Tag: schizoaffective disorder

solemn Saturday

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

Solemn Saturday

I woke up before 0500 in pain. I took some pain meds and then set my alarm so I could go to the barber’s early to fix the back of my head. I fell back to sleep and when the alarm sounded. I shut it off but didn’t get up. I slept for 45 minutes and then got ready. It was already humid out and I was dreading it because I had to wear pants in this heat. I found a button down shirt in my office and grabbed a tie. I had to go to a wake after I got my haircut.

I left with time to spare and as I was at the bus stop, I pulled out my wireless headset. I should have stood up but I didn’t and one of the sides came undone. Dammit. I had to go back to the house to get my wired set. I was hoping to fix it but I couldn’t because the screw prevented me from putting it back into place and I didn’t want the wire to get undone.

The bus came and I went to the barber’s first before Starbucks. He fixed my head and trimmed the top. He cut the price as I saw him last week. I just gave him a bigger tip. I went to Starbucks and had my espresso and a sandwich. I still had plenty of time before the wake was supposed to happen. I was going to take the train but then I thought one of the buses in the Square would take me to the green line and I could connect to the blue line easier than going from red to orange to blue.

I was still really early by at least an hour and I just rode the train from one end of the line to the other until it was time to get off. I walked to the funeral home and the voices started harping on me like I didn’t know where I was going. I grew up in this town so was very familiar with the lay out. However, I am used to the starting point being the house I grew up in so it took me a while to get my bearings. The voices kept on doubting my judgement. I was getting so aggravated. Some stores and stuff had changed in the 25 years since I was in that area. I saw my elementary school and once I did, I knew where I was and where the street to the home would be.

I was sweating pretty good by the time I got there. My friend’s mother was appreciative that I came. I had known her when I was a teen as she did some workshop with the youth network I was involved in. I said hello to my friend and offered my condolences. I saw his wife, who was another friend of mine and said hello. I saw their beautiful daughter but she didn’t know me so I didn’t say anything to her. It was sad and my friend’s mother was very upset. I guess it wasn’t a planned death, the hardest kind. I had known my father was going to die. It was just a matter of time and so I had time to prepare. As I left I told them if they needed anything, they knew where to find me (FB).

I left and stopped at a gas station to get a bottle of water. I was so parched in the heat. By the time I got within a block of the train station, my foot exploded. Fuck and I wasn’t anywhere near home. I didn’t take any pain meds with me. I just didn’t think. So I hobbled to the station and the train came soon as I walked in. Score. The same thing happened on my connecting train home. I had to wait for the bus though. My feet were not happy.

I came home and hit the shower. I was soaked. Everything went in the hamper. I don’t think anything was dry. The shower was so refreshing. My feet didn’t like it but I didn’t care. I took some pain meds when I got up to my room. I have been keeping a spreadsheet on my phone on how many pills I take a day and it was 12 hours since my last dose. I waited a little bit for it to work before making something to eat. I was hungry but I wasn’t. I decided to make hot dogs rather than to order out.

After dinner, I fixed my Bluetooth headset. I was grateful it wasn’t broken and I needed to get another one. This one is pretty good with stand-by time and length of use. Only thing that sucks is that it takes a full 2 hours to charge but it’s worth it. I generally use my powered USB port so I can charge it and not have to be on the laptop to do it.

wake up tired and try again

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

Wake up tired and try again

Voices have started while I was cleaning up after dinner. I was going to respond to them, but my mother was in the kitchen so I couldn’t. Thank god I held my tongue, which is really hard thing to do when you are hearing voices. The music was going on as well and for a minute or two, I could have sworn it was entertaining the voices.

I guess the stress of finding a lump and not knowing what it could be was more than I thought it was. I am really tired from going out to my appointment and being in pain. Now I am listening to an Eric Church song on repeat because I find it soothing and keeps the stuff in my head quiet. I can concentrate.

I emailed my psych to let her know I took a PRN of trilafon to help the voices. If that doesn’t work, I will take an Ativan. If that doesn’t work, I have her on speed dial. I don’t know if she will get the email tonight or not. For some reason my computer is slow and it’s annoying the fuck out of me. Ever since I got the new modem, my Twitter tweets haven’t been refreshing like they did before and Facebook shows the last four days of stuff instead of today.

Sox are losing right now so I am not going to follow the game. I can’t listen to it because the voices will come back. Least the cacophony of music has stopped. I like listening to just one song because it forces my brain to focus on one thing. The song I am listening to is called Mixed Drinks about Feelings. I kind of wish I had some whiskey but that is ok. I can’t drink with my pain meds anyway. It would be too dangerous, not that I am a drinker anyways. I did and still do like a shot every now and then.

