p>In the meantime, premature discharge is a BAD thing for her and for you, until there is a clear aftercare plan in place. I’d check with the hospital’s UR staff to see if they’ve been able to get additional days authorized. What insurance co are you dealing with, and is it a PPO or an HMO? Is there a mental health/behavioral health carveout you are dealing with?</p>
<p>If insurance does not pay, then you may need to keep her there and pay out of pocket. Use her college funds. She needs to stay until she gets it. Or be evaluated at another inpatient location.</p>
<p>Since your daughter has very recently been using drugs like marijuana, alcohol, and perhaps other drugs, I don’t see how the psychiatrist can make a diagnosis so quickly, assuming that some drugs may still be in her system. I do know that introducing additional “medications” could be harmful to patients with an addiction, yet there are medications that are useful in treating patients with addictions. Is she in a facility for patients who have addictions, and being treated by a psychiatrist who specializes in addictions?</p>
<p>I still think that you and your wife should go to Al-Anon or a similar type of group. It might help to speak with parents who have walked in your shoes. They can offer hope, experience, and strength to you. You’ll need all of those things. It may seem strange that I say this, but you seem too involved in everything that “she is doing”. She has professionals who are working with her. How are you doing? You sound frazzled, and Al-anon can help you focus on yourself and the rest of your family while learning how to live with your daughter.</p>
<p>I also think you need to forget about being the cool dad and restoring things to the way they were. You will need to call upon all the parenting skills you have and you need to deal with this. There will be time you need some tough love. You will need to love her and show love, but be firm. No time to worry about hurt feelings. This can become a life or death problem. And you need to understand what it is to enable. Al-anon will actually be tough for you at first. You will have to understand that when it comes to drugs and alcohol she is powerless, and when it comes to HER YOU are powerless. You can’t help her. You can only help her to help herself. And you can help yourself to do the right things. Sometimes realizing one needs help only comes when a user hits bottom. And with co-morbidities of alcohol and mental illness, it is difficult to know when to step in and when to let her realize that she has to accept she has a problem first. </p>
<p>This is the time to be financially supportive, but NOT PERMISSIVE. You need counseling, the family needs counseling, and you need to visit many al-anon meetings to find a group you are comfortable with.</p>
<p>Is she in a facility competent to diagnose and treat mental illness, or a facility that is really primarily geared towards substance abuse? If the latter, I’m concerned, because it really does sound like she has an awful lot of the symptoms of bipolar disorder – and the drug/alcohol abuse is often found along side of that (along with the lying, mood swings, promises,…)</p>
<p>It sounds like she needs inpatient care at this point – but you may be using up days of eligibility in the wrong setting.</p>
<p>This is tough on the whole family. And while it is hard to cope with her behavior – especially the repeated lying – it may help if you can continue repeating to yourself: “The disease is pushing her to behave this way. She’s ill, and these are the symptoms. At her heart, she doesn’t want to hurt us, but the disease has taken over.”</p>
<p>It is so easy to take this all personally, and that’s part of your challenge. I have personal experience on this front with another family member, and it was about the hardest thing I have ever had to cope with.</p>
<p>When she does get out of an in-patient setting, I’d agree with the suggestion of finding a board and care home, particularly since you have younger children who need some sheltering from this chaos. I also second (third, fourth?) the suggestion of getting in touch with your local NAMI – your employer may also have an employee assistance (confidential) help line that might be some real support for you.</p>
<p>arabrab is right on. Interesting how so many people are willing to accept a diagnosis of depression, but the stigma of bipolar disorder scares so many away from correct treatment. Here are some warning signs of bipolar mania:</p>
<p>Increased energy</p>
<pre><code>* Decreased sleep
- Little fatigue
- An increase in activities
- Restlessness
</code></pre>
<p>Speech Disruptions During Mania</p>
