Tag: suicidality

Schizoaffective Disorder: a clinical paper

by Midnight Demon, posted in mental disorders, mood disorders

Schizo-affective disorder is a mixture of two kinds of major mental illnesses, mood disorders and schizophrenia. The patient meets criteria for either major depression or bipolar disorder and criteria for schizophrenia. The illness usually begins in early adulthood and is treated with both pharmacotherapy and psychotherapy. The diagnostic criteria for schizo affective disorder is an uninterrupted period of illness during which, at the same time, there is either 1) major depressive episode, 2) a manic episode, or 3) a mixed episode concurrent with symptoms that meet criteria for schizophrenia. The type is usually specified as either bipolar type, if it includes mania or a mixed state or depressive type if the disturbance only includes major depressive episodes.
Criteria for Major depressive episode is as follows:
Five or more of the following has been present for at least 2 weeks and represent a change in functioning; at least one of the symptoms is either depressed mood or loss of interest or pleasure. Depressed mood is present most of the day, nearly every day, marked diminished interest or pleasure in all or almost all activities during the day, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation nearly every day, fatigue or loss of energy, feelings of worthlessness or excessive or inappropriate guilt nearly every day, diminished ability to think or concentrate, and recurrent thoughts of death, suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. The symptoms do not meet criteria for mixed episode or cause significant distress or impairment in social, occupational or other important area of functioning. The symptoms are not due to drugs or a general medical condition or caused by bereavement, i.e., after the loss of a loved one, the symptoms persist longer than 2 months.
The criteria for Manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week. During the period of mood disturbance, there are three of the following symptoms: inflated self-esteem, decreased need for sleep, more talkative than usual, insomnia or hypersomnia nearly every day, psychomotor agitation or retardation nearly every day, flight of ideas or racing thoughts, distractibility, increase in goal-directed activity, and excessive involment in pleasurable activities that have a potential for painful consequences (e.g. unrestrained buying sprees, sexual indiscretions, foolish investments.) The symptoms do not meet the criteria for mixed episode and are not caused by drugs or a general medical condition.
Criteria for mixed episode are met both for a manic episode and major depressive episode for nearly every day for one week. The disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or to necessitate hospitalization to prevent harm to self or others or there are psychotic features. The symptoms are not due to the direct effects of drugs or a general medical condition.
Criteria A for schizophrenia is the following symptoms that last for at least 1 week: delusions, hallucinations (auditory and visual), disorganized speech (incoherence), grossly disorganized behavior or catatonic behavior, and negative symptoms such as affective flattening, alogia, or avolition. Only one symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s thoughts or behaviors, or two or more voices conversing with each other. During the same period, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms and meet the criteria for a mood episode that are present for a substantial portion of the illness. The disturbance is not caused by drugs or a general medical condition. (from http://www.psychologynet.org/schizaff/html).

© copyright collerone, g

crappy day

by Midnight Demon, posted in Chronic pain, depression, mood disorders

I am having a crappy day. I had to go see my pdoc today. We talked about my week and that I am considering stopping my meds. She said she wasn’t sure how that would help my blood pressure. Little does she know that I stopped taking it a few weeks ago. I am waiting till next month when I see my PCP to see if I need it or not. I don’t think I need it but then it’s not like I am checking my blood pressure regularly either. There are no signs of being hypertensive. I just hate taking the pill. It’s a thick round pill and sometimes I have trouble swallowing it.

Then to make my day that much better my ceiling fan is on the fritz. I turned it on when I got home and it’s making a grinding noise. I don’t know if it is a motor thing or a fan thing. I’ll have my brother in law look at it tonight. Don’t think there will be much he can do without taking it apart, which is going to suck. I took two of the non working lamps off and that seems to help with the noise but didn’t cure it. It is driving me nuts but I need air on this humid day. I would run the AC but it’s too cool for that. Just another annoyance for today. Least I have a smoke detector in my room in case it really goes.

I haven’t showered all week. I meant to take one today before going out but I slept too late and didn’t feel like it. I still don’t. My ankle is bitching at me and I wish I could yell back at it but it won’t do much good. It’s going to hurt anyways. I might take it later tonight when it isn’t so angry at me. For some reason the ceiling fan is causing me to have a “brain freeze” affect in my ankle. I think I will have to shut the fan off soon so I can take a shower. Maybe that will help the mood that I am in.

I hate the new update for my rocket player app. It is the app I mostly use to play my music on my phone. I have an android app but it doesn’t pop up on power up like rocket. The latest app shuffle sucks. I listen to a whole album of the same artist before it “shuffles” to the next artist. It then plays two songs and then plays an album. ANNOYING!! I have switched to the android player for now. It still suck shuffling but not as bad as the rocket app.

