It's Where I Am with Zandra Polard

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Unknown Speaker 0:43
Good morning Las Vegas. This is Dr. G and you are listening to it's where I am on 91.5 FM K you envy. I am guest hosting for Zondra pol ARD, who continues to enjoy a much needed respite after being on the air for four years. If you are missing Zondra you don't have to miss her too hard as she will be back full time in June. I'm Dr. David JENICE, clinical and PR director from great mind counseling and Wellness Center and on it's where I am, I have been spotlighting different mental health programs throughout the state of Nevada. My goal is to decrease stigma for accessing mental health resources and extending a hand to ask for help when needed. On this morning show I would like to welcome back psychiatrists, Dr. Deepa has Sesia from Satori behavioral health. Good morning, Dr. Ecija. Nice to have you back on. It's where I am.

Unknown Speaker 1:42
Thank you, David. Good morning, Las Vegas. I'm so happy to be invited back. I'm ready to help David, Dr. G with any questions or anyone else.

Unknown Speaker 1:58
So Dr. Sasha thing, Dr. Sesia is a fan of the show. And and we we and Zondra really value and respect Dr. Sesia. So Zondra last year, put together a women's empowerment conference. And Dr. Has Sesia was one of the women that was chosen to speak on the panel at at this women's empowerment conference that was held on site at UNLV. So Dr. Has Sesia is a big fan of the show. It's where I am. And so I'm just delighted to welcome her back on and to utilize her brain to ask her lots of questions. I hope that will make parents guardians feel more comfortable accessing psychiatry for their child or adolescent. So Dr. Sesia, many parents and guardians have concerns about having their child take psychotropic medications. So my aim this morning and bringing you back onto the show is to hopefully provide clarifying information for caregivers of children to take into consideration when they may be determining if psychotropic medication may help their child. So, you know, I've experienced that many parents when they are first approached with considering having their child prescribed medication, one of their first responses or concerns rather, is if the family has addiction with within their family system. Is their child at risk of becoming addicted to the medication that could be prescribed?

Unknown Speaker 3:51
David Yeah, that's a very good question. And as a parent, I totally understand that concern for any parent. Wanting to know is a medication option, right for my child. When they come to child psychiatry, I know most parents fear that a child psychiatrists will automatically start them on medication. And that's definitely not the case, we actually, you know, evaluate the child first and most of the time, our first option is therapy. And if a child fails, therapy and other behavioral modifications don't work, then we consider medications at that point. But even then we would look into sleep first, we would look into environmental factors before we decide okay, medication is the way to go. So there's a lot of education behind it a lot of background information that is gained. So we're not starting a child on medication if they absolutely don't need to be on it because as a parent I would not like my child to be on medication if they didn't need to be on it. I really

Unknown Speaker 5:05
appreciate Dr. Hill Sesia, that you take that approach and how you treat young children and adolescents, and that you're coming from a perspective of what is the least restrictive level of care, or the least restrictive services that you can recommend first, and treating a child or adolescent. And, you know, being a parent myself, you know, I appreciate the fact that, you know, you're really looking at the larger picture and taking everything into consideration as far as what changes potentially, or what supports the family may need, and really wrapping the child with the most appropriate interventions. Dr. Cesar, if you don't mind? Could could you give a very simple, layman's overview of the brain and and talk a little bit about how psychotropic medication works and, and, and how it, you know, impacts the brain.

Unknown Speaker 6:13
So, David, it really depends on which psychotropic medication that is chosen for that specific patient. But during a full assessment, a psychiatrist will go over the symptoms first. And based on the symptoms, we come to a conclusion, okay, this is depression, this is purely anxiety. This may be a mixture of both this may be ADHD, according to that we can prescribe medication that can target the chemical imbalance if the child has that.

Unknown Speaker 6:53
Okay, so let's say then that, you know, it is determined that potentially the use of psychotropic medication could benefit a child or adolescent. And let's say, you know, that that the team, the parents made the decision, okay, we're, we think we're ready to move forward with utilizing this additional intervention. Also, in addition to utilizing therapy, you know, so when I go visit my PCP, sometimes doctor has seizure, I might be ordered additional exams that I have to go and complete prior to starting a new intervention. Is there anything that a parent or caregiver may anticipate that after maybe the recommendation of utilizing psychotropic medication is recommended? Is there other things that, you know, maybe that they may have to follow up on?

