Roll Call 34

That sucks! If you moved back in with your parents, does that mean that you had to change pdocs? If not, I really think it was completely irresponsible for your pdoc to discharge you so soon after stopping meds. When I studied psychiatry it was very common to keep people who were doing well on annual appts just to 'keep an eye on them' and keep them 'on the books' in case things went south suddenly and they didn't have to wait for a brand new referral, which takes A-G-E-S as you know.

This pdoc seems determined for some reason to give you a mood diagnosis (mentioning bipolar before and now depression). You never mention mood symptoms here though - do you just not talk about them, or is this pdoc way off base? From what you've said so far, I much prefer your previous one. I hope he hurries up and sorts his practice out so you could go back! I also hope that the therapy wait isn't long cos I know you found it very helpful before - would it be CBT for psychosis again?

I don't know a lot about BPD only that I've never felt it resonated when I've read the criteria. People talk a lot about mixed states being like a yo-yo of mood, which always sounded more to me like BPD mood swings. I'm not entirely sure that I've had a mixed state or if it was severe akathisia from meds (but then I had 2 med-free so idk), but for me it was a mixture of manic and depressive stuff AT THE SAME TIME rather than really happy/angry, then depressed, then happy/angry again on and on (that doesn't sound mixed to me, but I'm not an expert).

A pdoc once explained mood states to me which explained mixed states, and I will try to describe it but it's difficult without a diagram. Most people consider depression and mania to be complete opposites and don't understand how you can be both at the same time, probably assuming swinging rapidly from one to the other. But he described it as a
H
with mania on one vertical line and depression on the other vertical line, and energy on the horizontal line if you imagine a graph. So the top left of the H is high energy mania with top right being high energy/agitated depression. Then the bottom left would be low energy/catatonic mania and the bottom right would be catatonic depression. In that description mania and depression aren't polar opposites once energy is taken into account.

What I've termed a 'mixed state' before was preceded by a 'hypomania' (very uncommon for me and different from a 'good week' in that I feel completely confident, am not socially anxious at all - none of which has ever been my baseline pre-MI and is what makes me think this is abnormal for me). Then the mixed state is awful BUT the feelings are consistent the whole time (no oscillating from good mood to bad mood for me) - racing thoughts, impulsivity, more energy/fidgeting/pacing for hours, colours are blindingly bright, noises are too loud, touch makes my skin crawl, very irritable and quick to rage. Along with the typical depression stuff of low mood, worthlessness, hopelessness, feeling suicidal (and actually having the energy & impulsivity to possibly act on it, which is dangerous).

Now this could possibly be agitated depression for me, idk, though Uni pdoc agreed mixed episode. The difference between the times it was on meds (so possibly akathisia) and off meds, is that on Abilify/aripiprazole there was no 'hypomania' preceding it and colours weren't jarring and my thoughts weren't racing, but on Fluoxetine/Prozac and Venlafaxine/Effexor and off meds there was. Then I have a huge crash where I become slow depressed and don't move/think/do anything for several weeks until it picks up and I'm my 'usual' low-energy-but-can-move depressed.

I have no idea if this is correct (only Uni pdoc was convinced that I was BP2, before he changed it to SZA - bp type) either for me or for mixed episodes in general, but that is my current understanding; hope it helps. And nice to see you Didgee!

*Willow*

She gives me a depression survey and an anxiety survey every time----it talks about how may days of the week you've felt bad in like 10 categories I had to say I was depressed the better part of a week out of the last 2----there was also another category I was up in----those were in the black----I explained it was due to my bird...

when I filled it out last time there were things in the black due to negative symptoms possibly----I explained it was due to a total lack of concern one way or another to interact socially but did not feel depressed.

She asked if I was getting onto a downward spiral or upward trajectory---I said the second----we'll reassess in 3 months unless it gets worse.

I know I ran into old pdoc this morning again---he was late rather as usual so he had to grab a different bus so we didn't say much but I really do miss him.

No the cbt for psychosis was part of a research project they don't offer it here I have no idea what I'll get probably something for depression

I don't know how long the wait is but better to make it easy with work etc.