I told my pdoc what my therapist did about reading my blogs without my permission. She didn’t offer anything about it. But then there really isn’t much to say. My therapist can read my blog like a million other people. I wish I knew why it bothers me so much. I know I should let it go but I just can’t. My therapist is on vacation this week. I have one full week without her annoyances and nosiness.

My pdoc informed today she is on vacation the middle two weeks in August but she is still available via email if I need her. She also has not had a chance to read the paper I sent her for some input. It is a paper I already posted as a blog but I think needs some final touches to but don’t know about. My friend hasn’t gotten back to me about the suicide and relationship one that I started. I think I wrote a page about it and now have no idea where the ideas went.

I am having my own Taylor Swift concert in my room tonight rather than watch Lackey pitch. From the sounds of Red Sox Nation, it looks like they are not doing too well. I am passionate about my Sox but I love Taylor so don’t mind listening to her. It has been a while since I heard her songs. Other than the ones I have picked for my “mixed” playlist, I really don’t listen to her other songs. Just hope the Rocket app doesn’t mess with playing all the albums one by one. I would like some of the older songs mixed with the new. Wonder if I can tailor it to my satisfaction?

Papers and ice cream

by Midnight Demon, posted in depression

I had a very busy day and now I am paying for it. I went to get my coffee and then did a little shopping. I literally just bought two things, some cold cuts for my lunch/dinner and then went to the bakery to buy some Scalia bread. I then walked to Walgreens to pick up my prescriptions and then came home. I am exhausted and my foot is killing me now.

Now that I had something to eat, I decided to write my blog. Exciting I know. I had a good therapy session with my therapist. She wants me to keep in contact with her while she is on vacation next week. I think she will need the support as she is visiting her in laws, in FL where the humidity is worst than here. I feel mixed about her being on vacation. I am both happy and sad to see her go. But I need some time off to regroup after all that transpired last week.

I sent my “mentioning of suicide” paper to my psychiatrist and a friend to give me some input. While I think it is a good paper, something is just not sitting right with me about it. I think it needs a better conclusion but can’t seem to figure out how to do that yet. Intros and conclusions are my biggest finks when I write a paper. I can write the body of the paper well, sometimes, and then I am left with how to end it. I think I did good on it but I just don’t know. My other friend wants me to write a paper about relationships and suicide. I started that last night but right now I have a brain fog as to where to go with it so I emailed her and asked her for some help. I don’t know why I can’t just finished it. There is plenty of material I can use but I don’t know if I want to go there.

My therapist and I also talked about my book. I don’t see it going anywhere so I have not worked on it in weeks. I attached some of the “mentioning” paper to it. Thing is, I lost my confidence with this book. I don’t think I can write it anymore. It just drains me after writing just three pages at a time. Plus it’s not like an excel file where I can just click on the end tab to add new stuff. When I open it, it starts from the beginning and I have to scroll all the way to the end. If there are any Microsoft word geniuses reading this and can tell me how to make this simpler, please comment! I would love to know how to get to the end of the document without going through forty some odd pages of work.

I guess I am just at a standstill with my life so my book is also at a standstill. I probably should reread my old journals to get a fresh perspective or something. But that will take some work. I have journals every where (I write a LOT) and they are not exactly in chronological order. I don’t think they ever have been. I know some of them do not make any sense, especially my early journals as I just wrote in code. I wrote about my fantasy life, in code, and my soap operas that I was watching. I didn’t talk about my life at all, like I do now. Trouble is that I forgot what the code meant. I didn’t want my journal being read by my mother or sisters so I developed this code. Trouble is that I don’t fricken remember what it stood for so I have a whole notebook of meaningless words jumbled together. Yea, I was pretty creative back then. But then, having a fantasy life, you had to be creative.

I was so disappointed today that Walgreens didn’t have B&J Cherry Garcia ice cream. They had like all the other flavors BUT this one. So I tweeted it that I was disappointed and their social service rep DM’d me about where they were. I should be here back from the store manager in a few days. If I get a free ice cream, that will be a SCORE! I have been craving cherry ice cream since my friend posted it on her webpage. I actually would have been satisfied with even the Walgreen brand of Garcia but they didn’t even have that in stock! So I am ice creamless tonight. I might go to Rite Aid tomorrow and see if they have it. I just hope it’s not more than $5. Stop and Shop had a pint going for like almost $6!! WAY too much for a stinking pint of ice cream!