My pillow is calling me so I think I will call it a night and hope that a trip to the ER doesn’t happen this weekend. I found yesterday that a childhood friend lost his father yesterday. The wake is tomorrow. I’m not sure if I will be going as it’s in my hometown and I am not sure I can walk in this heat. I will need a haircut as I fucked up my hair shaving my head. Still haven’t mastered it. I will though, one of these days.

relieved and other things

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

Relieved and other things

I had a difficult morning waking up. My sister, who is still in Italy, called me this morning, waking me up. She wanted to talk to my mother. I told her she had already left for my Aunt’s house and wasn’t home. I fell back to sleep until my mother called me. It was good that she did because I needed to be up. She wanted some antibiotic ointment and I told her I would get it today.

I went to Starbucks and had a sandwich with my espresso. I wrote in my journal until it was time to leave. I went to CVS to get my mother the ointment. I wanted to get my T pass at the station but the line was too long. I decided to get it as I got off my stop.

I was early for my appointment. I wore light shorts so I could be weighed. I lost 6 pounds since my last weigh in, which was at least a few months ago. I felt good about that. The resident saw me and then after she felt the lump, quickly left for the attending, which made me nervous. She didn’t say anything good or bad, just left in a hurry. My doc came in and examined me. He said it was just fat, a lipoma, which is nothing to worry about unless it grows. I felt so relieved I almost left my bag behind! I left the office and made my way to the station.

It was really muggy once I left the AC’d hospital. I was sweating by the time I walked to the station. I emailed my psych to let her know what my doc had found. I also let one of my friends know and she was relieved as well.

I came home and it was just in time for my bowels to unleash. Another minute and it would have been in my pants. I asked my mother if she wanted Chinese food for supper and she did. I bought it from my favorite places, though they were skimpy on the fried rice. It was good, though I wasn’t a fan of their lo mein. It tasted funny.

My mother asked me to change her bandages. She had pustules on her legs, at least a half dozen of them. I hope the antibiotic ointment helps her. I told her if it doesn’t get better to go back to the doctor. She waved me off like I didn’t know what I was talking about. You can’t tell my mother nothing these days.

I felt like getting an iced coffee at Starbucks while I was waiting for the bus. I didn’t get it. Now I wished I did. I am so sleepy and it’s too early to take my night meds and go to sleep. I hate humid weather as it just makes me sleepy. It’s really hot in the house and I don’t want to make coffee like I did last night. Just having dinner, I was sweating. I don’t know how my mother can stand the heat. It drives me nuts.

While I was cleaning up after dinner, I started hearing voices on top of the music in my head. I had to catch myself from speaking to them as my mother was still in the kitchen. I took an extra trilafon to try and quiet them down. I don’t need an incident like last year. Hard to believe that I have been on trilafon for almost a full year now. I hope the extra med helps and doesn’t lead to worsening of voices, than my normal ones. I think the stress of the day caused it and I should be fine tomorrow, I hope. Just wish the damn music in my head would stop.

CBT for Preventing Suicide Attempts: A Review

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

CBT for Preventing Suicide Attempts: A Review

I have been reading CBT for Preventing Suicide Attempts edited by Craig Bryan, PhD and these are my thoughts about the book by chapter. I also describe what each chapter is about.

Chapter 1: Deals with the problem of suicide and how it’s on the rise. It also describes the difficulty of knowing what works and what doesn’t. The authors goes on to what the book is about and how CBT has been shown to be useful in some clients with suicide ideation.

Chapter 2: Describes the dreaded nomenclature of suicide attempts, ideas, suicidality, etc. The authors describe how the term SDV (self-directed violence) is a more accurate term and also other terms to decide pathways on treatment protocols. They term the entire suicidality as SDVCS-Self-Directed Violence Classification System. It is used by three large federal organizations- the CDC (Center for Disease Control and Prevention), the VA (Veterans Administration), and the DOD (Department of Defense).

This chapter gives good examples of how different researchers, clinicians, and other professionals can use this classification system. I didn’t review the system pathways and yes/no guidelines because terms don’t mean that much to a suicide attempt survivor writing about my lived experience. I’m either suicidal or I’m not. I don’t need to classify and put myself into a category. But if you are a clinician/researcher or other academic interested in suicide prevention, the nomenclature is pretty good and better than what Silverman et. al. proposed in 2007 a and b (see this blog post on my thoughts about their terms).

