BLOG No. FORTY

Welcome back to my blog on anxiety and depression. Yes, I am still at the lake in Wisconsin with friends. And no, I don’t have Chardonnay poisoning…yet. And after much mental anguish and arguing with myself (4 ½ minutes) I decided I did not have a really good case study for hoarders, but I did remember a great case demonstrating the power of D2 dopamine on the brain. It will be a bass-ackwards approach to my next blog on pediatric depression. But for now, let me tell you about the case of “Johnny”.

Johnny was a six-year-old blond kid that I had never seen as a patient. I took care of his mother who suffered with bipolar type II depression. And she was well controlled on medication. Johnny was, at his pediatrician’s request, seeing a child and adolescent psychiatrist for unruly behavior. Because of his poor focus in kindergarten, he was diagnosed with ADHD and placed on Ritalin (methylphenidate). When mom complained that he seemed worse at his next appointment, the psychiatrist reassured mom and raised the dose. This happened six times until the young man was on 160 mg, about 6 to 8 times the normal dose for his weight. Mom finally had enough, and brought him to me for a second opinion.

Teacher: Bobby, can you please focus on the lesson?

Bobby: Sorry, I can only focus on one thing at a time. I have ADD.

Teacher: What else is there to focus on right now?

Bobby: Arguing with you!

The final event that drove mom over the edge was when Johnny slashed the screen on the back porch with a butcher knife in the middle of a summer night. He went next-door and then slashed his way into the home of an older gentleman.

Johnny climbed the stairs quietly and entered the neighbor’s bedroom, knife over his head with both hands on the handle. When the neighbor thought he heard something, he clicked on the light that sat on the bedside table just in time to see a knife coming towards his chest. He caught Johnny’s wrists just before the knife plunged into him.

As mom shared the story with me she cried, while Johnny sat with arms crossed, looking like he had his been caught with his hand in a cookie jar, a wry smile at the corners of his mouth. Although I already had my diagnosis, I needed to ask Johnny a handful of questions, if nothing else to make mom feel like I was more involved. She had already experience multiple five-minute appointments with the psychiatrist.

I asked Johnny if his brain went really fast sometimes. He said, yes. I asked him if he got really mad sometimes. I clenched my fists and gritted my teeth for effect. He said, yes. He then nodded his head and dropped his chin to his chest and his arms to his sides. I asked him one more question, regarding him being really sad, sometimes for no reason. Once again, he nodded yes.

I looked at mom who was bipolar, and I looked at Johnny who is the spitting neurochemical image of his mother. I wonder how the psychiatrist missed such an obvious diagnosis. I put him on 5 mg of olanzapine, a D2 lowering agent. A week later after follow-up appointment mom told me, “Thank you, I’ve got my son back!”

As I thought about the case later that night call I said to myself, ADD my ass! As mentioned in a previous blog, ADD and ADHD patients don’t have unprovoked anger or sadness. If the psychiatrist had actually talked to Johnny and talked about family history perhaps he would’ve made an accurate diagnosis.

Well, my good friend has brought a few cold pale ales down to the lake, as it is very warm today. But I must say it pales in comparison to my Chardonnay. Until next time when I will discuss pediatric depression, this is Dr. G saying keep the faith!

PS: If you enjoy these blogs, please take the time to share them with a friend! Thanks, Dr. G