Potpourri

Potpourri, I have always loved that word. The word congers up wonderful thoughts of bountiful fragrances, a palette of beautiful colors and a feeling of tranquility. It brings back memories of my grandmothers house with little aromatic bowls that gave her home its signature scent. It is a wonderful word.

The word potpourri has several definitions. The first, as I mentioned, is an aromatic mixture of dried herbs, spices and flowers. It also, in present day use, describes a miscellaneous collection or medley. The etymology of the word is French pot pourri, literally, rotten pot dated back to 1749.

When using the word Potpourri in reference to the child with a mental illness it takes on a whole new meaning. Professionals use the term "co-morbidity". I think I like "potpourri" better. Co-morbidity is the term used for multiple disorders. It is "literally a rotten pot".

Comorbidity makes for high rates of misdiagnosis among these children. It is rare that you find a child with just one disorder. Tourette Syndrome, OCD, ADD, PDD, Autism, Depression, Bipolar disorder the list goes on and on. Often times these children have one or more additional disorders which not only makes the diagnostics more difficult, but the treatment pure trial and error.

Adding to the confusion are the subgroups within the disorder. An example: A child with Tourette syndrome with severe exacerbation of tics or ocd symptoms after a strep or viral illness would be considered for a diagnosis of PANDAS or PITANDS as their subgroup. A test to identify the D8/17 marker would be performed. Treatment would be initiated. Seems simple, but it is not. There are subgroups within even this subgroup. Example: some children with PANDAS or PITANDS have different presentations. There is a subgroup that only have exacerbations after viral illness and others only after bacterial. Some respond to antibiotic treatment and some do not. On the autistic spectrum, there are some children who while with fever have significantly reduced symptoms. Dr Andrew Zimmerman at John Hopkins has done studies on these children and its relationship to the release of cytokines. Some of these children respond to augmentin - a preparation of amoxicillin and the potassium salt of clavulanic acid - rather than its base component amoxicillin alone,others do not. It is an eclectic puzzle. A potpourri.

Treating the child with multiple disorders, a potpourri, is a daunting task. Sifting through the symptoms to label the disorder is sometimes futile. It is understandably necessary for insurance coding but often times serves no purpose. Treating the symptoms is key. Looking at the child as a whole instead of a diagnosis, I feel, often times serves the child better. We are all complicated creatures but the child with a mental illness is like a convoluted bowl of emotional potpourri.

Mental Illness - Its Not All In Your Head

Many people diagnosed with mental illnesses seek the help of

psychiatrists and other mental health care providers. It seems

the obvious treatment. What many people with depression,

anxiety and phobias, do not do, is seek out consultations to

find a possible medical cause for their symptoms.

There are many endocrine,neurological and cardiac diseases

that present symptoms of depression, anxiety and even

intermittent bouts of rage. Proper treatment of these disorders

can reduce and often times resolve the psychiatric symptoms.

Some patients will benefit from both psychiatric and medical

interventions. This is not to say that every person or child with a

mental illness is misdiagnosed, but many are.

The endocrine system, is a complex group of glands. These

glands make hormones which help to control activities in

your body. Along with growth, metabolism,reproduction and

development, hormones control the way you respond to your

surroundings. Diseases that alter the hypothalamic

-pituitary-axis may produce anxiety-like states. It important

to differentiate between medically induced and primary

anxiety disorders. Treatment with psychotropic medications

alone may not significantly improve the emotional symptoms

and may, in some cases, contribute to the hormonal

imbalances.

 Anxiety frequently occurs in endocrine patients with adrenal

dysfunction, Cushing's Disease, Carcinoid syndrome,

hyperparathyroidism, pseudohyperparathyroidism, hyperglycemia,

hyperinsulinemia, pancreatic tumors, pheochromocytoma and

thyroid diseases including hyperthyroidism, hypothyroidism

and thyroiditis. These diseases can be the organic basis for

an anxiety disorder and with proper diagnosis and

treatment can improve the quality of life of many

anxiety sufferers.

Psychoneuroendocrinology: The Scientific Basis of Clinical Practice

Polycystic Ovarian Syndrome is another very common

endocrine disorder which, in a large percentage of patients,

causes anxiety and depressive states. PCOS is caused by

irregular levels of estrogen, progesterone and testosterone.

