September 3, 2014

Medina
Mostly clear
65°F

ASK THE DOCTOR

Dr. Ranjan

Dr. Ranjan

I have received so many emails and questions from readers that I thought I would answer some of them here.

Dr. Ranjan,

I read your article regarding ADHD in the Medina County Gazette today, and I was wondering if you could make a suggestion as to whom I could take my eight-year-old daughter for an ADHD screening.
She has been identified as having a high I.Q., does very well academically and is well-mannered. However, she often complains of feeling like she is on a roller-coaster—either hyper or ready to cry. She says she feels like a kernel of popcorn getting ready to pop. To get through the school day she has found discreet ways to expend her energy such as clicking or shaking or tapping, but when she comes home, she can longer maintain the facade of being calm. She cries in the evenings, saying that she can’t focus on her homework or sit down and play the piano.
She changed schools this year to give her more of a challenge academically because she constantly complained that 2nd grade was too easy. The new school has moved her up to 4th and 5th grade coursework, and she seems to want the challenge, but is unable to sustain concentration.
In the summer she swims, plays outdoors and does organized sports for hours each day, and she is in better control of her moods and energy levels, but as soon as school begins, the problems come back. Finally, she is an insomniac. Do you have advice or a referral to someone with expertise in gifted children and ADHD?

Thank you,
Concerned Mother

Dear Concerned Mother,
You do have a gifted daughter. It’s too bad she has academic and emotional difficulties. Based on your description of her, I’m concerned that your daughter may have a mood disorder eg: bipolar disorder. The feelings of being on a roller coaster, having too much energy, a tendency to cry often and easily, and difficulty sleeping could all be red flags of early onset bipolar disorder. Additionally, she seems to have some symptoms consistent with ADHD such as poor concentration, fidgety behavior, and a tendency to get bored easily. It’s not uncommon for many children to suffer concurrently with symptoms of both bipolar disorder and ADHD. It is believed that the genes responsible for transmitting ADHD and bipolar disorder are closely linked.
The first step that you should take towards helping your daughter is to have her evaluated by a psychiatrist. If she is diagnosed with both a mood disorder and ADHD, then the mood disorder should be typically treated first. Once the mood symptoms are improved if attention/hyperactivity is still a problem then a medication for ADHD should be added. I highly recommend a combination of medications and counseling. We treat a large number of children with ADHD and mood disorder at our practice. You are more than welcome to call us for an appointment. Alternatively, you can call your insurance company or local chapter of NAMI for referrals.

Dear Dr. Ranjan,

My husband and I have been reading your columns on bipolar disorder and I felt compelled to write to you.

My son is almost 24 years old. He has no job and no health insurance. He seems and acts like a teenager. He can only hold a job for about 3 months, then he gets fired. He says a lot of things that don’t make sense. He interrupts conversations with things that do not have anything to do with what you are talking about. He doesn’t think he has a problem.

Because of his age, we cannot make him see a doctor. We are not sure really what to do. Any suggestions would be greatly appreciated.

Sincerely,
Worried Parents

Dear Worried Parents,

I truly empathize with your predicament. I talk to many family members who feel quite helpless as to how to take the first step in getting their family members the help they need. Since you know your son well, you must find a way to begin the dialogue about his difficulties in a non-judgmental, non-admonishing fashion. If you could find a way to frame the conversation as to how he can have a more successful and better quality life, he may become more amenable to see a professional. If you can get him to see a counselor who specializes in job coaching etc., that could be a good starting point. A good counselor will convince him to get a psychiatric evaluation based on the difficulties you described he is having.

Dear Dr. Ranjan,

My husband has been diagnosed with moderate Alzheimer’s disease. He has shown behavior you described in your article on bipolar disorder. He has anger outbreaks and unpredictable moods. He is on Namenda, Seriquil, and Arecipt. Are these symptoms of Alzheimer’s or does he have bipolar?

Thank you,
Concerned Wife

Dear Concerned Wife,

I don’t know how old your husband is, but if he truly has Alzheimer’s dementia, the symptoms you describe could be part of the dementia syndrome. Also, if these symptoms appear only after your husband began having symptoms of dementia, then it’s even more likely that these symptoms are part of the dementia syndrome.

Dear Dr. Ranjan:

Could you please list the symptoms of Bipolar Disorder for me in detail. Also how you go about being diagnosed.

Thank you. Your assistance is appreciated,
Curious

Dear Curious,

You asked me to list the symptoms of bipolar disorder. Due to space constraints, I am not able to do that here. However, may I refer you to my article on Bipolar Disorder on Adults which was published in The Medina Gazette a few months ago? All my articles are archived on the Medina Gazette website (www.medina-gazette.com)

The best way to explore if someone has bipolar disorder is to get an evaluation from a competent psychiatrist

Dear Dr. Ranjan,

I have been on antidepressants for many years and have not found one that has really worked for me. My doctor is no longer in practice. I need to get a doctor that can help me get on medication that will suit me. I have zero energy and want to sleep all the time. Could you please help.

Signed,
Searching For Help

Dear Searching,
Nowadays, there are numerous options for antidepressant medications. At our practice, we use a very methodical trial process to find the most effective medication for a given individual. If you have difficulty finding a provider, please feel free to call our clinic.
Dear Dr, Ranjan,
I eead your column regarding bipolar disorder and am hoping beyond hope that you can give me some guidance before something happens. I have a 28 year old son who is a college student. He is uninsured because of insurance denials due to a past mental health diagnosis of bipolar II which was then changed to Adult ADD. He is definitely in a downward spiral and has no idea where to turn for help before he hits the bottom. He is currently working but fears he may lose that job. Other than a roof over his head and the loan of one of our cars, we can’t help him financially. We don’t know where to turn for help. I hope you can give me some direction as he has been getting increasingly erratic for the last few months and is getting worse. PLEASE give me some direction or somewhere I can call. Thank you for any help you can give,
Anxious Mom

Dear Anxious
I realize you are truly in a difficult situation. If your son is willing to receive treatment, I suggest you make arrangements to have your son seen by a psychiatrist at a community mental health center. For listings of community mental health centers, please call the mental health board in your county. Your other option is to take him to one of the Free Clinics in your area where mental health care is usually available.