<pre><code>* Rapid, pressured speech
- Incoherent speech
</code></pre>
<p>Impaired Judgment Caused by Mania</p>
<pre><code>* Lack of insight
- Inappropriate humor and behaviors
- Impulsiveness
- Financial extravagance
- Grandiose thinking
- Hypersexuality
</code></pre>
<p>Changes in Thought Patterns Due to Mania</p>
<pre><code>* Distractibility
- Creative thinking
- Flight of ideas
- Disorientation
- Disjointed thinking
- Racing thoughts
</code></pre>
<p>Mood Changes</p>
<pre><code>* Irritability
- Excitability
- Hostility
- Feelings of exhilaration
</code></pre>
<p>If your D has several of the above, I’d be thinking bipolar disorder. Here are some warning signs of the depressive side of bipolar:
Changes in Activity or Energy Level</p>
<pre><code>* Decreased energy
- Fatigue
- Lethargy
- Diminished activity
- Insomnia or hypersomnia
- Loss of interest in pleasurable activities
- Social withdrawal
</code></pre>
<p>Physical Changes Caused by Depression</p>
<pre><code>* Unexplained aches and pains
- Weight loss or gain
- Decreased or increased appetite
- Psychomotor agitation or retardation
</code></pre>
<p>Emotional Pain of Depression</p>
<pre><code>* Prolonged sadness
- Unexplained, uncontrollable crying
- Feelings of guilt
- Feelings of worthlessness
- Loss of self-esteem
- Despair
- Hopelessness
- Helplessness
</code></pre>
<p>Difficult Moods Associated with Depression</p>
<pre><code>* Irritability
- Anger
- Worry/anxiety
- Pessimism
- Indifference
- Self-critical
</code></pre>
<p>Changes in Thought Patterns due to Depression</p>
<pre><code>* Inability to concentrate
- Indecision
- Memory problems
- Disorganized
</code></pre>
<p>Preoccupation with Death</p>
<pre><code>* Thoughts of death
- Suicidal ideation
- Feeling dead or detached
</code></pre>
<p>If your D has suffered from several of the above depression symptoms, plus a few of the mania/hypomania symptoms, then bipolar disorder could be the problem. GIVING ANTI-DEPRESSANTS SUCH AS LEXAPRO TO A BIPOLAR depressed person often induces the manic symptoms.</p>
<p>As far as the OP’s “attitude” is concerned–folks, let him vent. Tell your D that you love her and you will not stand by while she refuses to participate in her own treatment.</p>
<p>Other posters have correctly cautioned you that the facility that focuses on the addiction part might not support the mental illness piece appropriately. Until your D is on the right meds (these may not be lifelong, or maybe they will be), it’s tough for her brain to function well enough to benefit from groups or talk therapy. So many of these places say that they handle “dual diagnosis” but most of them don’t do it very well. IF your D is self-medicating to help herself deal with the depression and/or mania, in many cases the desire for drinking or illicit drugs goes away when the bipolar or whatever is effectively treated.</p>
<p>Good luck. It will likely get worse before it gets better.</p>
<p>I have little to no useful expertise to contribute here, but I wanted to state that my older sister has bipolar disorder and this sounds just about like her teen years. And without appropriate medication (mood stabilizers, not anti-depressants) she has absolutely no control over her behavior. And in the case of my sister, when she does terrible things to people when she’s manic, she comes back down eventually, realizes what she has done, and is suicidal-- she attempted suicide when she was in high school and to this day we never know what’s going to happen. I am not going to diagnose OP’S D, but symptoms that sound like they could be part of a mood disorder are not to be made light of. You can’t let them get to you, can’t take them personally, and need to deal with them head on in the most aggressive way possible before someone gets hurt. Complacency is not an option. Wasting time with hurt feelings is not an option. Save that for therapy in the aftermath. Check your feelings at the door and help her get better, the feelings can wait, the girl can’t. That is our experience, anyway.</p>
<p>It isn’t always easy to get an 18 or 19 year-old to agree to meds, and even if she does agree, she can easily hide them while telling you she is taking them. And finding the right med takes patience and time. Sorry to be even more depressing, but, again, a good relationship between parent and child is pretty important in all this. (A good website is Child and Adolescent Bipolar Foundation, CABF, if bipolar disorder is relevant here.)</p>
<p>(I guess I am posting a lot here because I spent the day Saturday helping to bring a music program to a pediatric psych. unit, an experience that was kind of heart-rending.)</p>
