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Getting Help — Comments Off on Working with Your Teen’s Psychiatrist
26
Mar 24

Working with Your Teen’s Psychiatrist

PsychiatristTeenShakeHands.jpg“Things will go smoothly with your teen’s psychiatrist if you understand the assessment process as well as how to best communicate with him or her.”

A first-time meeting with a psychiatrist can be nerve-wracking. You may be concerned that they will misjudge the situation or give you unwelcome news or, worse, leave you feeling like you wasted your time. Bear in mind that you and the doctor have the same goal: to help your teen. Things will go smoothly with your teen’s psychiatrist if you understand the assessment process as well as how to best communicate with him or her.

Your Teen’s Assessment
The initial appointment may take as long as an hour because the doctor will request a thorough history about your teen. Later, appointments may be only fifteen minutes or so, but for now the doctor will need to ask your teen a long list of questions. As tedious as this may seem, it is only for the first visit and it will help them to get a broad picture of your teen. Hold off on asking questions until they have had a chance to talk to your teen. They will then ask you for a family history, including any family members who may have had a mental illness.

Your Many Questions 
Many parents come to an initial assessment wanting to tell the psychiatrist every detail about their child and what they have been through. This is understandable because we don’t know what it all means and we often feel like the doctor has to hear everything. Try to be patient and let them ask the questions. They can put things together more quickly than you would imagine. After they have gone through their questions and gathered a history from you, go ahead and mention the two or three items that you think they did not cover and that will help to complete the picture.

Try to let your teen do as much of the talking as possible. You may think you know how they will answer every question, but if you sit back and let them speak, some surprising things may emerge. Besides, the psychiatrist must establish a rapport with your teen. In a few years, they will be coming to these appointments alone, so now is the time to begin building the necessary trust and rapport.

In fact, do not be surprised if the psychiatrist asks to speak to your teen alone for a few minutes. This is a smart move on the doctor’s part because your teen may be withholding important information that they do not want you to hear. Try not to worry that something serious may be going on; your teen is in the hands of a professional now.

Your Teen’s Medicine History
If your teen has taken any psychotropic medicines, including ADHD medicine, write down the dates, dosages, and your teen’s reactions to the medicine. Bring the list of your teen’s medicine history with you to the first appointment. It is important for the doctor to know what has or has not worked so that they don’t waste time trying the wrong medicine. If any family members take psychotropic medicine, and it has worked well for them, bring the name of the medicine to the doctor. Sometimes families members do well on the same medicine.

If your teen has not taken any psychotropic medicine, you may be worried about letting them start. Bear in mind that the doctor may not start medicine. They may choose to give the situation more time while they continue to evaluate your teen. If they do think that some medicine is appropriate, listen to their explanation of why they are choosing the particular drug. They will give you instructions for how your teen is to take the medicine. Often, the dose is very small for the first few days, followed by a gradual increase. Write the instructions down and don’t be afraid to clarify. Make sure your teen gets the opportunity to ask any questions they may have about the medicine. Sometimes parents are surprised to leave the doctor thinking they have a plan only to discover that their teen wants nothing to do with the medicine.

If the doctor tells you that your teen does not need medicine, try not to appear disappointed. Often, we place hope in medicine and may feel let down when it isn’t offered. The psychiatrist may decide that therapy alone is the most appropriate treatment for now. Sometimes parents are surprised to hear the psychiatrist suggest that the parent see a therapist or psychiatrist. Try not to feel insulted. They are seeing something that they feel you should address in order to help your teen.

Practicing Patience
Psychiatry, more than any other branch of medicine, requires patience. There are no blood tests to guide the doctor toward a diagnosis or appropriate medicine. Over time, they gather more information as your teen continues to report symptoms. Medicine is tested on a trial-and-error basis. Most of the medicines used in psychiatry take several weeks to begin working. This can feel like an eternity, especially if the first medicine does not work. Remind yourself that for every failed drug trial, your doctor scratches one off of the list. They will find the right solution. If your psychiatrist is methodical and communicative and your teen trusts them, give them a chance to get it right. Meanwhile, progress will continue to occur through therapy and the coping strategies your teen is learning.

