severely pissed -- what to do?

Well, no response from my therapist. I even left a voicemail for my pdoc's "assistant" out of pure desperation. No response from that lady either.

It makes me wonder if they even care or take this seriously. Maybe they would have responded if I was honest and said i feel like a danger to everyone. But I don't want to go to IP when this could be handled over the phone, so I didn't say that.

I am not even depressed, but it makes me want to die because the feeling is awful. I am trying not to do things I would regret, such as ******* someone out or damaging ****. I can be a very violent person when my anger gets out of control, and well, I do not want to hurt anyone if I can avoid it, either emotionally or physically.

Hey Blue,
Are you still taking med for akathisia?
Any symptoms of akathisia?

Do you think any of this agitation is related to akathisia?
There are relationships between akathisia, violence and suicide according to the results of my google search.

I know you understand studies and papers on studies better than I do.
Are you up to looking at akathisia and violence with me?. I have googled this and there are many references.

If not, I will keep looking and will find something to link for y ou.

Love ya!

Honestly, I am ******* done with this ****. I don't even want to talk to them anymore. It's a huge waste of my time. I will just stay pissed off, I guess. Hopefully I don't hurt anyone or do more damage to my apartment, but whatever happens, happens.

My therapist pisses me off for ignoring me, and I honestly just want to cancel my appt on Friday with her. I don't want to deal with her stupid ****. It will just irritate me more. She has already left for the day, which is why I know she is ignoring me or doesn't care.

Both of my "providers" (therapist and pdoc) don't care.

I know you said you don't want to go inpatient but that may be your last resort to keep yourself and others safe. A phone call can't do everything that going to the psych ER can, either. You said you can't trust yourself not to hurt anyone. "Whatever happens, happens" you said. I think that's pretty serious.

Blue, I think you have to say more or something different to get their attention.
I know you are concerned about being forced into IP.
I think that is a chance wel all take when needing emergent help.

Yet, if you feel it can be handled with the right meds and safely at home, then ... maybe contact the pdoc and tell his voicemail or something that you are experiencing a severe episode and you think, if it is handled well and right away, you can get a h andle on it.

You cannot secure meds to help right now, without you pdoc. You've got to get through to him. Same with your therapist. You need to tell them something that WILL get their attention. I know this feels very risky for you,.

Hang in there....

Grrr. You have my empathy. Anything like that would feel beyond risky to me

This is NOT a study. There is a lot of information that reads like this or very similar.

Infrequently, agitation and violence have been reported to be associated with antipsychotic treatment and
could be related to akathisia.2,3 Differentiating between akathi-
sia that manifests itself as violence and generalized psychotic
agitation is clinically important in order to avoid a vicious
circle of violence in patients who are being treated with anti-
psychotics. We report a case of persistent agitation and vio-
lence in a patient with bipolar mood disorder that was probably
a manifestation of akathisia.

(JOUNAL OF CLINICAL PSYCHIATRY 1997)