Unknown Speaker 8:01
Yes, absolutely. Dr. G, so most of the time we do get bloodwork and the reason we do that is there's a lot of medical issues that can also present as psychiatric issues. So we want to make sure a medical issue is not causing something like that. For example, thyroid conditions can present a severe depression and anxiety, or even person becomes more hyperactive, and it could be a thyroid issue. We don't know. So a medical exam, medical bloodwork review of that blood work is very important.

Unknown Speaker 8:42
Okay, so for starting the psychotropics, and then is it routine as well that potentially sometimes an EKG might be ordered prior to starting a new medication?

Unknown Speaker 8:54
Yes, I specially get an EKG for patients if I'm considering an ADHD medication, especially if that medication is going to be a stimulant medication. We want to make sure we get a thorough history of the family history of any cardiac issues, any kind of arrhythmias and we definitely get a EKG on the patient to make sure there's nothing going on that would worsen if they were started on a stimulant. Okay,

Unknown Speaker 9:27
so let's, let's I'm gonna stick with this scenario that that you have kind of started for me Dr. Sesia. So let's say we have a child or an adolescent that is presenting with some concentration challenges, maybe with some impulsivity, and this child or adolescent and family are already participating in therapy. And the therapist recommends to the parents, the caregivers that you know, I think maybe it It's time for us to consider meeting with the psychiatrists just to have another pair of eyes and to access another lens and understanding the needs of the child and the family. And and so this, this family is then referred to meet with either a primary care physician or hopefully can be connected through their insurance with a psychiatrist that has training in providing the psychiatric oversight for a young child or an adolescent. And, and so let's say, you know, this, this child or adolescent comes to you. So, you know, they're, they're coming to you with, with some presentation, some observation of symptomatology related to ADHD, what what? What assistance from the primary therapists that's working with the child or the family and or the family that might help you doctor her seizure to feel comfortable first, in acknowledging the diagnosis of a DD and then helping even helping and assisting you to confirm the diagnosis of ADHD.

Unknown Speaker 11:26
So I really would like the therapists. evaluation as well to see what symptoms they are seeing if the patient is very hyperactive or cannot sustain attention. They're being taught in something in therapy, but the focus is off. So they're barely even learning the skills that are being taught to them in therapy. So if this has been going on for a while, and we've gotten bloodwork and there's no issues medically, and the parents are open to starting a medication, then I would definitely go over, you know, Vanderbilt testing that they may have done at home or at school, we can refer them for Connors testing for ADHD, the therapist input is very important as well. And after that, I would explain to the parents the different options, the stimulant medication versus a non stimulant medication for their kid, and explain why each one works differently and why it may be better suited in some conditions for one parent versus not suited well for someone else.

Unknown Speaker 12:45
Very good. And so so a big takeaway from from what you just shared Dr. Sesia. And I think this is important for caregivers, for parents to hold in mind is the collaboration between the family therapists, the child's therapist and the psychiatric provider, that that is really key to hopefully better understanding the child and the family's needs. And whereas there are some opportunities to provide further support within the system, so that the child and the family may move forward in a positive way. Sometimes I find that parents are a little reluctant. I think that's the word I want to use and having the therapists and the MD talk to one another. And I find though, that that's so essential and so important.

Unknown Speaker 13:44
I agree with that as well, I think that it does make a difference, you know, to make the parent comfortable and also have both providers kind of collaborate and discuss.

Unknown Speaker 13:59
Well, and I think, you know, it's it's bringing together different lenses and really working towards the same goal though, as far as understanding how best to support the child and the family. Now, let's just say Doctor has seizure that I'm the treating therapists and I recommend to a caregiver that I do believe it may benefit their child having a psychiatric evaluation with you at Satori, behavioral health. So let's say you know the family reaches out confirms you know that you're contracted with their insurance schedules in an appointment through your scheduling system, and they see you for the first time. So they see you for the first time where you're formally completing the psychiatric evaluation. So what what can they anticipate then, after the initial visit with you