It is estimated that 1 in 10 women have PCOS. Women with

PCOS may suffer from acne, excessive hair growth, loss of

hair, infertility, loss of menses, diabetes and weight gain.

Some data reports that almost 80% of these woman

suffer from anxiety, depression and other mood disorders.

Treatment with birth control pills as well as medications to

regulate insulin along with proper diet and exercise can

significantly improve the physical and emotional

symptoms of this syndrome.

Along the way you may have what is referred to as an

incidental finding. These unanticipated findings in the

course of testing or medical care can hold they key to

some anxious states. An incidentaloma is a tumor (-oma)

found by coincidence (incidental) without clinical

symptoms or suspicion. In our case it was a pituitary tumor,

a microadenoma. Cushings Syndrome -an endocrine disease

known to cause anxiety and phobic states -is suspected, as well

as Polycystic Ovarian Syndrome.

Although I have primarily focused on the endocrine -

anxiety connection, the list of diseases, disorders, syndromes,

and medications that can contribute to or cause anxiety and

depression is significant.

Treating depressive and anxiety disorders, in some cases,

needs to be a joint effort with a team of psychiatric as well

as specializing physicians working in harmony.

It has been my experience as a parent of a child with a

severe anxiety disorder,that what you see is not always what

you get. Proper diagnosis is the key. Finding the origin of a

mental illness is often like finding a needle in a haystack.

It took seven years and four endocrinologists before the

proper treatment was initiated, a lot of time lost.

Article: http://www.aolhealth.com/condition-center/chronic-pain/autoimmune-diseases-symptoms?icid=main|main|dl3|link5|http%3A%2F%2Fwww.aolhealth.com%2Fcondition-center%2Fchronic-pain%2Fautoimmune-diseases-symptoms

References:

http://www.drrichardhall.com/anxiety.htm

The Silence is Deafening

The organic basis of anxiety disorders in children and adolescents, this has become my focus.

I have spent a lot of time reading, researching and interviewing on this subject.

A few months ago I was approached about contributing to an advocacy book for special needs children. When I first decided to take this project on I had no idea what to expect. I had no idea what direction it would take me in or what if anything I would contribute.

It started with a few articles I had written that were read and picked up by bloggers and special needs websites. Soon, I began meeting a lot of people that were very passionate about these children and the struggles of their families. They are an eclectic group with different perspectives and theories on the causes of emotional disorders in children. Some have directed their focus on the environmental impact such as food additives, pollution and poor diet and exercise. Others have focused on vaccines and their role in autism. Videos games, music videos and present day stress is considered in learning disabilities. The genetic component is universally accepted. All have done their research and have educated themselves and others on the possible cause of this dysregulation in children. I believe there is validity in all.

I remain steadfast in my belief that some, not all, of these children's disorders are secondary to a primary medical condition. I began networking in many different venues to seek out parents, caregivers, nurses, adults who had been diagnosed with anxiety or depression as children as well as mental healthcare providers. The response was overwhelming. Within the first week I received over 80 responses to my request for people to be interviewed. I have spent weeks emailing and screening the responses.

To my surprise, I have had a tremendous response from psychologists, psychiatrists and otherhealthcare professionals. The internet has been an amazing tool for them to share their findings, research articles, case studies and opinions with me. Daily communication through text messaging and social media forums has been invaluable.

What became a striking similarity to me was the fact that none of the parents or adults I have been in communication with were given a thorough medical evaluation before being diagnosed and treated. A routine check-up and often times a blood panel to check liver and kidney function was performed but nothing further. Although a neurological evaluation was sometimes recommended, not one of the people I have spoken with were referred for an endocrine evaluation. It is important to add that the majority of people I have spoken with have either Cushing's Syndrome, Polycystic Ovarian Syndrome or another endocrine disorder. One out of every ten women has PCOS. Eighty percent of woman with PCOS have now or had as a child, some form of anxiety or depression. That is a very large population.

A week ago I decided to ask the mental healthcare providers I have been communicating with to let me know what type of endocrine testing they have recommended for the girls they treat for anxiety related illnesses.

I have not received one response.

Sometimes silence is deafening.