link: (PDF) Akathisia as Violence

CASE REPORT
Case Report. Mr. A, a 47-year-old white man with a diag-
nosis of bipolar mood disorder, was brought to the emergency
room because he was screaming in the streets. Mr. A had over
30 past psychiatric admissions associated with agitation and
violence and was often discharged against medical advice. He
was nearly always noncompliant with his antipsychotic medi-
cations, claiming that they made him “jump and lose my tem-
per.” Prior to the present admission, Mr. A’s daily medications
included haloperidol 20 mg, lithium carbonate 1500 mg, dival-
proex sodium 500 mg, and benztropine 1 mg. At admission, the
patient was grandiose, had loud and pressured speech, and ad-
mitted he was not taking haloperidol. He was given haloperidol
15 mg q.h.s. and benztropine 1 mg q.a.m. Within 24 hours he
started pacing; became restless, agitated, and violent; com-
plained of feeling “jumpy”; and attacked a staff member. On
Day 5 of his hospitalization, haloperidol and benztropine were
discontinued; chlorpromazine was started, and the dose was in-
creased to 950 mg/day. Mr. A, although sedated, remained
threatening and violent. On Day 13, chlorpromazine was dis-
continued, and haloperidol was restarted at a higher dose of 15
mg p.o. b.i.d. Mr. A again complained of “jumpiness” and
punched a television cabinet, causing a self-inflicted fracture.
On hospital Day 17, owing to an error, haloperidol was discon-
tinued. The patient became calmer, less irritable, displayed no
angry outbursts, and required no further room restrictions.
After 5 days, when the error was discovered, haloperidol was
restarted at a lower daily dose of 10 mg. Within 3 days, the pa-
tient became violent and required room restriction. Haloperi-
dol was then discontinued, the patient’s agitation and violence
resolved, and a week later he was discharged. His daily medi-
cations were lithium carbonate 1500 mg (serum level = 0.9
mEq/L; this dose had not been changed during his hospitaliza-
tion), lorazepam 1 mg, and divalproex sodium 500 mg. On
these medications, he remained well 6 months postdischarge,
his longest period as an outpatient.
The association between antipsychotic administration, aka-
thisia, and violence in psychiatric patients has been noted in
two reports.2,3 Herrera et al.2 showed a trend for more violent
episodes to occur with haloperidol than with placebo or low-
potency neuroleptics. Crowner et al.3 found that for violent
psychiatric patients taking antipsychotics, half of the assailants
had akathisia before the assaults, while only 20% of nonviolent
patients had akathisia. However, to support a causal relation-
ship between antipsychotic administration, akathisia, and vio-
lence, it is necessary to document a clear onset of akathisia and
violent behavior upon initiation of antipsychotic treatment and
resolution of both with antipsychotic discontinuation. Al-
though agitation and violence result from a severe manic epi-
sode, Mr. A’s case documents such an association: on two occa-
sions, the onset and the resolution of both his “jumpiness” and
his violent behavior coincided with the beginning and the end-
ing of antipsychotic medication treatment. The fact that the
jumpiness occurred with haloperidol and not with chlorproma-
zine is another factor indicative that Mr. A has exhibited aka-
thisia rather than nonspecific activation of mania; this is be-
cause akathisia is more common with higher potency as
compared with low-potency neuroleptics. One can also specu-
late that Mr. A’s rocky clinical history was related to aggressive
behavior perpetuated by antipsychotic administration. The pos-
sibility that aggressive and violent behavior unresponsive to
antipsychotic treatment could be a variant of akathisia should
be included in the differential diagnosis of acute psychosis and
in alternative treatment strategies for bipolar mood disorder.
Benzodiazepines in combination with lower neuroleptic doses,
lithium, or valproate should be considered.
REFERENCES
1. Braude WM, Barnes TRE, Gore SM. Clinical characteristics of aka-
thisia: a systematic investigation of acute psychiatric inpatient admis-
sions. Br J Psychiatry 1983;143:139–150
2. Herrera JN, Srameck JJ, Roy S, et al. High potency neuroleptics and
violence in schizophrenics. J Nerv Ment Dis 1988;176:558–561
3. Crowner ML, Douyon R, Convit A, et al. Akathisia and violence [let-
ter]. Psychopharmacol Bull 1990;26(1):115
Igor I. Galynker, M.D., Ph.D.
Deborah Nazarian, M.D.
New York, New York
Cessation of Self-Mutilation in a Patient

Well... that stinks, when they give AP's to people who are not psychotic and who could and would be helped by a decent therapist

Well, my therapist pisses me off for ignoring me, so I just want to cancel my ******* appointment with her on Friday. I don't want to deal with her and her ********.

I am going to leave a message telling her "forget it. I don't want your ******* appointment on Friday. Cancel it."

None of them care, so whatever. I don't see the point in reaching out. And I don't see my pdoc for a LONG time.

@Wild Coyote: no, I don't think my anger is due to akathisia. I am just reverting to my old pissed off self, when I *wasn't* on medication. I used to be like this a lot.

But honestly, I am at the point of not giving a **** what happens.

I had a therapist who ……..

I am sure it is very tempting to tell them both off!