<p>A quick rattle off of some answers…we could pay some out of pocket to continue Res. Inpatient… like another 2 weeks and unfortunately that is all. I don’t know what kind of people can afford 10k+ a month in treatment I’m not one of them.</p>
<p>As far as treatment the facility specializes in Substance/PTSD. Our insurance classifies coverage aseither substance abuse or mental health there is no true dual diagnosis coverage she has to meet primary criteria for one or the other. She didn’t meet for mental health and did meet for substance abuse, so that narrowed the search to substance abuse as the primary focus. After talking to many people we went with the a highly recognized Res. Inpatient facility. Our search was limited to 200 miles and this was the best we could find within a 200mi radius. We figured deal with the substance abuse and deal with the rape…she is on Lexopro and figured at least part of the mental health side was being addressed.</p>
<p>We get so much advice that conflicts. Some say focus on mental health first, get her through detox then do the mental health part, others say focus on the rape because that is the most acute and traumatic event. We are really trying to absorb it all and doing one step at a time as she fails we’ll move to the next step.</p>
<p>I’ll just hope it’s all medication and finding the right people that can diagnose her correctly add a lot of love and patience and hope for the best. She was definitely not like this when she was at home and this monstrous transformation has occurred over 9 weeks now. There were signs of issues but normalcy was intact for the most part now …she is just nuts I’ll explain in a second I’m getting ahead of myself.</p>
<p>Insurance did cancel today…it is UBH and they need to see improvement to stay in the program. If you are not being agreeable, not following the treatment plan, recieving numerous violations, the evaluations with the therapist just don’t go well. She likes to hang out with the rehab people, joke almost, talk about the people trying to help her, blows the work off, then last minute apologiizes for all of it. The therapist said with all that has happened UBH would not extend benefits.</p>
<p>Now for the really bad!! Well, we got a call today that someone snuck in alcohol somehow. She and two boys drank it she passed out. Under some law in the state they were allowed to bring her to the ER where her blood alcohol level was .3 or almost 4x the legal limit.</p>
<p>That was the straw that broke the camels back. She will be discharged tom and we will go get her. My fear is if she can pull this off while getting forcefed group therapy, small group, individual therapy, all day long and that didn’t stop the attitude and ultimately the “party” in her. What in the world will happen as she comes home and is alone for 6-8hrs day? Wife and I are both terrified…of that. We have no support system that can be a watchdog. Just to reiterate we have 3 kids under the age of 9 in the house remember that part too.</p>
<p>The short term plan is outpatient rehab 3 days a week 3hrs a day, Al Anon 1 day a week at night, a sexual abuse therapist once a month, a local Psych. MD to get a different opinion, and the option to see her old therapist if she chooses.</p>
<p>With that being said we are scared! I didn’t trust her at all before even less than that now. We are willing to give her another chance and will again wipe the slate clean and let her move home. She will not have access to a car, cell phone will be cutoff at 10pm nightly, no going out obviously, she can hang with the family or go to therapy and that’s it for the foreseeable future. We will be the sole mode of transportation think Little House on the Prairie…that’s what I think of in my head at least.</p>
<p>What do I do if she screws up? Sneeks out? Get’s drunk? Steals? These are realities that will provoke some very serious decisions to be made. My wife and I agree we cannot devote 100% of our life to her while leaving the rest of the kids on the back burner they don’t deserve that either. She has one chance and we will be bending over backwards, but how long do you bend before you say “I’m sorry you can’t stay here anymore”</p>
<p>Hopefully she doesn’t stumble much and this is a mute point we’ll see thanks for the replies.</p>
<p>Given that the facility was negligent in providing adequately for your daughter’s safety and she ended up in the ER, you might consider a <em>polite</em> (ahem) call the the Medical Director and ask them to comp you a few days until an APPROPRIATE discharge/aftercare plan is in place (IMO the plan in place now is not the level of intensity that she needs). They are not supposed to discharge her if she is not stable, or if an adequate aftercare plan is in place. Also start the appeals process with UBH. They suck wind big-time (which is why I am no longer a UBH provider-- got offa that awful plan eons ago).</p>
