Q. I am writing about my 15 year old son who has bipolar, attention deficit hyperactivity disorder, oppositional defiant disorder, turrets syndrome, & possibly obsessive compulsive disorder. He is on the following medications lithobid 300 mg 2 in Am 2 @ noon 3 @ bedtime adderall 15 mg Am 10 mg @ noon 5 mg @ 4 PM Risperdal 2 mg in Am 2 mg @ 4 PM 4 mg @ bedtime tenex 1 mg @ bedtime. At 18 months old he was very hyperactive. At 2.5 years old I enrolled him in a specialized preschool up until he was 5 years old. At 4½ years old he was put on Ritalin till he was 6. He raged so bad I had to put him in a Psychiatric Hospital for an evaluation he was there for 2 months he was Dx with Adhd, Odd, & Ts He was Rx Ritalin & clonidine. At 14 he was admitted again to the hospital for a month we have had some mood swings but not like before. His rages have calmed down a lot. Discipline is a problem due to his new Dx bipolar & being a teenager. He has had a real bad attitude toward us and other authority figures. He punched out a window in his bedroom & started a fire outside his window a few days ago when I asked him why he did it first he said he wanted to die then he said he did it for attention he has been the most disrespectful & disobedient child it is like he wants us to hit him or hurt him. I told the psychiatrist today what he has been like as well as him sleeping in school but she did nothing I thought she would have put him in the hospital. Can someone please tell me what this sounds like? I do not know if this is a bipolar episode or a behavior. He has been away from me for 7 years in placement through children's services because of my ex-husband. While in one placement he had to eat dog food & in these placements he was told that I did not love him nor did I want him that I completely abandoned him which was a lie he said this was bothering him along with the abuse he incurred from me ex-husband he is in counseling for this.
A. Sounds very complicated, and talking to him and you for more data would definitely help. Nonetheless, there are a few things to consider. First, while it is possible that the current treatment is as good as it gets, this level of wellness sounds unacceptable for all parties concerned. Therefore, it makes sense to look for alternatives. A second opinion at a University-based hospital might be indicated.
I have a handful of cases with similar behaviors, and there is not any one way of addressing the problems that will work for everyone. Since the current treatment is unacceptable, I might make the assumption that the diagnosis needs to be changed. There is a large incidence of aggression, fire-setting, rage, and Tourettes in adolescents with OCD. Usually, I try using Luvox in cases like this. Dosing ranges from 200 to 400 mg/day. Luvox is less likely to exacerbate Tourettes symptoms than any of the other SRIs or SNRIs. Ritalin and Amphetamines will make Tourettes worse. Lithium and Risperdal are all sedating, and this might account for his trouble staying awake. None are helping him.
If this works, the lithium, Adderall, Risperdal, and Tenex can all be eliminated with time. Again, this is only another theory based on the symptoms you gave. Get a second opinion or try talking again with your current doctor.