Tag: mood disorders

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

trying something different

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

Trying something different

I woke up in pain again around 0630. I took some pain meds and so far, I don’t seem to be needing anymore for the time being. I went back to sleep a few hours later. When I got up, I decided I was going to try the liquid protein diet again. So I had a drink and then made coffee. The coffee came out a little weak because I put too much water. I hate when I do that. I am going to try and stick with this diet. If I can make it all week on it, I will try it next week or until I run out of protein drinks. I have gained four pounds so I am hoping to lose that and a little more. It is hard to lose but I hope I can stay on this course. It’s my second attempt at this as the first time didn’t work out as well.

Allergies are really bad today. I am congested and sneezing a lot. I am going to try and work on my paper. I am going to try and read it and see what information I can pull from it. The one piece of information I was waiting on from the author of the paper wrote back to me so I will include that in my analysis.

It’s another nice day. I opened the back door. My mother needs to have the screen doors repaired as they are getting more patched up than screened. Every time it rains, the patches blow away as they are just stuck on with tape-like thing.

I got my favorite country radio station playing on my Kindle. I really want to go back to sleep but I am going to try and avoid it. I need to write like a bullet point for this blog and then write up some things that I want to work on with my therapist. I was thinking of them last night as I was drifting off to sleep. There are about three or four things I really want to work on. I am kind of scared because I am not used to asking what I want from therapy. I just expect the therapist to know after I talk for a little bit. But the last few sessions haven’t left me feeling like anything is happening other than me rattling off my history and how bad my childhood was.

My new Depends underwear came in so I will start wearing them tomorrow. I got a couple samples in the package with a coupon. I’ll take a shower tonight. I just hope they fit me. I have a huge package so if they don’t fit, I am screwed. I hate that it has come to this. I have stopped one of my medications. I am not taking it this week and see how my bladder does.

academic self aside for today

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

Academic self aside for today

I thought after I wrote my blog this morning, I would have lunch and then either pass out or read until I did from my meds. I texted a friend and that friend came over with food and snacks to watch the baseball game with me. He kind of annoyed me because instead of watching baseball, he kept talking about things throughout. I kept missing key parts of the game and it was pissing me off. I didn’t care though. I know that is how he is and I was glad for the company. I haven’t seen him in a long while. The Sox won 11-1. It was their first win in over a week. I hope it continues.

I was beat after the game. I wanted to retire to my room but my mother made me wash the dishes we used for the meal we cooked. I kind of had a feeling I couldn’t get away with it. My ankle wasn’t happy but I did the deed. I am feeling really bloated right now because I had a cup of tea to try and keep myself awake until I take my night meds. Before I made the tea, I am not sure if I took my pain meds or not. I don’t want to double dose so I will take it later before I go to sleep. I think that will be safer. I had wanted to work on my paper but I just can’t seem to focus right now. I still haven’t finished the blog project. I just keep getting behind. I feel like if I was in academia, I would be forced to do this stuff because of deadlines and what not. But I am just pushing myself along with these “projects”.

I have a sinus headache and I just want to snooze. I was reading a blog before my friend came over and just finished it a little while ago. It was a clinical blog so I passed it along to my friend who is studying to be a psychologist. I think he might find use for it. The guy that wrote it was on Twitter so I tweeted him it was a good blog and that I passed it along to my friend. He just responded thanks. I love that I am connected with a bunch of professionals at different levels and good or bad, they respond to my tweeting. It makes me feel apart of something big. I guess I am feeling the pressure of producing these projects that I have because of these professionals. They are not forcing me to do anything I don’t want to do. I guess it’s just I want to please them and have them think of me as someone of value. I just want to expand their knowledge through my interpretation of things. I am constantly on the lookout for things related to suicide and therapy. Hell, half my stack of to read pile are books on CT and suicide prevention, suicide malpractice, or ethics regarding suicide in clinical practice.

I need to get into a routine of some sort to do this part of my academic self. It just sucks that pain meds and pain get in the way of doing it. Or my damn depression gets in the way like it has so many times before. If I wasn’t depressed, I would have had my degree already and I might be in grad school now or at least applying to it. Just makes me feel like a loser because I know I am intelligent but I don’t have the degrees to back it up.