There is time for that later on. Right now, we need a strategy to get you back into a better space. You have a good job and you don't want to lose it.

You don't want to go as far as to lose your life..

It feels like you are "stuck" and there is some kind of a standoff. Maybe there is? Maybe not? You said it yourself a few posts ago you'd thought maybe you should say more to them than you have been saying?

There is a disconnect here. How do we fix it?

Remember, unless you go to the ER or other, you need your pdoc and your therapist in order to get what you need to settle down.

How can any of us help?

I know I want to help and I am starting to feel like I am spinning wheels, wondering what you really want to happen, Blue.

Do you truly want to give up?
I hope not.

Maybe just upset?

Hang in...

Sorry to hear that, Fuzzy.

Mine never said she doesn't give a f_ck, but just because she doesn't vocalize it, it doesn't mean she doesn't feel that way.

I remember when she wanted me to go for a second psych evaluation at the office, and she took THREE MONTHS to write up A SINGLE PARAGRAPH explaining why I need another eval.

So yep, she really doesn't care. I'm not on her priority list. On top of that, she kept saying I had no friends because of my flat affect and flat vocal tone. She says that both of those things "push people away." Then she didn't even offer to help me. Wow, thanks...

Maybe it's time I start looking for a new therapist.

Ugh, yes it does sound like a new therapist would be a good idea. It stinks when they have lists of …. and we are not on it. grrrrrrrrr. She sounds quite similar to a T I saw except he was also violent with his words as well as indifferent grrrr.

I hope you find a good therapist soon

You say you are reverting to your old pissed off self and it was under those circumstances you sought professional help and medication originally, correct? You make it sound like returning to that state is no big deal and unavoidable. It is huge and it doesn't have to go like this. You don't have to accept living like this.

I know you are furious with your pdoc, but I agree with WC. It is time to just be honest. Do you feel there is a chance this will just resolve on its own? If it is truly a reversion it seems intervention is warranted. I know you do not want to take the Rexulti, but there must be something that can help.

Have you discussed any of this with your parents? They seem loving and might be able to serve as a mirror to help you see where you're truly at.

I share WCs concerns about you losing your job or worse trying to tough this out on your own. You may not be at the point of caring anymore, but can you believe us when we say the Blue we normally speak with who is stable cares very much what happens.

I'm not a Boston area expert, but are you familiar with these services? The urgent care option would be a way to be seen without dealing with your own pdoc maybe???

Emergency Services Program | Psychiatry

Urgent Care Centersffers an option when an office-based evaluation is desired. Urgent Care Evaluations provides short-term crisis evaluation on both a scheduled and drop-in basis. Always call the 24 hour Hotline prior to visiting Urgent Care.

Community Crisis Stabilization Units: serves persons 18 years of age and older, providing short-term crisis intervention over a three-to-five day stay at facilities in partnership with Bay Cove Human Services and Child & Family Services of New Bedford. The Crisis Stabilization Unit is a successful alternative or diversion to inpatient hospitalization.

Ehh, I don't see the purpose in trying with these people anymore. Or maybe my expectations are too high. I thought if you called them desperately asking for help, that they would respond to you within the same day. So maybe I am just expecting too much out of these people. Maybe I am in the wrong?

If I see my therapist on Friday, I will probably flip a **** and swear at her because I'm mad at her. I don't know how else to say I am fuming mad when I literally said, "I am VERY, VERY, VERY angry," and "I am severely pissed off" several times in my voicemail. I even mentioned that I had to isolate myself at work so that I wouldn't get into an altercation, physically or verbally. But I guess that's not a pressing matter in her eyes.

If I get in a fight with someone, it'll be her fault and my pdoc's fault for ignoring me.

I don't know what I want for help. I just want to talk to someone to figure out how to relieve some of this anger. I am already destroying half my apartment and I'm having to isolate myself. But no, they couldn't care less about that.

I seriously feel like cancelling my therapist appointment because I don't want to deal with her stupid ****. She is utterly useless right now, as is my pdoc.

I don't know if this will resolve on its own. It's tough to tell at this point.

