Schizophrenia?

I wanted to give a quick update on Oksana's last visit to the psychiatrist.  She had spoken with Oksana's therapist before we met so she had a good idea of what we are dealing with.  No one doubts at this point that Oksana is having regular auditory and visual hallucinations.  I also brought her a document with a list of things we had experienced regarding Oksana's mental health since seeing her last.  As we started talking I told her that as she could probably imagine my fear is schizophrenia or schizoaffective disorder.  I thought her answer was a good one.  She said that Oksana fits all of the diagnostic criteria for bipolar.  The diagnostic criteria for schizophrenia is delusions, hallucinations, etc. that are present for at least 6 months and impair a person's ability to function in life.  She said that if Oksana had a known family history of schizophrenia we could be pretty confident that's what we are dealing with but since we don't know her family history we will continue to monitor her.  She said that she would rather diagnose up than down.  In other words, better to hold off on a diagnosis until we know for sure than to give it to her now and have to say 15 years later we were wrong.

I pointed out to her that we are dealing with medicated symptoms.  How do we know what is really under all of her meds, and how do we get an accurate diagnosis without knowing?  She agreed that without medication she would very likely meet the diagnostic criteria but she said that her medication will not provide the good results we are seeing now forever.  Eventually she will grow and the dose she is on will not be enough, at which point we will get breakthrough behaviors and we will take data off of those. 

She pointed out that her meds are in a very good place right now so we aren't changing a thing and that giving her a schizophrenia diagnosis makes no difference in our treatment plan.  I asked her if it made a difference for insurance.  For example, if she needs inpatient psychiatric care at some point will insurance pay for more days if she has a schizophrenia diagnosis.  She said insurance pays based on symptoms not diagnosis so even there we are fine.

With all of that she also made the comment "I believe her diagnosis will change in time."  Our guts all say this kiddo is schizophrenic but there's no rush at this point to call it that.  We are just dealing with whatever symptoms we have.

I was very pleased with this visit.  We had been going every 2 months but this time we are going 3 months because she really wants to see her after the transition back to school.  I don't know how specific I was on here about Oksana's first day of school last year.  I know I mentioned it was bad but let me assure you that bad doesn't begin to describe it.  She displayed violence that shocked all of us.  Even after the horrible summer we had I didn't see that one coming.  We ended up making an emergency appointment with the psychiatrist, so she is smart to give us a set appointment for that time period.  She said that, of course, if anything changes at all, or I have any concerns I can call any time and she will fit me in.  We are so incredibly blessed to have this woman supporting our family.

Besides all of that Oksana is doing rather well.  She hasn't been without incident, but it is NOTHING like last summer.  So far so good!  We are talking to her quite a bit more about her mental illness.  She hears us talking to doctors and therapists all the time.  No sense anymore in hiding what the word bipolar means or anything else that we know for sure she is dealing with.  She has no problems telling a doctor that she sees things that the rest of us don't see.  She went to school and told her para that mom goes to NAMI meetings.  She isn't ashamed of it at all, nor should she be.  However, I did suggest that she use some discretion in sharing every detail of her mental illness so she is aware that the grocery clerk doesn't need to know she has bipolar ;). 

Funny how just a year ago if I had to write this email I'd be an absolute mess, and now I write like it's just normal.  Well, I guess it is now.....it's our normal.  What can I say?