Tag Archives: mixed state

The Many Faces of Psychosis

My attempts at writing lately have not been particularly fruitful, but I have finally gotten some sleep. Unfortunately, the sleep was also accompanied by several intense conversations with my health care team pointing to ongoing psychosis the past few weeks (at least).

When it comes to psychosis I find myself in something of a pickle. I have not been able to tolerate taking an antipsychotic on a daily basis (because of intense side effects like ultra-rapid weight gain and feeling so fatigued and exhausted I can barely move) so my psychiatrist allows me to take it only in times I am experiencing psychosis. It definitely isn’t the sort of thing I would generally expect is a good idea, however my rapid cycling paired with my inability to tolerate the drugs for more than a few days at a time make it more useful than, say, nothing at all. Many times it seems like one or two days are enough to kick the legs out from under the psychosis before my mood cycles away from it.

The biggest hurdle in this method for me has been being able to identify when the psychosis is present on my own. With a good team looking out for me (my boyfriend included) it becomes easier… but even after meeting this “character” (psychosis) on and off for at least the last 50% of my life I have a hard time picking it out of a crowd.

Meeting psychosis when physically ill or on various medications has left memories that were already too fuzzy around the edges to be able to account for an accurate depiction.

Meeting psychosis when manic has been like stumbling upon a huge party where the music and lights are easily drowning out the words and the intentions of the faces I see around me.

Meeting psychosis when in a mixed episode has been like crawling into a crime novel where I don’t know who I can trust, and psychosis might look just as innocent or guilty as anyone else I stumble upon… leaving me with no distinguishing features.

Finally, meeting psychosis when I feel (or think I feel) stable has been the most confusing thing of all. The encounter is totally unexpected, and I find myself quickly trying to write the ensuing conversations and situations off as simple irrational fear or rapid mood swings happening too fast for me to put a defining stamp on them.

The best indicator I have of psychosis is when pieces of my life, pieces of stories don’t line up the way they ought to. When the memories I have don’t correspond with the half dozen other people who were there at the time. When my boyfriend seems to have me caught in a “lie” but as far as I know, I’ve only spoken the truth.

At any rate, I expect to spend the rest of the day on the couch due to the exhaustion I feel from the rispiridone today, but if that is what is necessary to aid in alleviating the confusion, I am ready to do it.

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the mania/insomnia symbiosis

I am no stranger to insomnia. I’ve experienced the overactive brain induced insomnia, the straight up fear and adrenaline based kind (airplanes are notorious for producing that for me), even insomnia formed by a series of horrible nightmares and my body and mind developing a fear of sleeping.

Typically, though, the type of insomnia that tends to really sneak up on me (and especially in the summer) is the kind where I’ve missed my sleep window and can’t reclaim it.

My energy level is very rarely a straight line, it is more often a series of peaks and valleys, and their intensity seems to be associated with my mood swings, diet, and anxiety or excitement, among other things. I have found that for my situation, going to sleep in the evening at the first sign of tiredness has typically been the only way for me to ensure I get to sleep. The problem is that this energy trough might occur at 6 pm (right after I’ve eaten dinner) and the best case scenario would put me in a position to wake up the next morning at 6 am. Once that energy lull passes, I can find myself wide awake again -thus unable to sleep.

I’ve always needed a lot of sleep. More than most people. 12 hours tends to leave me in the best emotional position the next morning, but 10 hours can be manageable.

Missing my sleep window because of anxiety or outside forces (loud neighbors, hot apartment, unfavorable reactions to medications, etc.) might mean I only get 7 hours, sometimes less. That might be sustainable for a day or two, but the longer I go without sleep, the more symptoms of mania I begin to acquire. The more symptoms of mania (even hypomania) I acquire, the less likely I am to be able to sleep the next night.

This fuel might be racing thoughts, or a huge spike in energy, or euphoria (where feeling good seems to counteract the idea of sleeping) among others. Regardless, these traits begin to mix with an increasing fog that sets in from insomnia. My actions start to feel like they matter less, since the fog distorts any of the negative consequences that might be on the horizon… leading to impulsive and relatively irrational decision making. That poor decision making might include missing my next sleep window, when one (rarely, with hypo/mania) occurs.