<p>Any chance the ETOH O/D was a self inflicted effort to hurt herself? You can argue for transfer to a MH facility due to continued unstable and self-injurious behaviors. </p>
<p>Good luck. And read the book I mentioned- it will help you.</p>
<p>We don’t know the whole story only what our daughter has said…there is a beach and another patient got someone to plant it at night…pretty desperate…it was 2 pints of vodka. They apologized, but have a big disclaimer yada yada yada. </p>
<p>We are appealing and are using the incident as a example. UBH is just stingy 14-17 day maximum hopefully tom. that changes.</p>
<p>There are only 2 IOP facilities within a 35 mile radius both are 3day / 3hr week, with AA and NA during the week, we are providing the therapist for depression, therapist for rape, and new psych. doc. and are hoping for something.</p>
<p>In all honesty with our extremely limited support system it will hard enough to get her to all of the meetings 6 week and keep her supervised. </p>
<p>She apologized vehemently we’ve heard it all before. Nothing else to say really…can’t think about it 24/7 it’s just a day by day thing now.</p>
<p>There are other Int. In patients that are local, but they are not “Cadillac” programs and my daughter only wants to go to the “nicer” rehabs. Also ironic is a mention of a all womens rehab and it’s a sound NO.</p>
<p>Hopefully someone that understands this far more than me can help her.</p>
<p>Supposed to be 3 days a week 3hrs a day sorry.</p>
<p>I hate to be harsh, but your dau should not be dictating which program <em>she</em> wants to go to. OF course if she gets “pushed” into one she doesn’t want, she’ll use that as an excuse to again not cooperate. I’d let her know firmly that if she will be welcome home only if she cooperates in her treatment.</p>
<p>That said- Doesnt matter how many “disclaimers” the facility can try to cite-- your dau has been involved in what is called “adverse incident” and they cant wash their hands of responsibility. She doesnt sound stable enough for a reduced level of intensity. Push for an extended LOS (length of stay) and get in your daus face and politely but firmly let her know this is not a game and she has a responsibility to own her problem and work to fix it.</p>
<p>I am assuming this was not a dramatic shift in her behavior that could suggest an underlying neurological issue ( eg tumor).</p>
<p>There is the mention of not welcoming your daughter home but where would she go if she was not welcomed home? Would you really want her out in the streets? I just can’t imagine that all of this has transpired within 7 weeks and there is talk of not being able to have her be at home. I guess it is difficult with three younger kids in the house but your oldest is your “baby” too. This is going to be a long difficult road to make progress and often the progress is 10 steps forward and 8 steps back. Other times it is 4 steps forward and 10 steps back. You will need to work out the logistics of having her home whatever that may mean right now. She needs you.</p>
<p>OP, your D is in rehab and went to a beach??? The hospital will be lucky to avoid lawsuits…and I hope they are paying the ER expenses, not you.</p>
<p>If she doesn’t like the “nicer” rehabs, wait til she discovers what jail will be like if she goes out and does something stupid. Getting thrown out of rehab isn’t going to solve anything, either.</p>
<p>Others with expertise – what are the issues and standards used in trying to get a civil commitment for a young adult? Do the parents still pay for treatment or does a commitment make her Medicare/Medicaid eligible?</p>
<p>
Emanheevul – wise, wise words.</p>
<p>OP, there is a lot of wisdom, experience and pain being shared here. Please don’t discount it.</p>
<p>Appeal the discharge. File a complaint with the hospital – allowing an in-patient being treated for alcohol and drug abuse to obtain alcohol and get that drunk indicates a serious failure of supervision. File a complaint with the state – all by fax, so they’re put on notice very quickly. She is not stable; if this isn’t the right placement then the correct placement needs to be determined – not on the basis of what she thinks would be “nice.” Her BAC could be considered to be evidence of a suicide attempt. Here’s a state by state list of adverse event reporting requirements: </p>
<p><a href=“http://www.nahdo.org/documents/25StateAdverseEventReportingRequirements.pdf[/url]”>http://www.nahdo.org/documents/25StateAdverseEventReportingRequirements.pdf</a></p>