Communicating with the Psychiatrist
Your teen may struggle or even reach a crisis point in-between appointments. Call the psychiatrist’s office and ask for the doctor’s voicemail. Prepare, ahead of time, a description of the problem. Try to anticipate what the psychiatrist will ask you when he calls so that you can save him time with a succinct, thorough message. For example:

“Doctor, I’m calling about my son, Jeffrey Smith. You saw him last Tuesday and increased his Prozac from 20 mg. to 30 mg. He’s also taking 100 mg. of Lamictal. He hasn’t missed any doses and there haven’t been any new stressors in his life, but he hasn’t gotten out of bed since yesterday. I believe his depression is worsening, although he told me this morning that he has no suicidal thoughts. The receptionist told me that the earliest opening you have is next Wednesday, so he’s scheduled for that day. Will you please call me at the following number…”

Let your teen know that you have made the telephone call since this will reassure them. You may also feel that your teen should see their therapist if they are struggling.

Coordinating Treatment with the Therapist
A good psychiatrist will be very interested in communicating with your teen’s therapist, especially during times of crisis. Although you and your teen can explain what is happening to the doctor, a few words from a clinician can really give a psychiatrist the full picture. For this reason, they may have you sign an agreement giving them permission to speak to your teen’s therapist. In order for the therapist to communicate back, you will need to sign a similar agreement with the therapist. Professionals who take the time to follow this extra measure are special, so be sure to thank them for taking the extra trouble.

Why Hasn’t My Teen’s Psychiatrist Made a Diagnosis?
As frustrating as it may feel, it is actually a good sign if your teen’s psychiatrist holds off on providing a diagnosis. Mental illness tends to emerge slowly in teens, and sometimes it is just an emotional blip that clears up with a brief intervention. Then again, it may hint at something that will develop further down the road. A symptom may be a “disguise” or manifestation of something currently hidden. For example, let’s say your daughter has lost a great deal of weight. She may be anorexic, or she may be so depressed that she cannot eat. Similarly, a boy may be getting into frequent fights, leading you to think he has an anger problem.  But some people, especially boys and men, exhibit irritability or anger when they are depressed. They may not be sad or weepy like we would expect. Similarly, teens with bipolar disorder may not display mania for years; instead, they often suffer from one or two long stretches of acute depression.

The most important question to ask yourself is whether you think your child’s treatment is helping. If the doctor’s care is addressing their symptoms, try to relax and see where things go. The doctor may provide a working diagnosis, a “best-guess” about what is going on. In this case, you may want to read about the symptoms and treatment for the specific illness just to flesh out your knowledge. But try not to get too hung up on the name. Neither of my kids’ illnesses were truly diagnosed for about two years, but their doctors and therapists accomplished some good work with them during that time.

 

Caring for Your Hurting Teen — Comments Off on Caring for the Anxious Teen
22
Mar 24

Caring for the Anxious Teen

anxiousteen.jpg“Sometimes anxious people fail to give themselves credit for what they have accomplished.”

Anxiety can be described as conscientiousness run amuck. I once heard a corporate manager point out that anxious people make wonderful employees: they’re never late for work, they rarely make mistakes, and their work is immaculate. But anxiety can be crippling, causing your teen to miss school, experience insomnia, and hide from friends.

Putting Anxiety in Perspective
During an anxious episode, start by expressing sympathy for your teen’s anxiety. This can be difficult if it seems like they are blowing the situation out of proportion. Yet, a simple acknowledgement of their discomfort can significantly reduce the anxiety immediately. We all need to feel understood.

Now that you’ve been able to get your teen to relax and trust you, ask in a calm tone if they can isolate the specific triggers that are causing anxiety. There may be several. They may recognize on their own that one of them is not really a big deal. For the remaining issues, ask a few questions. If possible, have your teen sit down with you and write their answers on a piece of paper. Seeing the words on the page can provide clarity and reassurance. Ask these questions:

  •  What is the worst that can happen? If that happens, what can you do?
  • Is there anything you can do about the problem now?
  • Can you create a step-by-step plan of action?
  • Can you forgive yourself in advance if you don’t achieve your goal?

The point of the exercise is to try to get your teen unstuck from the circular thinking typical of anxiety. Try to get them to step outside of the immediate worry by promising that every situation eventually has a resolution.

