Category: mood disorders

Grumpy Gus

by Midnight Demon, posted in Bipolar Disorder, blogging, cauda equina syndrome, chronic physical pain, depression, mood disorders

Grumpy Gus

I have been in a grumpy mood for most of the day. I had a bad night of sleeping. I woke up around 3 in pain and it never settled down. I am sticking with my diet today, though. I just need two more shakes and I will be done for the night.

I tried taking a nap but couldn’t so I took some Ativan to calm down. I really wanted to take a strong pain pill because my foot was going fucking berserk on me and it was really getting me agitated. I couldn’t move my foot/ankle any which way without pain. I didn’t go out today. Just going up and down the stairs to use the bathroom was torture. I know I will be having a bowel movement soon and I am not looking forward to going down the stairs again.

My fricken mother woke me up from my nap and I was not happy. She wanted to know what I wanted for dinner, at 1430!! WTF. She usually calls me around 1530 to ask. I was so bullshit. I still am. She always calls whenever I nap or am sleeping. It’s like I am supposed to be at her beck and call. And then she gets mad if I don’t answer the phone, especially if I am home. I am so pissed at her. Now she is playing her dice game and it’s annoying the fuck out of me. I’m going to hide it on her and throw the damn kettle out of the window.

Forget about changing the sheets today. That is not going to happen because my foot is being a fuck. I’ll just wrestle with the sheets one more time to get them back on the bed. I should have put in a refill for my meds through my PCP’s office today but I was so out of it, I didn’t think of it till now. Now I will have to wait until next week. Fuck. I hope I can last the weekend. I have been trying to be conservative with my meds which is why I didn’t take the strong pain pill before my nap.

I have the appointment with ortho tomorrow for my Achilles problem. I am really nervous and I know I am not going to be able to walk after they poke and prod my ankle. I am going to get there early in case they need to do X-rays. I might bring my cane with me just in case. It will be cold out so I won’t be wearing shorts. I will wear sweatpants so they are easy to pull up. Jeans would be difficult to roll up.

The psychotic stuff that I experienced on Monday has left. I think I am over it for right now. I just got to keep my stress levels low and I think tomorrow’s appointment is weighing on me more than I realize. I keep on having dreams of my father, nothing scary or anything but they are just weird. I can’t remember them when I wake up.

diets and other things

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders

Diets and other things

I had a hard time sleeping because of pain and the voices. The voices started up around 1800 last night and they were telling me people were out to get me, they hated me, and were trying to steal my thoughts. I became really anxious so I called my psych, who told me to take some Ativan. I had taken a strong pain pill and I think that is why my sleep was disrupted. My psych wanted me to call her today.

I didn’t stick to my diet today. I just ate what I wanted. I wasn’t planning on going out today but I wanted a burrito so I went to the Square and got one. Then I went to Starbucks to eat it and have my espresso and write a little bit. I tried writing for about a half hour with my new pen. It was a fine point and wrote smooth. I liked it but I prefer my medium point. I saw my bus go by and checked my watch. The next bus was coming so I left to go to the bus stop.

I went to Walgreens for my mother and they still didn’t have what she wanted so I got a raincheck for the item. I got some instant pasta so I could have it for supper. My mother called me to say she was making spaghetti. I will just have the pasta tomorrow. I hate skipping my diet but I wanted real food. Just having liquid protein is tough. I made it through yesterday okay but I was starving when I woke up at 0230 this morning. I had another Ensure and tried to go back to sleep.

I was on Twitter for most of the day. I saw that the Star Trek Twitter had posted a game from Think Geek. It’s a Monopoly game with a Klingon theme. I want it really bad! I think it will be fun to play with my nieces and nephew. I will get it when my check comes in next.

My ankle is still fucking hurting really bad. I am tempted to take another strong pain pill as I can’t take my regular meds for the next couple of hours. I took Neurontin this morning to keep the burning away. I feel groggy from it and the espresso helped but I am feeling really sleepy now that I am home. My psych called me back and I told her about the stressors that contributed to my psychosis yesterday. I would write about it but I am being watched so I can’t talk about it.

I didn’t have any sweets today though I really wanted to get a donut at Starbucks. I am trying to lay off junk food and sweets. It’s hard because I like those things.

I caved in and took a strong pain pill. I couldn’t help it. The pain is getting worse and I am going nuts from it. My suicidality is increasing because of it. I figure if I stop the pain, the suicidality will go down. I just want to end my life anyway, just for the hell of it. Just try it and see what happens. I die, I die. If I live, I live. I don’t fricken care. I just want to get the devil out of my system.

I think tomorrow, if I am not hungover or in really bad pain, I will change my sheets. The sheets I have on now keep coming off the bed, which is annoying me. The stupid foam topper keeps shifting and I don’t know why, which takes the sheet with it. I have had to adjust the thing every other day and I am getting tired of it!

errands and therapy

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders

Errands and therapy

I woke up at 0300 in pain and had a hard time getting back to sleep. I thought about staying up but it was too early to be up all day. So I went back to sleep around 0600 only to wake up about three hours later. I didn’t want to do a damn thing. I thought about cancelling therapy or at least rescheduling but I didn’t. I took a shower and that further exhausted me. I rested for a bit. I had to go to the bank and drop off my jeans to the tailors to be fixed.

I got dressed and made my way to the bank. It was slow going and I had to stop at the bus stop to rest for a few minutes. I went to the bank and did what I had to do. I then walked down to the tailor’s shop about three blocks away. I was getting so tired, I didn’t think I was going to make it home. I dropped off my jeans and had to register for the computer system. It’s been a long while since I was last there. I walked home and at another bus stop, I stopped to rest for a few minutes. I came home and was dragging. I didn’t want to go back out. I just wanted to nap the rest of the day. My legs were killing me. My ankle was sore (bad one). I finally managed to get to my room and I crashed. I drank an Ensure with my pain meds and tried to nap. Course, it was close to the time I had to leave so I couldn’t fall asleep. I just rested for about a half hour.

