Mood Disorder-NOS

[blessedwithboys]

My 8yo ds has an official diagnosis.  Well, 3 of them actually.  Generalized Anxiety Disorder, Specific Phobia, and Mood Disorder-NOS.

Does anyone have a BTDT with MD-NOS?  I have felt that ds is bipolar since he was about a year or two old.  The first psychiatrist we saw told me ds had no signs of BPD (how can one even tell in 45 minutes?) but offered to give us a rx for Ritalin anyway, the second one ignored my son stabbing himself in the face with the earpiece of his sunglasses while she typed up a referral to a nurse-case manager, and the third and current one agreed to meds the first time we saw him but now keeps trying to convince me to admit ds, even though he is not presently a danger to himself or others (if and when that changes, I will have no qualms about driving him to the hospital myself, I think the issue is that this dr is involved in a study and is trying to recruit participants).

I have spoken to two other dr's who aren't afraid to dx BPD in such a young child, but they aren't covered by insurance.  One would cost me about $600 and the other (Papolos) is closer to four grand.

What is Mood Disorder-NOS all about?  Is it a provisional dx that will likely be changed later, or is it one that sticks?  I am happy that ds is now trialing meds (although 6 wks on Risperdal hasn't done squat) but I don't know how to feel about this particular dx.

Oh, and I should mention that the dx was actually given by the psychologist who did his most recent round of testing.  The new shrink gave ds a dx of Psychosis-NOS even though I never described anything even approaching psychosis.  *shrug*

[chiefmir]

Hi-  I saw your post and had a few thoughts that I hope will help.

First of all, full disclosure :)  I don't have a child with a MH diagnosis, but I have a doctorate in clinical psychology.  From what you posted, I think that the diagnosis of Mood Disorder, NOS 1) most likely won't stick as your DS gets older..whatever he is struggling with may/will eventually become more clear as he gets older and his symptoms "settle" in to the more familiar "adult presentation" and patterns that would fit something more specific. That may be BPD, may be Depression with psychotic features, may be any number of things.  and 2) the diagnosis doesn't matter at all right now as long as you have found a psychiatrist who has experience treating children your DS' age with meds like risperdal.  He'd likely start with that same medication even if he had a more clear BPD diagnosis-- so the exact word listed  on the piece of paper probably won't change much. At this age and at this stage, the dr is treating the presenting and most quality-of-life damaging symptoms regardless of what it is called. SO, SO many kids have been through multiple diagnoses.... and its not necessarily because any doctor was "wrong" in what they chose.  Or even "afraid" to make a certain diagnosis.  Especially when a problem surfaces very young, the symptoms of a disorder can look SO different from one age to another- so the diagnosis will likely change.  (this is especially common with some of the "larger" diagnoses like BPD or schizophrenia where they look very different in children than what is traditionally seen in adults).  Also, things like BPD and childhood psychosis are really relatively rare in a very young population-- particularly when compared to other things like ADHD, depression, etc.  So a doctor's reluctance to diagnose BPD may also be related to the relatively few young patients they've seen with the condition.

FWIW, I've diagnosed a very few children under the age of 15 with BPD.  I HAVE done it, but not very often.  And by the time they have been seen by me, (I'm a neuropsychologist) they've usually been seen by psychologists, psychiatrists, developmental pediatricians, etc. and have had numerous diagnoses over time (most of which have been replaced and discarded along the way)... including austism spectrum, intermittant explosive disorder, ADHD, depression, anxiety, adjustment disorder, oppositional defiant disorder.  I've only rarely seen mood disorder, nos diagnosed, so my gut feeling is that the doctor was possibly "thinking" of BPD but wasn't quite ready to make the call yet.

I hope that your DS is on his way to feeling better.