Can I just say Willow----I'm so glad you are back----I always find your posts super-helpful and supportive----

This just makes me think that she cba to actually talk to her patients so she gets them to fill out stupid forms instead :/

It's perfectly natural to feel sad about your bird! I get the impression she's trying to fit you into a preconceived box in her head, rather than live with uncertainty for a bit and just see you as you :/

See those stupid forms are all down to interpretation and a form doesn't allow for any flexibility, unlike a real conversation would. I've never had to fill out forms for pdocs, only GPs (but it's a criteria that they get paid for so if they give you a SSRI, you get a form and then 12 weeks later, so they get their little bonus for that topic...it's completely stupid IMO but that's the NHS for you: all about measuring outcomes than actually improving them!)

Why is it either/or??

He reminds me of Uni pdoc...I miss mine too...though he'd probably be ramming meds down my throat at this point! Well, insisting quite strongly that I try them at any rate lol

Well I hope the wait isn't too long, and you get a competent one (they're like gold dust!). I'm also curious to see how you get on with a psychodynamic T rather than a CBT one. IME they're quite different! (Actually my new T says he does CBT on his website, but he's not the typical CBT therapist, so that might make me more receptive to the principles...we'll see!)

I've stayed in bed today (it's 9pm here), which is why I've posted so much today Will have to try to be more productive tomorrow!

*Willow*

Thank you so much! That really means a lot to me! I find your posts really informative too, though I lament that my brain won't understand all the research stuff like it used to.

And I always love a good lol

*Willow*

my T has me fill out schema questions every so often and he graphs them on his computer. he is a huge nerd for graphs. ok hes just a huge nerd in general.

@willow

i lived with feeling unsafe for a long time. unsafe from myself , and other people. i still have times when i feel that way but they are a lot lesser now. i understand how it becomes the norm. honestly therapy has really really really helped me a lot. im glad that u are going to continue meeting with ur T. i think if we find the right therapist things can improve a lot.

I think it's because she does bipolar so she's tracking moods etc over time for fluctuations.....

so my mom called me out of the blue to complain about my sister agaiin and her wedding. my mom says she thinks my sister doesnt want her to have anything to do with the wedding.

my mom just crying and crying on the phone. and my sisters "shes so dramatic".

its just a mess...

Is your mom paying for the wedding? If not I don't see where she gets a say...if so she should.....

I've had mixed states where I was both manic and depressed at the same time, and I've also had ultra rapid cycling, sometimes changing between moods several times in just a few short minutes. Everyone says that bipolar is over diagnosed and that rapid cycling is rare-they're wrong. Rapid cycling is very common, IMO. I've seen it both here online, and in one of my offline bipolar friends (he is definitely bipolar).

The difference I've heard between BPD and bipolar is that bipolar mood swings are usually untriggered, while BPD mood swings are related to something that happens in the environment. And I don't think that people with BPD get hypo/manic ever, just mood swings between depression, anxiety, and other negative states.

Sometimes I wonder if I've been mis-dx'd and if maybe I have BPD because I can really relate to a few of the symptoms (black and white thinking, poor sense of identity, etc.). I really, really don't want to have BPD because I know how they are treated. The stigma for someone with a personality disorder is like 10,000 times worse than what I have to deal with with my bipolar diagnosis.

Every pdoc and t I've asked tells me that I definitely have a mood disorder, not BPD. Most of them are puzzled by why I would even think I might have it. But I still wonder if maybe I was misdiagnosed. There is such a thing as a "quiet borderline"...

For anyone who is interested, here is an interesting article on the difference between bp and bpd, and why it may not even matter: borderline

yea shes paying. she she she was staying out of it for my sister because she felt like my sister didnt have any faith inmy mom to do anything to help.

my mom says its not having a say cause she paying. my mom said she wants to have a say because she envisioned her and my sister working together as a team for a once in a lifetime event.

apparently my sisters been asking everyone but her immediately family for help. idk why either. i asked my sister if she needed help with ANYTHING and she hasnt got back to me in weeks.

im not on anyones side but i also fear if my sister doesnt get things done in time for her wedding she will regret the outcome

This is so true. The stigma for personality disorders(especially the cluster B personality disorders) is truly atrocious. I've heard a lot of horror stories from people with BPD about how horribly they've been treated in the mental health system and it's a damn shame.

That sounds like a nightmare to listen to.....I'm sure it will all work out though it always does....

Have you guys ever seen Kate and leopold....it is cracking me up....the way they riff off mental illness plus it's Hugh jackman who is super hot.....