Evaluating and Reducing Anxiety
Another useful exercise for the teen who is either driven or a perfectionist, is to have them scribble down a list of their accomplishments at the end of each day. This should help them to realize that they are doing all they can. For example, if they are feeling overwhelmed about completing their college applications, have them list the things they have already finished. Sometimes anxious people fail to give themselves credit for what they have accomplished.

Help your teen learn to reduce big jobs into several small tasks. Make the first few tasks easy, and ask them to start with the first one. Note how long it takes and then tell them how quickly they completed the task. Ask f they will go through the list and assign to each task the number of minutes or hours it will take to complete. Then set up a realistic schedule for completing the entire job. If the job is going to take three days to finish, tell them to look at only the tasks for the current day. The next time they feel overwhelmed by a large job, remind them that they successfully handled it in the past, and they can successfully handle it now.

Getting Through the Worst Moments
During your teen’s most anxious moments, encourage them to take deep breaths. This advice may annoy them, but ask them to try it because it will refocus their energy. Another helpful exercise is to take a brisk, twenty-minute walk.

Ask your teen to come up with a mantra. For example, “I’m doing the best I can.” Ask them if they will allow you to say this to them when they are becoming overwrought. For example, you could say, “You’re doing the best you can” as they are getting out of the car for school. Remember, though, that you need to have their permission. Coming from you, the phrase could either soothe or irritate them, so ask in advance.

If a worry or a thought keeps intruding into your teen’s thoughts, teach them to put it on hold. They can do this by picturing a stop sign and silently saying, “Stop.” They may also choose to substitute a positive thought. For example, if they realize that they have been telling themselves, “I’m going to fail this test,” they can interrupt the thought by saying, “I’m well-prepared for this test.” The old message will pop back in, but if they keep halting it, the periods between episodes will lengthen and they will come to realize that they can control these intrusive thoughts.

Daily Pleasures
The anxious teen often neglects to indulge in a daily pleasure, preferring to torment themselves with the possibilities of future disasters. A daily pleasure means living in the moment. It might be watching a half-hour television show with you after dinner, playing a game of cards before bed, reading a mindless novel for an hour after school, or spending time each day on a craft project. As trite as it might sound to your teen, scheduling a routine activity that provides a pleasurable or creative outlet will add up to a big relief of stress.

Reducing Unstructured Time
If your anxious teen could see how many minutes a day she spends brooding, you might both be stunned. Unstructured time is an enemy to the anxious teen. If your teen is spending hours each day in their room and coming out looking stressed, it is time to take action. Get them involved in an activity outside of the house. This can include joining a club, getting a part-time job, volunteering at school, or taking lessons. At home, include a daily fun activity, chores, and some form of physical activity, such as walking the dog each day. They will probably not want to do any of these things, but start adding them one at a time. They can start dinner one afternoon a week, do their laundry another afternoon, and pick up their younger brother from football practice another day. All of these activities will keep their mind occupied with thoughts that force them to live in the present.

Anti-Anxiety Medicines
Your teen’s psychiatrist may prescribe an antidepressant or other medicine for their anxiety. Be watchful for side effects or an increase in their anxiety; if this occurs, report it to the doctor. If the doctor prescribes a quick acting, short-term medicine from the benzodiazepine family (for example, Ativan, Valium, Klonopin, Xanax), he is likely to monitor your teen closely because it can be habit-forming. If you are concerned that your teen may become dependent upon the drug, calculate how frequently they take it. For example, when you need to refill the drug, look at the date the prescription was filled and divide the number of days by the number of pills used. If they are using it once or twice a week, you can relax. If they are using it daily, you may want to bring it up to the doctor. Above all, do not have your teen quit a benzodiazepine cold turkey if they have been using it regularly because they are likely to experience serious withdrawal symptoms, including insomnia and temper outbursts. Your doctor can easily manage your teen’s titration of a benzodiazepine by gradually tapering it off. The same is true of antidepressants.

Anxiety tends to be a pervasive trait, even after the acute symptoms are under control. Help your teen recognize that their conscientiousness is a positive quality that will aid them in achieving their goals. To discern the difference, if they are fretting, they can stop and ask, “Is this helpful?” Eventually, they will learn to manage their thoughts so that they can benefit without suffering.

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