Chapter 3 deals with what works and what doesn’t in suicide risk. It talks about studies pertaining to talking therapies and psychopharmalogical treatment of suicidal behaviors. I found this to be more of a review of what I know as of right now in terms of evidence based practices (EBP) and what is not. Some studies were really small and others were large. Most centered around Borderline Personality Disorder (BPD) as that is a high risk group. What I found upsetting is that those with bipolar disorder or those that were psychotic were excluded from most of the studies. As I suffer from psychosis and bipolar disorder, my participation would not be included and I find that disappointing, especially since bipolar disorder and other psychotic disorders such as schizophrenia have a higher incidence of suicide than major depression alone.

Chapter 4 was an eye opening chapter that I really liked. It talked about all of the suicidologists that I have been following for the past eleven years. It discusses different theories and models of suicide and risk assessment. It also discusses protective factors of suicide such as reasons for living/dying. I found this chapter to be really good and a lead off to how all of the things talked about lead to the next chapter, which is a case example.

Chapter 5: In this chapter, a case is described step by step of a suicidal older gentleman and the cognitive steps, consent, etc. are used by a play by play dialogue. Things like safety planning, coping cards, and hope kit are discussed in detail and how to implement them in therapy using cognitive therapy.

Chapter 6 talks about a brief cognitive behavior treatment (BCBT) for inpatient units called PACT (Post Admission Cognitive Therapy). It discusses the criteria for engaging patient, pros/cons of treatment and how not everyone may be suitable for this type of treatment, e.g., those with active psychosis/mania.
It would be good if this could be implemented but as the treatment is 5-6 days and on average most admissions are 3 days, I don’t see how this is to be helpful. Discussion of staff resistance and burnout are also discussed.

Chapter 7: This was very interesting as I’ve never really read about military psychotherapy before. The chapter gives specifics on how to approach a veteran or active military personnel in crisis or dealing with suicidal thoughts. It talks in detail about Brief Cognitive Behavioral Therapy (BCBT) and the steps per session. Not all persons will respond within the 12 sessions. It is individualized for each person. The chapter also talks about hot to discuss lethal means safety and means restriction (see chapt 9 for more information; e.g., gun safety in particular). When the sessions are down to the last two and command of previous exercises are demonstrated to be efficient, end of therapy is initiated. Booster sessions are discussed in case of future crises should happen. I found this therapy to be specific not only for military but can be used for any type of suicidal behavior. It’s a collaboration between therapist and client.

Chapter 8: Emergency departments are the top places suicidal people end up, either with an attempt, ideation, or crisis. Sadly, if the right precautions are not set (e.g., inpatient care or some type of follow up care), individuals are more than likely to die by suicide.
This chapter talks about the challenges and brief interventions that can be initiated so that death by suicide does not occur after a visit. The authors describe specific suicide safety planning that is individualized for that person to help them cope with stress that makes suicide appealing. It also gives crisis numbers, either a trusted person they can talk to in time of need and/or the National Suicide Hotline (1-800-273-8255, text 741741 (US only)). Once a little role play is done and the individual can demonstrate they will use this plan, patients are discharged to follow up outpatient care.
Only trouble I have with this approach is that not all EDs are equipped with mental health professionals and don’t have the 30-45 minutes or so it would take to implement the safety plan, even though it is crucial this should happen.

Chapter 9: As more and more evidence is building that suicidal individuals are seeing a primary care provider prior to death by suicide, it’s become imperative that PCPs have the training to ask patients for means restriction. The author suggests several ways to initiate the conversation and lists steps to do this. If patients are resistant, the use of motivational interviewing techniques are employed. The end result is a means restriction receipt where PCP and patient have agreed to restrict their lethal means. If possible, a supportive person is asked to help secure the means.

Chapter 10: This chapter talks about the use of psychotropic medication and the use of CBT or BCBT in suicidal patients. To date, there has not been studies where therapy and medication has been shown to be effective in reducing suicide risk. It is suggested that despite the thoughts and black box warnings of the FDA, suicide ideation is still likely to occur of not treated or dealt with at the beginning of pharmacological treatment. The author also discusses the risk of substance use and dependence disorders that can increase the risk of a suicide attempt. PTSD has also been discussed as hyperarousal states can increase suicide risk.

Concluding thoughts: Overall, I found this book to be extremely helpful, concise, and important in the prevention of suicide attempts. With the right intervention at the right time, Brief CBT can help decrease the suicide risk and possibly the overall suicide rate.