I have a 15 year old daughter and she has been diagnosed as ...

Hi-

If you are thinking your daughter has been misdiagnosed, you should definitely seek a second opinion. Speak to her regular doctor about recommending a different psychiatrist for a second opinion. Unfortunately I am not able to tell you definitively what is wrong with your daughter - doing so would require an in person evaluation, possibly over a period of visits.

Regarding the medication - some people respond extremely well to Zoloft, while other people need to try a few different medications before finding one that works well for them. Other options she could try include newer SSRI's such as Celexa and Lexapro, or SSRI's such as Paxil, Prozac or Wellbutrin. For more information, click here.

As you can see, there are many medicines she can try - so if the Zoloft at 50 mg does not work for her, talk to her doctor about trying something else. Note however that it may take several weeks of being on the Zoloft 50 mg before it starts to work.

Sincerely,
Emily


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Actually, this is her third doctor. She was first diagnosed at age 8 as having psychotic episodes. She was only seeing a theripist and on no medication. Then her symptoms came back at age 14 and she was diagnosed as having OCD. The zoloft seem to help. Then we had to find another doctor due to insurance changes. The third psychiatrist diagnosed her as having PDST and maybe some OCD. So she has been taking zoloft for some time now. She just gave her Seroquel 25mg to take at night and zoloft 25mg in the morning. I was just reading up on this medication and it's for Bipolar Mania and Schizophrenia. Should I be concern?

Edited by Customer (name blocked for privacy) on August 18 2006 at 9:58pm

Could you tell me a bit more about her history? What sort of "psychotic episodes" was she having at 8? Did she experience any trauma earlier in her life? What is her daily functioning like? Is she social? Does she have friends?

I'll address the medication issue when I hear back from you.

Thanks,
Emily


Edited by EmilyT27 on August 18 2006 at 10:15pm

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Well, back when she was 9 (sorry I looked back on my records), she just starting having thoughts of wanting to kill me (never showing any anger towards me but crying), auditory hallucinations, intrusive thoughts of sexual nature and questioning whether she loved me or not. Keep in mind, she was never physically abused in anyway. I was the disiplinary and yell a lot but never spanked her. We found a therapist but she told us that she couldn't help us and we needed to find a Psychiatrist. Her pediatrician told me to bring her to the ER and that they had a pediatric psychiatrist to evaluate her. They talked to her and checked her to make sure she was not abused and everything checked out ok except for the fact that she said her thoughts were saying that she wanted to kill me. They then took custody of her (because they felt that she was a risk) and posted a guard outside her door. This was very tramatic because we went there to get help and she was now being held there and sent to an institution over 100 miles away to get evaluated since we did not have a pediatric institution locally. She was there for 3 days, and were told she should have never been sent there (test should have been done locally) and was released. Once back we found a Psychologist and also had numerous test done. I believe it was a CAT scan (head), theroid test, etc. Everything came out normal. She was seeing the Psychologist for at least (June 2000) 6 months (twice a week)and showed signs of improvement. She was diagnosed as having "Psychotic Episodes". All of her symptoms were gone and we pulled her out in January 2001. Then December (during christmas break) 2004 her symptoms came back and much stronger. She started seeing a psychiatrist since February 2005 and was diagnosed with OCD. Her sexual thoughts were so intensed and weird. Even thoughts of having sex with her own dad. Seeing a person on the street and wanting to have sex with them. She has never been sexually active. She always feels guilty for not telling me stuff even if it is about me (her wanting to hurt me), being sneaky. We communicate a lot, but if she has a bad thought of any nature, she feels that she needs to tell me and then it intensifies with more and more. She was then prescribed Zoloft. She was showing improvemtn and was better all the way until just about a week. She saw part of a movie "Final Destination 3" and it triggered everything and she just can't control her thoughts anymore. Keeps her up at night. Today was the worst, school just started tuesday and usually she is ok at school but it was bothering her all day today. I'm sorry that this ended up so long.

Edited by Customer (name blocked for privacy) on August 19 2006 at 12:47am

I feel bad for you and your daughter - it sounds like the last few years have been very trying for you both.

Your daughter certainly presents interesting and unique symptoms - it's not very surprising that the doctors have approached treating her differently, and that there has been some disagreement about what should have been done early on.

I wish I was in a better place to evaluate your daughter, but obviously there's a limited amount I can do given that I can't evaluate her in person.

However, it does sound like she is suffering from OCD, given that she seems to get irrational, obsessional thoughts which do not seem to go away on her own (for more information on OCD, click here). Treatment for OCD should include on going therapy and possibly medication. Zoloft is an excellent choice, but as I stated, if this doesn't seem to be as effective as it once was, she may benefit from a different SSRI.

The Seroquel is, as you stated, prescribed for Bipolar disorder and/or Schizophrenia. Seroquel is sometimes prescribed "off label" for other disorders, including brief psychotic episodes and as a preventative for Schizophrenia (e.g., when someone appears to be developing Schizophrenia, this will be prescribed to try and help prevent a psychotic episode). You should discuss this medicine with your daughter's psychiatrist, to see what her rational is for giving it to your daughter. However, given that your daughter has reported hearing voices, etc., the Seroquel is probably being given to her as a preventative measure. There is no harm in this, and in fact it may be very beneficial to your daughter given that she has experienced some early signs of Schizophrenia (for more information, click here).

It is very unusual for preteen children to show signs of Psychosis, and Schizophrenia usually doesn't present itself until the late teens/early twenties - she may be dealing with a more severe form of OCD instead. Therefore, she should continue to be monitered, and ideally receive therapy on a weekly or bi-monthly basis. [Regarding the PTSD, I really can't say whether this is an accurate diagnosis - if there has been no abuse, no accidents, no emotionally or physically scarring events (other than the hospitalization), I'm not sure whether she would have PTSD. You should ask the psychiatrist why she feels this is a proper diagnosis.]

Bottom Line: You should communicate all of your thoughts and concerns to her psychiatrist - you have every right to be actively involved in your daughter's care. Truthfully, your input regarding whether the Zoloft seems to be helping, etc., will only help the psychiatrist know what to prescribe.

Sincerely,
Emily



Edited by EmilyT27 on August 19 2006 at 1:44am

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Hi Emily,

I thank you very much. You have been very helpful. It has been tough on the family. I will definitely discuss further with the doctor, but wanted to just get input from other resources and you have done that. And a great job.

Thank you again.

Diane

Hi Diane-

I am very happy to have been of help! If you have any additional questions, feel free to ask! If not, please remember to hit "accept."

Best of luck to you and your daughter!

Best Regards,
Emily


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