Tag: physical pain

ASAD: Acute Suicidal Affective Disturbance

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

ASAD: Acute Suicidal Affective Disturbance

http://www.mdedge.com/clinicalpsychiatrynews/article/100017/depression/aas-acute-suicidal-affective-disturbance-proposed

I read the above article with interest. One of my Twitter buddies shared it with me and wanted my opinion on it. I think that it is right on queue and I hope that Dr. Joiner eventually sees this as a diagnosis. But I worry that if the stigma of suicide is not dealt with, it might just be an admitting diagnosis and thus cause more harm than good.

According to the criteria lined out, I meet this diagnosis, though at this time, I am unable to rule out whether a medical condition or conditions exclude the diagnosis. There have been many a times that while I am in excruciating pain, this condition is activated and I am acutely suicidal. The only thing that has saved me from actually making an attempt on my life is that I physically cannot walk and have refused to kill myself in my own home. Then in the morning (most of these attacks have occurred in the midnight hours), I no longer feel so suicidal.

It used to be that what I would call a “switch” would be activated and I would be suicidal until I fell asleep. Now I know that it’s this disturbance that occurs and it makes sense to me. But in every suicidal occurrence that has happened over the past two years, it has been because of physical pain or some kind of dissociative state brought on by physical pain. Very rarely has it occurred solely with psychache or psychological pain. Granted not every episode is psychache free and physical pain free. I will have what Shneidman calls the three Ps, Psychache, Perturbation, and Press as well as physical pain that causes me to be severely suicidal. These nights, I swear to myself I will end my life the next day when I can walk again. Fortunately, I don’t feel as suicidal the next day because I had a few hours or more of respite from these kinds of pain and perturbation. That isn’t to say that I won’t be activated the next night or come up with a suicidal plan to end my life the following day. These plans are usually a few weeks away to give me time to think things over and essentially put off today what can be done tomorrow. These plans have also given me time to work through my feelings and usually by the time that date comes, I no longer feel suicidal enough to go ahead with the plan.

Suicidality is a tricky business and not everyone’s suicidality is the same. What triggers my suicidality might not trigger someone else’s. There are mitigating factors that might be similar in nature like the criteria states but I would love to see the data in the context of ruling this a diagnosis. Just because I find this disturbance fits my suicidality, doesn’t mean that it will someone else’s and that is the difficulty with the nomenclature I think Joiner talks about in his article.

an upsetting chat

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

An upsetting chat

Nathaan Demers ‏@Doc_Demers 3h3 hours ago
We need protocols in primary care regarding MH & suicidal ideation. We flag pt records for med conditions- lets do the same for MH. #spsm

I came across this statement while going through the SPSM chat that goes on every Sunday on Twitter. What I find upsetting is that these suicide preventionists don’t realize that suicide and suicidal thinking are time limited. People who think of this in time of extreme distress are not going to think about it down the line. Now if they make an attempt, that is a different matter.

The way I see it, you can let the medical providers know that the patient has mental health issues. I am for that. But telling them they have suicidal ideation that won’t go on like pneumonia is just foolish. Sure you can document that the person had ideation but for what? So that some idiot insurance policy can deny claims because they were going through a tough patch and wanted to get out of it? To me, that is just perpetuating the stigma of suicide. If the patient attempted suicide, then that is cause for concern because the best indicator that we have right now is survived attempts leading to a death by suicide.

This isn’t the first chat that has called for the medical providers and mental health professionals to be working together. But once you place it in the patient’s chart, it’s there forever. You can’t erase it. More thought needs to go into this before I feel comfortable about my own thoughts going into my medical record. We’re not talking about a deathly reaction to penicillin. Those kind of things should of course be documented at every medical visit.

But passing suicidal thoughts that were thought of last week or last month or even ten years ago? Everyone has these thoughts. Not all go through with them. It’s the attempts that should be documented not the ideas if we want to save a life. Granted patients might be ashamed or embarrassed to bring up a failed attempt but it should be asked about. And again, this should all be done with dignity and respect and compassion. It shouldn’t be hurried and passed over once talked about. It should also be respected about the time. If the patient is currently have these thoughts they should be addressed. If it happened ten years ago and the patient is stable, then in my opinion, it should be documented but not be hounded and beaten to death. The crisis is over and dealt with. It’s what is going on now in the patient’s life that should matter, not the long ago past.

Completely Out of Spoons

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

Completely out of spoons

My groceries came and by the time I put everything away, including going to the basement for the frozen items, I was wiped out. In fact, I am pretty sure I am in the negative for my spoon count. I had a choice to make, shower or make dinner and actually eat it. I chose a shower followed by an Ensure. It’s not a meal but it’s something. I hope it will hold me off till tomorrow morning. I am so tired. I feel completely exhausted and I hope I get some sleep.

My ankle is starting to hurt so I know I did too much. I did order a car for tomorrow to see my therapist. It’s down the street rather than up the street so I think I can manage it. But it’s early in the morning and I am not a morning person. I set two alarms so I can make it. There is a chance I will wake up before it rings but just in case. Lately, I have been waking up before 0630.