Tomorrow is one of my down days. I have nothing planned except to go make my coffee run and maybe sit at Starbucks and work on my lyrics book. That is getting to be more writing than I thought. I know I should probably just print off the lyrics but I find that writing them out gets me thinking more about the song. I have yet to write my thoughts about the songs but I think I will once all the lyrics of the songs that I choose are in my notebook. I just wish that I could write another paper on the song “you found me” by the Fray like I did “how to save a life” (if interested in reading it, check it out here). Another paper gone. I should have wrote it when I was thinking of it as a sequel to “how to save a life”.

Mentioning of suicide, therapist panics

by Midnight Demon, posted in depression

Mentioning of suicide, therapist panics

I had been seeing an interim therapist while waiting to go to college after I graduated high school. I was seeing someone in the local mental health center and I was supposed to see her for the summer as my current therapist got laid off due to budget cuts.

Some where in the middle of that summer, I reach the lowest point in my life, about three weeks away from when I was going to leave for college up in Maine. Like anyone else would do, I told my therapist that I was having suicidal feelings. She then did something totally unexpected. She took a deep breath, held it, let it go, and then sat there stunned like I shot her with a taser or something. She didn’t know what to do. She asked if I needed to be seen by someone in the emergency room and I forget if I did or not. I think I did because I got to the local hospital and was admitted for two weeks. I was glad my summer job had come to a close so I didn’t have to worry about work.

What I didn’t realize was that suicide is a big deal in the mental health field. The therapist didn’t want to take me back after my admission so I was stuck seeing a resident who basically said it was her or the hospital. I didn’t have a choice of people to talk about my feelings of being suicidal. Sure they were fine in the confined settings of a hospital stay but were taboo on an outpatient setting. I always knew I was high risk and it wasn’t until I entered into the field of suicidology did I really understand what it meant to be suicidal not just as a patient but as a clinician as well. I am not a clinician but I do have a clinical way of thinking about things. I might not be trained (yet) but I have more experience in therapy than a new graduate or even someone who has spent their lifetime doing this. I like to think of myself as an expert but then all people who have attempted suicide feel that they are.

What strikes me is the legality of the dreaded no-suicide contracts, the risk for malpractice, the ethical responsibility of the patient in the course of therapy, and the risk of losing the patient. Those are some pretty big reasons NOT to take on a client but what if you were in the situation that I was in. I already had an “established” therapist and she got cold feet when I told her I was thinking about killing myself. And in the age of the internet, I find that I am not the only one who has had this experience. I also have had trouble finding another therapist. My current therapist, though she still gets anxious when I talk about suicide, is thirty miles from me and I don’t have a car. We communicate solely by phone unless I can take my sister’s car every so often to drive out the forty-five minute to hour drive both ways. I have tried to find a therapist within a five mile radius of my house and have failed, not once, not twice, not three time, but ten fucking times!!! That is right, I called ten different therapists and they all turned me down because I had a history of being suicidal. It hurts and sucks. They just asked the question, I answered honestly, and got either referred to another therapist or was turned down outright. So I was stuck with the far away therapist. I then got hospitalized during the course of trying to find a therapist I could see face to face and when I did, he was scared of me. I mean beads of sweat were coming down his face and he had a high pitched, nervous laugh. I could tell he did not want to treat me. He didn’t want to lose me because I was such a high risk person. What makes you high risk? Having a significant history of suicide attempts, history of being abused either physically, emotionally or sexually or all three, constant suicide thoughts, and feeling hopeless. There are other criteria but those jump out at me as the most significant. I once went to a suicidology conference where I listed the prominent symptoms of my condition and had it reviewed by one of the suicidologists at the conference. He didn’t want to touch this person with a ten foot pole. I never felt so hopeless before in my life. I knew at that point that there was no hope for me, that I was destined to always be suicidal, or at least have suicidal thoughts. But it shocked me that this expert had no advice for me other than good luck.

To be a suicidal patient and have no where to go is a tough situation. You depend on the therapist to be there for you and to talk openly about any topic you want to talk about, including suicide. But what do you do when the therapist has no clue? You would think that the therapist would know how to handle the situation. You are after all trusting this person to give you advice about your life. It seems kind of too late to start the training now while you are in crisis on what to do. It’s not like you can put your life on hold while the therapist gets a clue. All I can say is to be patient. Don’t buy into a no suicide contract, they don’t work. Go to the American Association of Suicidology’s website to help both you and your therapist. There are not too many therapists that know how to handle suicidal crises every where and each state has their own rules regarding suicidal safety. The best advice I can offer is to both be honest with one another and to listen to each to whether out the storm of the suicidal feelings. Have a safety plan in place. Use a crisis response plan. Pick up a book on Managing Suicidal Risk by David Jobes and give it to your therapist. If the therapist says she or he cannot work with you anymore, find someone who can. That might take some doing and some time but you can find someone that is not afraid of suicide.