Unknown Speaker 15:01
Well, after the initial visit, they will expect you know to get me back the medical bloodwork. I will collaborate with the therapist and then I'll make the recommendation, I'll explain the different types of medications, we often start at the lowest dose if that's what's needed and important. And we also get feedback from the therapist after this started on the medication to see if there's any improvement and also feedback from the teachers how they're doing better in class, are they able to focus back again? How many disruptions are they having throughout the day? Okay,

Unknown Speaker 15:45
so, question. Okay, very good. So let's say though, like the family came in, and they met with you, and then they left, they had the bloodwork completed, let's say just working with the scenario that we've been talking about, that the child is presenting with typical ADH D. presentation. So you order an EKG, the EKG is done, the results are sent back to you as the referring psychiatrist. Now then at that, at that point, does the family come back into your office to review the results and to discuss with you the recommendations?

Unknown Speaker 16:28
Yes, absolutely. Okay.

Unknown Speaker 16:30
So then, at that point, say, the parent agrees, like, Okay, this, this is a thorough job, as far as the clinical makeup of what you're determining, is the recommendation, and they decide to move forward with starting their child on a specific medication. So then the child starts the medication, you know, I'm going to say realistically, maybe within the for the week, from when they come in and agree that this is the treatment plan. This is how we're going to all move forward. What would be next? Is it another like 30 days before they follow up to see you like, what what can caregivers kind of anticipate?

Unknown Speaker 17:15
It depends on the situation, if it's something very extreme that we're concerned about, we would follow up sooner or maybe even a week or so. And if it's something that's less concerning, you know, a month follow up would be reasonable.

Unknown Speaker 17:30
Okay. All right. Very good. And so, let's say though, because I think I'm really interested in hearing clarification from you. And I think our parents who are listening this morning, may also have a similar interest in understanding what is what is the difference you commented on, potentially, for someone that struggles with concentration and impulsivity challenges. And if we are looking at a diagnosis of what is from the DSM five today, so it would be a DD, potentially, what we would refer to, from the DSM four combined type. What's the difference between a stimulant and non stimulant medication.

Unknown Speaker 18:15
So a stimulant medication is something that was very quickly within a few hours, but it's also out of your system fairly quickly. So if we started someone on it, we could potentially know, hey, this is working for this child right away, and it's very effective. The days that they don't need to use it, for example, the weekend, they don't want their child on a medication. It's very easy to do. Some of them don't take medication on weekends, they take it primarily for school, as needed for other children that are struggling on non stimulants. It may take some time to work, but it's just as effective. And it may be used for children who have an issue with their heart or they have abnormal EKG. So stimulants really should not be used for them. Okay,

Unknown Speaker 19:17
so great differentiation and helping me better understand how the stimulant versus non stimulant medication works for the diagnosis of ADHD. So So, I'm going to stick with the stimulant medication for a moment. What are some side effects that caregivers that parents may anticipate for a child that is prescribed a stimulant medication?

Unknown Speaker 19:45
A lot of them do report headaches, tell me loss of appetite, the stimulant medication. Long term studies show there might be height difference if this child is taking this vacation for a long period of time, and from what the studies show, it's approximately half an inch, so full into height change, maybe there for some people. It's not for everybody, but that that is something that is discussed. So those are some of the things to look out for with stimulant medication, some patients have worsening of tics if they're on a stimulant medication. So we do look out for that.

Unknown Speaker 20:35
And Dr. Ecija, can you describe for our listeners, please? What's an example of a tic?

Unknown Speaker 20:43
Tic is abnormal movements, like a child is just sitting then will just start blinking excessively, and that wasn't there before. Or maybe the child had a minor issue with it. And now they're doing it even more often. Okay,

Unknown Speaker 20:59
and so that is correlated to potentially the stimulant medication that the child's taking to help them manage their ATD symptoms. Yeah, yes, correct. All right. So so let's say, you know, we have an adolescent who is taking a stimulant medication for ADHD. And he's on a sports team. And the family is out as a family participating and cheering him on at his sporting event. And they forget to bring his medication. So he misses a dose of the medication. What is something that the family may need to be mindful of? Because they missed a dose of administering the medication to their adolescent? And then like, how should they get back on track? What What are your recommendations,

Unknown Speaker 21:52
so it says, a stimulant medication, and it was a few in the morning, and the match is in the afternoon, I would not recommend giving it to the nation right before the match. You know, I would just start the next morning again. Because you don't want to give it in the middle of the day, and then the child is awake at night. So it just depends on when the medication was missed. Sometimes the stimulants are dosed twice, once in the morning, once in the afternoon, it just depends on how long it lasts for that particular patient.

