Have Mental Health Questions? Ask a Psychiatrist Online
Hi! I'll be glad to help you with this issue.
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I'm glad you're in the chat now, hi.
First, let me say this must be very difficult for you.
Yes, I am here.
Your daughter is going through some real difficulties.
I'd like to start with the EMDR.
What was the purpose of you both having EMDR therapy?
Or, rather, the reason?
The reason for her was because of not being diagnosed with ADD until 19 she left home at 18 and went a bit wild and had a lot of trouble forgiving herself and couldn't get past the trauma. I have a sister with what I consider undiagnosed ADD and when my daughter starter acting in the same manner it brought back a lot of trauma issues for me due to my sister's abuse towards me.
And did EMDR help her?
Yes, very much. It helped both of us tremendously.
And has she had any therapy since then?
Not since she was released in June. I have asked her if she would like to return and she says she doesn't have the time. She goes to college and works. I have offered for her to lighten her work load; but she refuses.
So she's doing better, but you're worried about her now thinking she might have Bipolar Disorder.
That's why you're wondering about the Lawlis-Peavey center in Dallas, am I correct?
We thought she was doing great. That's the deal. She tends to try to deal with this by herself without help and then when it finally gets to be out of control she comes to us in a tizzy, frantically needing help! We don't see it coming. She had a melt down yesterday and said she has been feeling this way for quite some time.
I'm just not sure if the help we are getting her is enough or the best. That is why I am wondering about PNP.
First of all: would she agree to go down to Dallas and do the assessment with them?
Second, they're expensive. I don't know if your insurance will cover them, being out of Oklahoma.
I think she would agree if she could do it during Christmas break from school. We would have to check with our insurance to see if they would cover it. Do we need a referral to go to them?
That depends on your insurance. You should get a referral from her PCP to cover the bases.
I can tell you that the Lawlis-Peavey center is very highly regarded
especially in assessment of ADHD and anxiety disorders.
They also work with PTSD
but they are most known for ADHD assessment
So, it would be a terrific resource.
Do you think we have exhausted all our avenues here locally? We live in Edmond, a suburb of Oklahoma City. Is there any place closer that we could look into that has the same resources and expertise?
How close are you to a big university hospital?
We have the OU medical center about 20 minutes away.
You want to talk to her PCP and start finding out who are the top people in that hospital in ADHD. Most psychiatric practices associated with a university hospital are more diagnostically expert and that's what you're looking for.
The reason it:
I'm sorry, is:
because there are too many things going on here for her.
First, there is some element of trauma.
EMDR helped, but it's not clear if there is still some PTSD emotional overwhelm that is influencing her behavior.
Second, there is a diagnosis of ADHD that is being treated right now with the Focalin.
She's going off Cymbalta, so we don't know if she's having some side effect mood swing changes from the withdrawal symptoms (not uncommon)
and thus, the Bipolar suspicion may be suspect.
However, she is reporting BD type symptoms
so you see, there's just too much going on.
Oh, and I forgot about her going off the birth control and her hormonal situation that needs to be monitored.
That's why I'm concerned more about getting doctors who are known to be "diagnosticians" rather than simply treatment psychiatrists.
Because psychiatrists are so busy, that they usually treat the most "apparent" disorder and leave it at that.
But the hope is that at the U's hospital, you will have available psychiatrists who are teaching as well and thus more expert in diagnosing difficult cases. Does that make sense to you?
Yes. It is what I have been looking for. I am the one who suspected the ADD after watching an episode of Dr. Oz and took her to her psychiatrist to have her tested. I noticed a huge change in her when they boosted her cymbalta with Ritalin when she was suicidal. It seems I have had to be the researcher here for all her care. I got the book by Dr. Amen on ADD and that is where I found out about EMDR and the importance of family therapy and getting her into exercise and supplements. I'm the one who insisted that she have her hormones tested and yet they won't help to stabilize her. I just don't feel that we have found someone that knows what they are doing. Now this Bi-polar thing.....I just really need someone to help guide this. I feel very over-my-head.
Wow, you've been really shepherding her through this amazingly.
She's very fortunate to have you there.
You clearly need diagnostic help
and it would be so useful if it was nearby.
In OK, I mean.
I am neither suspicious nor "pro" the BD diagnosis.
The Cymbalta is a real wild card given that she's going off of it.
But really, you've taken her so far here
it would be such a help to you to have access to diagnostic experts in your U hospital.
I really think you should start with a conference with her PCP
and asking him/her to do some research as to which of the docs at the U hospital are considered the best psychiatric diagnosticians in the area.
Then interview them and get a feel for which of the docs you feel comfortable with.
Because they need to be comfortable talking with you and vice versa.
Again, BD may be a possible disorder present, but a good diagnostician needs to be there with you evaluating all the variables, okay?
You haven't responded, so I'm not sure if you want me to wait or to say more?
I'm sorry, I just got this. We have an appointment with her PCP on Monday morning and I will discuss getting this information moving along as quickly as possible. I keep telling her not to label herself with bi-polar. That is for a doctor to diagnose. Thank you for your help. This has been very reassuring and has given me a good direction to go from here.
I am so glad. Because she's fortunate to have you on her side!
Okay, I wish you the very best!
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Thank you Dr. Mark - You have been a great help. God Bless.