And no, I have not discussed this with my parents. My dad is on a business trip and my mom already has enough on her plate dealing with my grandma, her mother. (She has been having difficulties ever since her mastectomy due to breast cancer. She is very needy and we can't get a visiting nurse to come over. We think she doesn't have much longer left to live.) I don't want to bother them with this.

I don't think I will lose my job, as long as I stay home and stay AWAY from people.

Unfortunately, it looks like they only cover Boston, Cambridge, Somerville, and Fall River. I don't live in any of those places. I used to live in downtown Boston, but not recently. Thanks for the link, though.

I don't know of any urgent care centers nearby. This is likely because we have two hospitals very close to here, but I don't want to go to the hospital for this. I just want to calm down.

Unfortunately, Klonopin did nothing but sedate me. At least I slept, though. So, I had like 10 hours of uninterrupted sleep with zero anger. But the minute I woke up, I was pissed off again.

Bummer. Yeah, I wasn't sure about your specific location. I wish I could help more. The urgent care center seemed like a good call even if it was a decent drive away. I understand not wanting to go to the hospital.

I also understand not wanting to burden your parents. I think it would be more of a burden if this didn't end well and they didn't know to help, but I respect where you're coming from.

It beeawhile since I have lived in MA and nearby. When I did live in those areas, there were community mental health centers. Each center had a crisis team. The team was on call day and night. If someone was having an exacerbation of illness or another related issue, the crisis team would go out to the house of the person calling. They would have a chat with the individual and try t0 get a clear idea of what was going on. If a pdoc was needed, they called the person's own pdoc and asked him/hr to help to direct the plan of care. In some cases, the pdoc prescribed until an appt is open in his practice. Other times, when needed, someone might decide the hospital is the best option. There were always options and some were very creative,
Very few people ended up going to the hospitals. The whole idea behind these teams going to homes, is to try to help as many people as possible, while staying in the community. Many of these services were well-funded during the days when deinstitutionalization was a new concept.

I am wondering if your local community health center has a mobile crisis team? I am wondering if there is such a team available, if you might be willing to let them meet with you?

Just another potential resource.

Much Love to You, Blue

I am confused by your therapist's lack of urgency in this matter, especially with the level of detail you gave her. I definitely agree with others that it sounds like this is a pressing issue. I know you don't want to go IP, but I wonder if the ER could still be an option where they could offer something to help you relax? I don't know if agitation of this level would necessarily mean they would recommend IP right away if they could help calm the irritability, although it might depending on their assessment. I think the most important thing is that you get the help you need. Maybe you could try calling an after hours line for your psychiatrist or therapist (if that exists?) and tell them you are considering the ER or urgent care if they don't return your call? Just an idea. Please take care and stay safe.

Well, I left my therapist another voicemail about 10 mins ago saying that I am even angrier than before, and asked if she even got my original voicemail. I also asked if she thinks this is an important issue at all since she was in the office and never bothered to respond. Then I passive aggressively said, "if you think it's not a big deal, then you won't offend me by saying that."

I reiterated the fact I am isolating myself from people, but I still don't think she gives a damn. If she doesn't call me by tomorrow at 9:45am, I am cancelling my appointment with her and never seeing her again because she pisses me off. (I can't wait until past 9:45am because I have to give 24 hrs notice if I am cancelling an appt.)

I don't know why no one in that office wants to help me....?

I'm pretty sure if I said I wanted to kill myself, they still would ignore it.

Can you just show up in person and tell them you are in crisis?

I doubt I can just show up. They would likely reject me and say to schedule an appointment or go to the ER. The front desk staff is rarely helpful.

The truth is that there aren't many providers who actually care.



But I am not at that point yet. I will give it until tomorrow to see if anyone actually cares. Hopefully someone does

I know you feel like they do not want to help you.
I think there is some kind of a major misunderstanding .

You've outlined what you've said on voicemail.
What did you say that should have sounded your therapist's alarm?

Honestly, there's not much that's alarming in what you've said above:

You are angry. You are isolating. And the comment about you would not offend me if you tell me this is not a big deal.

What did you say that should have sounded your therapist's alarm?