My 'CBT for psychosis' T (that's in quotes cos that's officially what is in my notes, but that is not at all what it was) did a schema questionnaire with me at the beginning. I actually found that insightful. He was supposed to do it again when we finished to see if anything had changed, but then he suddenly changed jobs and dropped me. It wouldn't have changed anyway even if he had bothered to re-do it because, while I enjoyed talking with him, it certainly wasn't therapy as I understand the term. More of a medical student and a CPN having a chat about the nature of MI.

I'm glad that things are better for you. You seem to have worked hard on your recovery. I like my T so far. He seems honest and open minded, and I feel like he's listening. I'm just hoping that he doesn't get frustrated and start blaming me like lots have in the past. I warned him that I need to go slow. The CMHT/hospital situation messed me up even more :/

I'm sorry, I shouldn't criticise your pdoc and her methods. I just think it is easy to confuse negative symptoms and depression, especially using something as blunt as a questionnaire, and it seems silly to me to measure them routinely in someone without a history of mood symptoms.

I was taught that BP rapid cycling was rare and have never met a person IRL with it during my psych rotations. It sounds exhausting to cycle from one mood to the next in minutes though. Like I can't even imagine what that is like. I agree with the triggered mood swings distinction, but I often read about cycling on the BP forum that seems triggered to me, but then a few have both labels, and it's hard to know for sure even IRL so it's probably impossible to tell from posts from a stranger on the internet.

Psycheducation is a great website though. I even bought his book and that's what encouraged me to talk to Uni pdoc about BP2. I'm not sure I buy there not being an important distinction between BP and BPD and their treatments though. As far as psychiatry here is concerned, BP=illness which requires medication only while BPD=manipulative attention seeker which might get DBT on the NHS only if you win the postcode lottery and it's available in your area and you're enough of a PITA to keep getting admitted for SH/Sui attempts that they deem you worth the cost. This is NOT my opinion (I don't agree at all with the way MI is 'treated' in this country), but what I was taught in medical school.

I was so convinced before I got my notes that they'd labelled me with a PD, likely BPD, because I didn't understand how else they would treat me so horribly. I was terrified because I knew what a label like that would do to me...much like the 'faking for attention' label has I guess. God they suck! They don't seem to realise how powerful their labels are and they just throw them about all over the place, sometimes without even meeting you in person (my SZA label was dismissed before I went into hospital by a woman who hadn't even met me, despite a detailed 3 page report from Uni pdoc who is a professor and works for NICE, because of notes from ex-pdoc which were a YEAR out of date!!)

I'll get off my soapbox now, sorry guys

*Willow*

Willow to clarify we do talk about anything that falls into the black range...ie severe enough to warrant it....it's not entirely unreasonable and she did mention talking to my old pdoc this time and that it was in fact her primary diagnostic (his opinion) at this point and thus all I have are rule out Dx's....so it's almost like I have a treatment team in a way....

Its weird I can actually feel my self feeling worse when I accidentally skip a dose of my meds or take it a little off time.Its like I transcend from feeling really paranoid uncomfortable shaky and having strange thoughts mildly hallucinating to feeling calmer and being able to think a little clearer once the meds are taken.it scares me somewhat.

Everyone is probably sick of hearing this, but I only slept 3 hrs...Ugh!

I feel utterly exhausted emotionally, but cannot sleep. I may need to call psych nurse...

Sounds like a good idea... lack of sleep was making things much worse for me. I've been going on walks every day the past couple of days... just 2 miles or so but they seem to be helping.

For some reason, I seem to have an urge to rhyme at the moment, even writing this I'm tempted to make it rhyme... just came up with this:

If all was good, I wish I could,
go for a walk in the woods,
if you understood, I only would,
wear a hood, in the woods.

Lol, I liked that. You're in Scotland, I'll tell you from the pics I've seen it looks beautiful...

Scotland is indeed a beautiful place... got a bit of everything really. Still a lot of places I'd like to go in the Highlands & Islands. I love the NW... got some lovely scenery there. White sand beaches, clear water... hills coming up from sea level:





I'd like to get back into Hiking again sometime... lovely to get away from civilisation in place that look like that.

I was never a hiker, although I'd like to become one. I've went hiking maybe 2 times. It was fun.

Now I'm picturing walking with a hooded cloak through the woods.....stepping on wet leaves that have fallen....it sounds wonderful . Thanks for the image...

just got done training for my volunteer work. its really laid back.

I went to a friend's party yesterday. I became friends with her when I first met her on the psych ward. It was a celebratory party, celebrating getting out of hospital. I felt amazingly happy at the time. But now I'm home again my mood has hit rock bottom. Happiness never lasts.