Overdose Remeron Antidepressant & Others 06/08/2006 Washington 6 Year Old Dies on Psych Cocktail Summary:

Last paragraph [from NIMH] reads: "*It's critical to get the correct diagnosis. The drugs used to treat depression and attention-deficit hyperactivity disorder worsen mania in those with bipolar disorder."

Paragraph 10 reads: "Bailey apparently had ingested his medication for bipolar disorder and attention-deficit hyperactivity disorder, from both old and new prescriptions, including lithium, Risperdal, Remeron and Clonidine. Although bipolar disorder carries a high suicide risk, Holly and Nick don't think Bailey intended to hurt himself. They point out that he swallowed vitamin C from a bottle amid the heavier meds."

Paragraph 52 reads: "The parents doubt child-proof caps posed much of a challenge to Bailey, who had seen them opened many times in the two years since his first prescription for ADHD."

Paragraph 59 reads: "They cherish memories of the happy times with their only son, whom they describe as a graceful athlete, an affectionate brother to his two sisters who made up silly songs, called computers "minputers," and loved dinosaurs."

http://www.columbian.com/lifeHome/lifeHomeNews/08062006news48779.cfm

A brief and troubled life

Sunday, August 06, 2006
By ERIN Middlewood Columbian staff writer

Nick and Holly Schlentz sit on the bed in their 6-year-old son Bailey's room, where he died June 28. The boy died from an overdose of his medication, which his parents believe he took thinking it would make him better. DAVE OLSON/The Columbian

RIDGEFIELD -- Six-year-old Bailey Schlentz spent his last day alive trying to be a good boy.

His mother, Holly, took him to spend his tooth fairy money at a toy store. They lunched at McDonald's. And they stopped at the pharmacy for medications to treat his bipolar disorder.

A growing number of children are receiving the diagnosis. Bailey was diagnosed a year ago after an escalation in troubling behavior that included killing a hamster, biting the head off a pet fish, and episodes of violent rage.

He spent the first half of June in the children's psychiatric ward at Providence Portland Medical Center, until the Schlentzes' insurance benefits ran out. Nick, 25, works for his father's industrial air pollution-control company. Holly, 28, recently left her job at Lion's Eye Bank to stay home. They couldn't afford the $1,700 a day it would cost to keep him in the hospital, and were desperately searching for another option. "If services were available," Nick Schlentz said, "Bailey wouldn't be dead."

On June 27, after playing three games of Yu-Gi-Oh! and hanging out in the park, Bailey placed his hand on top of his mother's and asked her, "Do my medications make me not angry?"

Holly Schlentz paused. She worried Bailey would want to stop taking them, so she answered carefully: "Yes, they help you, but only you can help you not be angry."

The next morning she noticed sunlight streaming into his room. She worried it would wake him up too early, so she stepped in to close the blinds. Then she saw him lying in his bed, gray and still. She screamed. Nick called 911.

The dispatcher gave instructions for CPR. Holly, who used to work for the Multnomah County medical examiner and the Washoe County (Nev.) coroner, knew Bailey was dead, but frantically tried to resuscitate him.

Emergency vehicles swarmed the Schlentzes' house in a Ridgefield neighborhood so new it's not on most maps.

Bailey apparently had ingested his medication for bipolar disorder and attention-deficit hyperactivity disorder, from both old and new prescriptions, including lithium, Risperdal, Remeron and Clonidine. Although bipolar disorder carries a high suicide risk, Holly and Nick don't think Bailey intended to hurt himself. They point out that he swallowed vitamin C from a bottle amid the heavier meds.

"I think his thought process was, 'If I take all of them, I'll be fixed,'" Holly said.

Clark County sheriff's detectives found the pill bottles hidden under the boy's bed.

They won't officially close the case until the state crime lab returns toxicology reports, but Detective Rick Buckner said Bailey's death "appears to be a tragic accident."

Mental illness impairs about one in 10 children, according to the National Institute of Mental Health. Of the 7,555 people receiving help from Clark County's public mental health system, 2,813 -- 37 percent -- are children.

Bipolar disorder, which causes dramatic swings, afflicts perhaps one in 100 children. In journal articles, psychiatrists debate that figure, as well as the diagnosis, but agree more children are receiving the label.

It's difficult to diagnose in youngsters because the symptoms are similar to other childhood disorders and don't necessarily fit criteria established for adults.

"It's not clear that what's being called bipolar disorder in children is the same as in adults," said Dr. Jon McClellan, an associate professor of psychiatry at the University of Washington.

Adults' episodes of mania and depression last longer. Moods cycle more rapidly in children.

"They're often highly volatile and explosive," said McClellan. He's the lead author for the American Academy of Child and Adolescent Psychiatry's treatment guidelines for pediatric bipolar disorder, which he expects will be completed in the next year.

Psychiatrists aren't sure what causes bipolar disorder but point to a mix of genetic and environmental factors. Holly said she doesn't know of any instances in her family tree. Nick was the only father in Bailey's life since he was a year old. Holly wonders if Bailey's biological father, who was diagnosed with ADHD, may have the disorder. Children with one bipolar parent have a 10 percent to 15 percent risk of developing bipolar disorder, compared with a 1 percent risk among the general population.

Bailey's last three months were "horrific," his parents said. His behavior, already out of control, worsened after he witnessed sexual abuse of another child at the hands of a 14-year-old boy. Bailey's psychiatrist added post-traumatic disorder to his diagnosis, which already included ADHD, bipolar and conduct disorders.

As a 3-year-old, Bailey raged and threw tantrums. His parents thought his terrible-twos were lasting longer than usual.

