Diagnosed With Hashimoto Thyroiditis. Taking Synthroid. Having Severe Knee Pain. Suggestions
I can upload her latest blood test results shortly
Thanks for choosing health care magic for posting your query.
I would like to thank you for providing details extensively and would also like to appreciate you for handling your daughter with patience.
After going though whole of your account in detail, there are three possible diagnosis for your daughter:
1) Attention deficit hyperactivity disorder
2) Conduct disorder
3) Borderline personality disorder
or it could be a combination of all of them. The final diagnosis is possible only after a detailed mental state examination of your daughter.
i understand that you have tried her on adderal and it seems that she has not responded well. But then she can be given a trial of methylphenidate or Bupropion. Its an old concept that ADHD burns out by adulthood, but now it is said that it persists in adulthood as well and leads to lot many other psychological problems as well.
She certainly has some personality disorder, bordering on bordreline or dependent personality disorder. these personality disorders require loads of commitment from the psychiatrist and need extensive psychotherapy. The drugs are not a good treatment though mood stabilizers like carbamazepine may help her.
You can discuss these issue with the treating psychiatrist, who can help you out with the case.
If the outpatient management doesnt help then she should be considered for in-patient care as well.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you can close the discussion and rate the answer accordingly.
In future if you wish to contact me directly, you can use the below mentioned link:
bit.ly/dr-srikanth-reddy
Wish you good health,
Dr. Srikanth Reddy M.D.
Thanks for the follow-up question.
Suboxone has buprenorphine and naloxone , and is supposed to be taken sublingually (keeping below the tongue).
It will not interfere with her thyroid treatment. Anxiety is sure to occur if the opiods are withheld abruptly. She should be back on Soboxone as advised by your treating doctor and the dose can be increased gradually, looking at her tolerance.
As far as her anxiety is considered, she should take propranolol or a short course of benzodiazepines. That will help her in reducing the anxiety.
Thanks and regards,
Dr. Srikanth Reddy
Psychiatrist
You should start her on suboxone and let her get somewhat better. All the medications for her ADHD and possible depression and personality disorder can be started after her initial symptoms of opiod withdrawal have subsided.
If she doesnt co-operate in outpatient basis, then a possibility of inpatient care should be considered.
Also one thing I missed out mentioning was that she has indulged in lot many sexual encounters and drug abuse as well. Some of them might be even unprotected. If she is willing get her also tested for HIV and cousel her by an expert about the safe sexual practice and explain her that even a condom is not a 100% garuntee that HIV will not spread.
Thanks and regards,
Dr. Srikanth Reddy MD'
Addiction Specialist
When you take her for cognitive behavioral therapy, some of the sessions can be reserved for motivating her to follow safe sexual practice.
Along with your daughter, do take care of your self. In such conditions, the caregivers burden is huge and that causes burnout.
Maintain a positive life with regular exercise and good diet and keep socializing.
If you are healthy, you can take care of your daughter. Its your responsibility to help her but its not your responsibility to get er best of the results.
Wish you good health.
Dr. Srikanth Reddy MD
Addiction Specialist
Hope your back problem settles soon. Then you will be in better position to take care of your daughter. Unavailability of opioids will surely help in reducing your daughter problems.
I am glad I could be of help to you.
Thanks and regards.
Dr. Srikanth Reddy M.D.