Risperdal

[michele223]

We are on Risperdal for my 8 yr old son's anger. He also takes tenex for his tics and attention and prozac for his anxiety. He is kind of an ABC diagnosis kid. He has Aspergers and tourettes and OCD. Most likely PANDAS because of his history of strep and behaviors, but we can't get him treatment for the underlying issue whish is his immune response that makes him get worse symptoms. He still gets shor tempered on the risperdal and tenex and prozac. We have upped all the amounts except the risperdal is still at 2 mg a day. He was much better in the beginning. He takes 3 mg of tenex, 2 mg of risperdal and 10 mg of prozac. He still is impulsive and gets into arguments. It seems to be an ongoing problem to adjust his meds. We see the psychaitrist monthly. He has been on other meds and they either made him worse or stopped working. We used Abilify to 15 mg and it stopped being effective. All stimulants made him hyper and agitated. I find this is a very time consuming difficult process. I am recording his daily behaviors. I take him to social groups and a psychologist. Any suggestions on how to keep my sanity? The rest of the house has suffered by his outburst. I have four kids and they get sick of his tantrums too. I want him to have a positive self esteem but it is hard to e nice when he is destroying his and my things! Also the school says he is great there which adds to the mystery!


This discussion is related to Meds for ODD -- what's considered best? what to avoid?.

[Sandman2]

   Boy,lots going on here.   The first thing that comes to mind is it really PANDAS?   Because, that does effect how this is handled.  "The hallmark trait for PANDAS is sudden acute and debilitating onset of intense anxiety and mood lability accompanied by Obsessive Compulsive-like issues and/or Tics in association with a streptococcal-A (GABHS) infection that has occurred immediately prior to the symptoms. In some instances, the onset will be 4 to 6 months after a strep infection because the antibiotics did not fully eradicate the bacteria." "PANDAS children may have moderate to dramatic improvement with antibiotics within one week of treatment, however, further interventions may be needed. How to stop the entire syndrome is still debated, but many parents and doctors report prolonged antibiotics (two months to one year) and/or IVIG (intravenous immunoglobulin) treatment or plasmapheresis."    The term "sudden acute" seems to be important.   So did this suddenly happen?
     And even if it is not PANDAS, because he was treated with antibiotics, his gut bacteria is messed up and that can effect him in a variety of ways.  I would definitely try some Probiotics.  Don't go too crazy at the start.
    In terms of meds, you said, "All stimulants made him hyper and agitated."  The reason I mention this is because if Prozac is given with a stem medication - this effect can happen.  Basically Prozac blocks the liver pathway for the stim medication.  The medication then can back up, concentrate, and give symptoms like you mentioned.  This link explains it in detail - http://www.corepsych.com/2006/11/adderall-prozac-and-paxil-problem-not-solution/
     If your son was taking Prozac at the same time as the stim meds, that might be the reason for the problems.
     I am surprised I did not see an ADHD diagnosis mentioned..  He certainly has the symptoms and the other things you mentioned are all fairly common co-disorders.  The fact you said the stim meds were tried, does lead one to assume that at least at one point in time - that was the thinking.  What changed?
     Now the interesting point is that the school says he is great!   Would I be correct in thinking that school was more of a challenge before the meds started?   It does sound like the meds are working.  However things fall apart at home.  One reason for this is the length of duration of the meds.
Tenex can be an effective med for ADHD (not as good as stim meds, but still good).  However, Intuniv (a newer medication like Tenex), "is once a day in AM, longest duration, least sedating, often smoother and is a new brand."   Might be worth trying to see if it extends into his home hours.
      It really does sound like you are really trying to help him.  Many, many parents who I have helped on this site - http://www.medhelp.org/forums/ADD---ADHD/show/175 - where I am also the CL have not bothered to do the social groups and the psychologist.  You have.   Because of my work on the above mentioned site I have found lots of very helpful parenting links.    This is a good example - http://www.additudemag.com/topic/parenting-adhd-children/behavior-discipline.html
      So essentially, I have a ton of information on helping kids with ADHD.  What you have is a child with a bunch of diagnosis that may or may not be completely accurate.  This is a good link on OCD and ADHD - http://www.additudemag.com/adhd/article/6113-3.html - which might be helpful.
    So talk with your doctor about Intuniv.  Take a look at the link on "parenting-adhd-children/behavior-discipline"  it will help you at home even if he does not have ADHD.
    Please let me know if there are any more types of info you need.  I hope this helps a bit.   Best wishes.

[MarcyJones]

Risperidal, SSI's and ADHD medications are the WORST medications to treat PANDAS Children. If you suspect your child has PANDAS do what you can to get the correct diagnosis even if it means going out of state. Do not go to a PANDAS specialist that is also a psychiatrist they will try and mask the behaviors with the antipsychotic drugs and SSR's and every other kind of psych medication out there. These medications make PANDAS children 100 times worse. And it is an absolute NIGHTMARE to wean your child off these types of drugs. Risperidal isn't even FDA approved to use for children and trust me there is a reason for that. We are seeing it first hand weaning my son who was just diagnosed with PANDAS off it. I am speaking from experience and again if you suspect your child has PANDAS good chance is they may not have any of the diagnosis that the doctor is using the meds to treat. Pandas children should be treated with antibiotics and Aleve.  I have one of the best PANDAS doctors out there. I had to learn the hard way about the psych meds so if I can help anyone out there NOT to use them in the case of PANDAS I will share my story. Behaviors get worse and worse with these meds and the docs keep going up on doses which makes it that much harder to wean your child off. Remember even if there are no PANDAS docs in your area drive hours or take a plane and get your child correctly diagnosed. It is life changing.  Good luck!