"We'd written off a lot of his behavior because he was our only boy," Holly said.

At age 4, he intentionally sat on a hamster his older sister had received for good grades on her spelling tests.

Bailey later admitted to his parents, "I killed it because it was evil and it had red eyes."

"Alarm bells go off in your head. I thought my son was going to be the next (Jeffrey) Dahmer," she said. "We tried parenting classes, family therapy, outpatient psychiatry, inpatient treatment."

Bailey would improve for a while, then his bolts of rage would again strike the household. During these fits, his parents would restrain him to keep him from hurting himself or someone else.

"It was almost like he was possessed. He would kick and bite. I would look into his eyes and it was not him," Nick said.

Once Bailey calmed down, he wouldn't remember why he was mad, Holly said. It was usually because he had been told "no."

Something ticked him off at school in late May, when he was hospitalized.

"He kicked the principal and was throwing chairs at teachers," Holly said.

As she tried to get him into the car, he thrashed at the windows. She drove him directly to the police station.

An officer got on his knees and told Bailey, "You need to mind your mom and dad."

"We were hoping for a scare tactic," Holly said.

Later that day at home, Bailey flew into another rage.

"I restrained him for an hour," Nick said. "He was kicking, spitting and saying, 'I hate you.'"

They called 911, and an ambulance took him to the emergency room at Legacy Salmon Creek. From there he was transferred twice, ultimately ending up at Providence Portland Medical Center. He stayed in the hospital 17 days. Even after insurance, the Schlentzes' bill reached $25,000.

"That's hard to swallow, when we don't even have our son," Holly said. (Before Bailey's funeral, the family asked mourners not to send flowers, but instead to donate to a memorial fund in their son's name at Bank of America to help them pay for medical expenses.)

Bailey's psychiatrist tried to get him more time in the hospital, Holly and Nick said. But without more expansive insurance coverage, they couldn't afford to keep him there. They brought him home, and worked out a plan for him to stay with a relative while they researched their options.

"We make too much money to qualify for state aid, but we don't make enough for $1,700 a day," Nick said.

"Keeping him at home was becoming unsafe for him and our two girls," Holly said. "We have a defenseless 2-year-old. He was violent."

Finding him a foster home, given his behavior, didn't seem likely. Nick considered getting an apartment and living with Bailey, but didn't like the idea of splitting up the family. The Schlentzes looked into the state's Children's Long-term Inpatient Programs, known as CLIP, which have room for 91 children at four facilities. The application first must be approved by Clark County officials, who say they receive only one or two a year. The process takes months. As of last week, 23 children statewide were on the waiting list.

"We work hard to try and use up all services available in the community before placing a child in a more restricted residential setting," said Cheri Dolezal, deputy director of Clark County Community Services.

Hospitalization is expensive and disruptive, and community-based programs have proven to be as effective, according to a U.S. surgeon general report on mental illness.

"The best treatment is generally considered treating kids at home," said McClellan, the UW professor. He's also medical director of the Child Study and Treatment Center in Lakewood.

That's the facility where Bailey likely would have gone, if his application were accepted.

"It's the only long-term psychiatric hospital for a kid that young," McClellan said.

The center has 16 beds for children ages 5 to 12. The waiting list varies but is months long.

Nick and Holly had just started filling out the application when Bailey died.

Since their son's death, Holly and Nick Schlentz have replayed events of his last day in their minds.

There was a mix-up with the prescriptions Holly picked up at the pharmacy, and she used the phone in her bedroom to try to sort that out. She set the bottles, normally stored out of the children's reach in a kitchen cupboard, down on the nightstand.

The parents doubt child-proof caps posed much of a challenge to Bailey, who had seen them opened many times in the two years since his first prescription for ADHD.

It was a hot day, so Holly and Nick decided to sleep downstairs on the couch instead of upstairs in their bedroom, adjacent to the children's rooms, which unlike the parents', are equipped with ceiling fans.

"If the medication hadn't been in my purse, if I hadn't talked on the upstairs phone, if we had slept in our room, there are so many 'ifs,'" Holly said.

The biggest: "If we had been able to continue with inpatient treatment," she said, "he wouldn't be dead right now."

The Schlentzes have only begun their journey through grief.

After the funeral home returned the stained dinosaur sheets from Bailey's bed, his parents washed them and put them back on.

They cherish memories of the happy times with their only son, whom they describe as a graceful athlete, an affectionate brother to his two sisters who made up silly songs, called computers "minputers," and loved dinosaurs.

"My little boy, he just had a big chunk of my heart," Holly said, her voice cracking.

Nick had been saving a walking stick he found with his dad to give to his own son. Now it's in Bailey's casket.

Holly and Nick admit to feeling some measure of relief. Managing Bailey was all-consuming.

"Now we can give these two," Holly said gesturing to the girls, "the attention they deserve. He's not hurting anymore, either."

But she said she and her husband would gladly cope with Bailey's volatile behavior to have him back.

"We would restrain him 24 hours a day if we could just hold him again."

Erin Middlewood can be reached at 360-759-8031 or erin.middlewood@columbian.com.

Did you know?

* Bipolar disorder is also called manic-depressive illness.

* Unlike adults, manic children and adolescents are more likely to be irritable and prone to destructive outbursts than to be elated or euphoric.

* Evidence indicates that bipolar disorder beginning in childhood or early adolescence may be a different, possibly more severe form of the illness than older adolescent- and adult-onset bipolar disorder.

* It's critical to get the correct diagnosis. The drugs used to treat depression and attention-deficit hyperactivity disorder worsen mania in those with bipolar disorder.

Source: The National Institute of Mental Health