I got dressed again and went to the bus stop to go to the Square. My Bluetooth headphones were giving me grief. They kept on skipping while playing the songs. I tried everything I knew and nothing was working. I went to my bank to deposit the money I took from the other bank. I had to pay a bill. I went to Starbucks and got my espresso. I didn’t feel like having anything else. I uninstalled the MP3 player, thinking it was the reason the songs were skipping. I installed a new music player and was having the same issue. Now it was either the connection or the headphones. I was too tired to figure it out. I wrote in my journal and then left for therapy.

I am starting to think this guy is not for me. We are just talking and it doesn’t seem like he cares at all about my problems or suicidality. I discussed the blog post I wrote yesterday about the new diagnosis and told him it fits me. We talked about it but didn’t. He noticed my mood was low and I told him I was frustrated because I now have to wear diapers, my family isn’t supportive around my medical or psych issues, and I just want to kill myself for the hell of it. Some how we ended up talking about baseball and the session was over. See you next week. Meanwhile I am wondering what the hell just happened. I am getting frustrated by this guy. He doesn’t want to use any psychometrics or assessments in my suicidality. I am having a hard time with this.

I left his office feeling like “what the fuck am I doing”? I was really hungry. I have been on this liquid protein diet all day but didn’t have any protein other than the soy I put in my espresso. I couldn’t decide if I wanted a burrito or not. The bus came so I just went home. I restarted my phone and the Bluetooth glitch fixed itself. I went to Walgreens because my mother wanted a few items that were on sale. I got a protein bar so I wouldn’t cheat on my diet. I ate it on the way home and then had another Ensure. I am feeling full and sleepy right now. I met the protein requirement for the day with 40 calories to spare. I’m taking my meds early and going to try and sleep early. I just hope I don’t wake up in the middle of the night in pain, again. I knew it was going to throw me off. But I did a lot despite being sleep deprived. Tomorrow I am just going to rest (or try to). I am in a lot of pain right now as my ankle is screaming at me. If I hit being overtired, I am screwed.

Review: ASAD, Acute Suicidal Affective Disturbance

by Midnight Demon, posted in Bipolar Disorder, blogging, depression, mood disorders, suicide, suicide attempt

Review ASAD: Acute Suicidal Affective Disturbance

This article was written earlier this year and I was able to get it to evaluate it. The following are my thoughts about it:

Suicide affects over 800,000 people worldwide but there is not much in terms of preventing death by suicide or attempts. Risk factors mostly focus on suicide ideation. Even though the DSM 5 has created a SBD (suicidal behavior disorder), it is something to be explored but not a full diagnosis. The authors of this article have proposed the diagnosis of Acute Suicidal Affective Disturbance because it is a relatively immediate response to stress or some other factor. The criteria is:

• A geometric increase in suicidal intent over the course of hours or days, as opposed to weeks or months
• One of both of the following: marked social alienation (e.g., severe social withdrawal, disgust with others, perceptions that one is a burden on others) or marked self-alienation (e.g., self-disgust, perceptions that one’s psychological pain is a burden)
• Perceptions that the foregoing are hopelessly intractable
• Two or more manifestations of overarousal (i.e., agitation, insomnia, nightmares, irritability)

All four criteria must be present for a diagnosis and must not be the direct result of an exasperation of a mood disorder or substance use. I am guessing this means that a mixed state would exclude the diagnosis. I also wrote to the primary author, Megan Rogers, to find out if a medical condition would be exclusionary, such as a chronic pain condition, but it hasn’t been established.

Exclusionary criteria for the studies were active psychotic symptoms, imminent danger to self or others, and unmedicated bipolar spectrum disorders.

343 outpatients from a university-affiliated clinic were enrolled in the study. Various measures were used to assess anxiety, depression, suicide ideation, anger, dream activity, etc. 7,698 inpatients were enrolled in the second part of the study. Measures were a little different than the outpatient sample, as the SSF-II (Suicide Status Form) was used to measure ASAD symptoms as opposed to the Beck Scale for Suicide Ideation. The SSF-II has a good validity rate (Jobes et.al., 1997). Other measures were length of stay (mean 7.54 days, SD 6.41), PHQ-9, and past suicide attempts.
The statistics of the tables were confusing to me as I am not a stats person so I can’t really interpret the results. The discussion had good markers for ASAD being a diagnosis and I went from there. One take away was that ASAD was associated with numerous psych disorders but was not redundant in association to suicide risk. It was related to past suicide attempts above and beyond symptoms of depression, which I think is important. Depression symptoms only tell one side of the story and not all people with depression are suicidal or have thoughts of suicide.

As with this being relatively new, more research is needed in multiple areas to ascertain whether this can be a useful diagnosis in the management of suicidal behaviors or even to prevent suicide. The authors did note that once ASAD is established, good safety planning is necessary to monitor suicidality throughout the course of treatment. This is important in all therapeutic endeavors when dealing with suicidal individuals, even if the episode has passed. A tailor made plan must be made, not a “one size fits all” model.

Acute Suicidal affective disturbance: Factorial structure and initial validation across psychiatric outpatient and inpatient samples. Rogers,M. Chiurliza, B. Hagan, CR. Tzoneva, M., Hames, JL., Michaels, MS., Hitchfield, MJ., Palmer, BA., Lineberry, TW.,Jobes, DA., Joiner, TE. Journal of Affective Disorders 211 (2017) 1-11