Fear of Harm Phenotype

There is a reason that I firmly believe my youngest son is Bipolar. It’s not just that I am Bipolar, because that part is genetically complex. If one parent is Bipolar than you have a 50% chance of passing a mental illness on to your kid. That’s right, just by having Bipolar it’s an automatic chance of 50% that your child will have a mental illness of some kind too. I don’t know what the chances become if both parents have Bipolar. Does it matter? And it’s not guaranteed to be Bipolar due to genetic crossover linking that we are only now beginning to discover and understand. In the end, being pregnant and Bipolar is incredibly complicated and not something to be taken lightly.

In light of this, I honestly don’t know if I would have had children if I had known that I had this disorder but I didn’t know until my third son was born so I suppose this sort of musing is a waste of time. I just know that I wanted children and I am glad that all three managed to make it into this world despite being told it wasn’t possible. I can’t imagine my life without them for they are my three little miracles. Now I agonize over how they too must suffer the shit I deal with in my head every damn day. But I’ll be damned if I send them off alone in this world unarmed and unprepared. I’m going to make sure they understand what it is they’re dealing with and that they have the skill set they need to manage it the best they can.

Anyway, I digress. The primary reason I believe my youngest is Bipolar is because he fits the patterns of behaviors that the Juvenile Bipolar Research Foundation calls the “Fear of Harm” phenotype. If interested, you can read this PDF that goes in greater depth about the Fear of Harm phenotype and the research that has gone into it along with the research that has gone into identifying Juvenile Onset Bipolar more accurately. I’m pretty sure you can find all of the same information on the foundation’s website but they’ve put it all here into this brief review of their research as of 2013.

He also matches up with ultradian rapid cycling – he tends to start slow and grumpy in the morning but by the end of the day he is usually high flying. The staff at the intensive outpatient program used the term “brittle affect” to describe him. Think of it as a brittle diabetic, but instead of dealing with blood sugars you’re dealing with emotions. So what’s happening here is even though we are trying to control his mood, and he is trying to control himself, every day he is constantly having these sudden, drastic, and extreme emotional outbursts. If moods were TV channels for this kid, then someone else has the remote and is surfing them like mad.

I get why the care team is reluctant to officially give him the Juvenile Onset Bipolar diagnosis. The medical field has come under fire in the past for over diagnosing children with Bipolar who then later grew out of it. You don’t grow out of Bipolar because it’s a lifelong degenerative illness which means those children who supposedly did were misdiagnosed. And that’s one hell of a label to carry by mistake. I get it.

However if it’s true that each episode causes damage to the brain making the next episode easier to happen, then it must also be true that early intervention to prevent and mitigate those episodes will reduce or even prevent that damage. Otherwise what is the point of all these the medications?

Don’t tell me money – that’s a given. If it was just the money they could simply sedate our asses and call it a day. And in some exceptionally severe cases I believe that is what they do. But not in my case. Not in my oldest son’s case. And that’s not what they’re doing with my youngest son either. They are honestly trying to find a medication mix that will stabilize him in such a way that he can still participate in an education program, be a part of the family, and most importantly get to be a regular kid as much as possible.

I just wish that the grueling process of finding the right mix of meds wasn’t so grueling. And I think a big part of that is having the right diagnosis. Typically Conduct Disorder doesn’t have a list of known meds that are successful. I don’t know of anything used for Impulse Control Unspecified. And as for DMDD – well shit that falls into the depression category and is usually treated with antidepressants. The medical field is shifting away from using those for Bipolar more and more due to treatment induced mania. I happen to be one of those patients that respond to antidepressants that way so I’m grateful that they at least put him on a mood stabilizer instead.

Previous mix of meds for him was

  • 1mg Intuniv at morning
  • 2mg Tenex at night
  • 250mg Depakote twice daily

And it wasn’t working.

The Intuniv was snowing him completely so he was sleeping until noon. The Tenex was supposed to be making him sleep at night but it wasn’t working and the Depakote barely balanced his mood. Ever day he was irritable and aggressive – if not physically he was certainly verbally.

He’s currently taking 0.5mg Lamictal and nothing else. We have Clonidine on the side as needed for emergency use if we see a rise in aggression. It’s been almost a month since the switch and I haven’t used the Clonidine even though he does still get verbally aggressive. Sometimes he starts to get physically aggressive, but so far I’ve been able to talk him down. Thus I don’t think the Clonidine has been warranted. I anticipate an increase in dose for the Lamictal at his next med clinic appointment. What we are seeing is better than what we were seeing before, but we still have a long way to go.

 

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