Unknown Speaker 22:31
Okay, so your recommendation was is to, you know, take into consideration. What is the usual time when the medication would be administered? You know, look at what time of day it is, and what's happening in the child or adolescents life, and then most likely wait until the next dosing time or period to continue taking the medication. Yes,

Unknown Speaker 23:00
and I would definitely to any parents say, you know, write down all these questions, because when you go to a provider, most of them, you know, they forget the question when they're there. And these are important questions, so I would definitely write them down before they have a visit.

Unknown Speaker 23:19
So one of one of the factors that I appreciate you highlighting earlier on in our discussion this morning, Dr. Has Sesia is that when you are meeting with a child or adolescent and family for the first time, that you are not necessarily intending on recommending the use of medication or psychotropic medication, and that really you're just collecting information to make a diagnostic impression of the child's needs. And so, what are some other interventions? Let's say that, you know, the family is coming to you because they feel like maybe, maybe they would like to discuss utilizing medication in the future, but they're just not there yet, in terms of jumping on that bandwagon, and maybe the child is not there yet, in terms of the need for the child to start medication. What are some other interventions that you might recommend to families?

Unknown Speaker 24:31
So I think the diagnostic impression is important and discussing what, you know, possibly this diagnosis is. There might be also some referrals like referral to therapy or referral to speech therapy or occupational therapy, to see what's needed. I would have them start those assessments, you know, get them sorted out. Maybe even watch videos or use the internet to see what other parents have said about starting medications versus not. And go to some support groups and see what other parents say before they decide, okay, I want to try it. And I always tell parents, you can try it. If you don't like it, there's no force behind it. You just see how it works. You may feel comfortable, you won't, you know? Yeah,

Unknown Speaker 25:29
I really I like what you are encouraging other parents and caregivers to reach out, reach out to other parents, who have children that may have used stimulant or non stimulant medication and ask questions in regards to how those medications may have impacted the other parents child so that they can become more comfortable with the thought of utilizing medication as an intervention to help sport support their child and thriving in their different environments. Part of you know, me wanting to welcome you back onto the show Dr. Sesia, is really to hopefully further reduce the stigma associated with the utilization of psychotropic medication with children and adolescents. And in my 24 years of working as a therapist, and training many other therapists who have worked with many children and their families, I have found that the the sometimes the the addition of medication can be helpful. And ways in which I've seen it be of assistance in the therapy process is that you mentioned prior that some children who have difficulty really being able to focus and to concentrate and sustain a certain level of focus so that they can learn new skills, and then practice new skills, sometimes without the use of medication can be very, very challenging. And so it's up to the therapists to really be creative and how to stimulate the child where, you know, we can get maybe five minutes worth of sustained concentration, where we can actually work on some skill building for a short period of time, while they're in the therapy office with the provider. So, you know, I'm really hoping that through this conversation that parents guardians feel a little bit more comfortable and at least feel comfortable in asking more questions about the use of medication and supporting their young loved one, in moving forward in a more positive way where they can experience increased success in their school environment, potentially, in fostering and building healthy friendships within their peer group, and experiencing success in their different extracurricular activities. Anything else you'd like to say Doctor has seizure before we end this morning show?

Unknown Speaker 28:30
I am very happy that I was part of the show again, I appreciate you having me on and I'm happy to provide more material to our listeners.

Unknown Speaker 28:41
Yeah. So So again, thank you so much for being a support to it's where I am. And if if any of our listeners are interested in reaching out to Satori, behavioral health, is their preferred way in which they may reach out to you if they'd like to have more contact with you. And if they have more questions.

Unknown Speaker 29:04
Yes, you can Google us and it's Satori behavioral health and the phone number is 702-780-6200. Or you can even email us at info at Satori, s a t o r i, B as in boy health.

Unknown Speaker 29:28
Very good. And as always, we appreciate you supporting. It's where I am. And I'm Dr. G. Great mind counseling and Wellness Center, clinical and public relations director. Until next week. Have a great morning.

Transcribed by https://otter.ai