Because I am not planning on baking, I have decided to donate the Boston coffee cake to the party I will be going to Saturday night. There is a chance I still might make one of the cakes Friday but just in case I don’t feel like it, I won’t show up empty handed. I was really looking forward to that coffee cake, too. I should have bought two.

I can’t believe how exhausted I am. I really didn’t do more than what I normally do and I had caffeine. I guess my stamina has taken a hit because I have been spending more time in the house than I normally do. But it’s so hard to get out when you are in pain most of the time or haven’t had a good sleep because of pain. I think I finally broke the pain cycle but the pain is still there, just not as severe as it was. I hope later tonight I am not in mind boggling pain. I never know when my pain will flare up. I could move my ankle a millimeter and that is all it takes to start it up. And this is after resting it for several hours.

I hate having to decide what activity to do. If I wasn’t so wiped out after getting my haircut and going to Starbucks, I probably would have had dinner and then shower. But tonight it was one or the other. I couldn’t have both, not after the groceries took every ounce of energy I had. I still didn’t put all of them away. I will save that for another day. Or my mother will put them away, like she normally does because I take too long. She doesn’t get it. She think she does or pretends to, but she really doesn’t. And she suffers from chronic back pain, you think she would understand.

I have been trying to take it easy on myself since changing my sheets the other day. My back still hasn’t fully recovered, which was probably why I am exhausted tonight. Today is the first time going out since I took out my back. I guess I wasn’t up to being myself but I had to go out. The four walls can only stare at me for so long before they get to me. I didn’t go out this weekend because the T is crap and they were diverting buses. I rather stay home than deal with that mess. Only time I went out was to get my prescriptions and corn chips at Walgreens. It bothers me that I am still limited in what I can and can’t do. But my body doesn’t tell me right away that doing these things is taking spoons away. Before you know it, I am in the negative and I am exhausted. I know part of it is I push myself without knowing it. Normally getting a haircut and going to Starbucks doesn’t wear me out. But throw in back pain just two days ago and wham, I am out of spoons real fast.

I find it hard to control my life when there are these invisible things that I can’t foresee. I know that getting groceries wore me out quicker because I had to go back and forth and all around the house to put them away. Then stand at the fridge to put them away. This takes energy and I forget that. It’s one thing to stand in front of the fridge because you are hungry; quite another when you are putting things away. And carrying a gallon of milk and juice isn’t a light load. It just adds to the strain of your back pain. No wonder I was really pooped by the end of the groceries and only had enough energy left to either shower and shave or cook and eat. I knew I had to wash my hair because there was no way I could sleep in my clean sheets with hair clippings on my head. And even if I could manage it, washing my hair in the sink would just put most strain on my back. So I showered. It’s not like missing a meal would harm me. I am not a malnourished person, anything but. I had an Ensure though because I was hungry. Those things come in handy when you need them.

Early start to a Monday

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

Early start to a Monday

I have been having a difficult night sleeping. I got a stuffy nose so I couldn’t breathe right for most of the night. I kept waking up having to sniff. I knew if I got up to blow my nose, that would be it and I would be up. I finally gave up around 0630 and blew my nose. I was pretty congested so I took my nasal medicine. I hope I am not getting a cold. I hate colds more than I do other illnesses. I haven’t been in contact with anyone with a cold so I hope it’s just allergies. Course the weather has been a pain in the neck the past few days. One day it’s 70 degrees the next it’s in the 50’s or below. All this week it’s supposed to be in the 40’s. Fun.

My ankle and foot are hurting me and I said fuck it, I took two pain pills. Then I got stabbing pains in my foot that are killing me so I made the right choice. Now I just need to wait for them to kick in. I should be sleeping most of the day. I just hope my nose cooperates.

I checked my bank account and my check didn’t come in. I had a feeling it wasn’t going to. I don’t know if it is my bank that is the issue or the LTD people. I should get it tomorrow morning. What a bummer. I really was hoping to get some things today that I need, like my groceries and my car reservations. Now I got to wait. I hate being dependent on someone else’s time.

If I am up to it, I might go to the Square today and take the bus to city hall to vote. It all depends on my mood. I should make coffee but I don’t want to be up until later this afternoon. If I drink coffee at home, I usually don’t go out to get coffee because that will be too much caffeine for me. I will be bouncing off the walls and jittery and I don’t like that feeling.

I am so looking forward to making my Nantucket Cranberry Cake this week. I finally will be using the food processor I bought. I hope using it is easy. I have never used one before. I know the cake is going to be yummy. Then for the party I am going to, I will be making my pumpkin cake. I love cake, in case you haven’t figured that out yet, LOL. I have gained about 5 pounds since baking all this stuff, but I think the Neurontin that I have been taking the last week and a half has been helping to keep it on and then some.

Well, my meds are kicking in faster than I thought they would. I am feeling really drowsy. I hope I sleep. Until later my friends.