Keeping my mood under control begins to feel less important, as my sudden frequent crying spells also begin to alternate with fits of hysterical laughter can’t contain… and though there is an audience at the grocery store as I have a laughing fit so severe I am crying and sitting on the floor, it just makes me laugh harder because their concerned faces look increasingly hilarious to me.

Insomnia makes me feel like I am doing a better job of managing my mood swings even though I have had several outside opinions that this idea is not true. While I definitely become more reactive and my swings can land in rapid succession (as they do normally for me, many in a day) my perspective on this situation varies largely from an outside opinion. An outsider might argue I am more difficult to manage (since my brain seems too tiered to bother with trying to negate my impulses triggered by mood swings… well, and the fact that I begin to express everything that crosses my mind, even to strangers) but the euphoria I experience makes me feel that I am doing a great job of taking care of myself, and the fog that has come from not sleeping makes every moment that isn’t the present seem long gone. Out of sight, out of mind.

Ultimately, I find that insomnia may not be the primary trigger of mania on all of the occasions that I experience it, but it does typically perpetuate manic and hypomanic symptoms for me in a symbiotic way.

The less I sleep, the more manic I become.

The more manic I become, the less I sleep.

 

The Number You Have Dialed Has Been Disconnected

I don’t know if you have ever spoken and felt like nobody could hear you, but for me this feeling can potentially trump symptoms like delusions and hallucinations for the most maddening feeling I’ve ever experienced. Even when I am experiencing hallucinations or delusions (and maybe even don’t recognize it) I can talk to someone about it; but the times when my mouth and body do not convey what I want them to (or they do but in such a way that nobody can understand them) have left me (the innermost me) feeling like a phantom limb.

Last weekend, in a matter of days, I became engulfed by that feeling. Everything I was trying to say, the jokes I was making, the observations I attempted to casually convey, became hostile. It seemed no matter how I spoke or stood or gestured, people were genuinely afraid of me. Those desperate sorts of pleas hoping to convey my intense sorrow came out, instead, angry.

My manic episode from the week previous had turned dark, and as the depression I was experiencing became more and more intense, so did my apparent rage. The rage left me incapable of conveying the depression, and being unable to express myself left me feeling so isolated and alone that I could feel the depression feeding on it and growing exponentially.

When Monday rolled around I tried everything I could think of to crawl out of the disconnected, suicidal funk I was in. I emailed my psychiatrist only to find out he was on vacation. I called the intake coordinator for the new clinic I’m trying to access therapy through but she did not have time to talk. I called the crisis line (as I’ve been calling them a lot lately) but all the phones were busy! This, if nothing else, seemed like a sign, so I grabbed my purse and a book and went straight to the emergency room.

It can be very confusing to watch yourself begin to destroy your own life (your job, your relationships, maybe even yourself through impulsive drug or alcohol use) and feel like you are a passenger during the whole experience. Unfortunately, this is a feeling I am familiar with so I knew that the only real card I had left to play was hospitalization.

What I didn’t know was that I would be spending all day and all night in the emergency room before reaching that inpatient bed. I was awake for 36 hours and extremely alert and energetic (as I said, mixed episode) fueling those depressive and hostile waves that kept coming until I was (somehow now in an inpatient room) crying uncontrollably for hours, and periodically ripping up anything in my room I could find to rip up.

My goal was to outlast the episode until it switched into depression or stability (whichever came first), a fairly easy goal I figured, since my episodes cycle so rapidly and I was already 12 days into the mixed episode. Though it wasn’t fun (but hospitalizations never are) I seem to have outlasted the hostility and was expelled through the other end of the hospital Friday experiencing severe depression instead.

So I am home now, and though my decision-maker seems to be broken and I had a panic attack trying to go into the grocery store I am, seemingly, a free woman again.

My mind has still been trying to whisper all manner of horrible things to me, but I can eat food that wasn’t produced in a hospital now… so it makes all that a bit easier to live with.

Needless to say, my posts may be somewhat spotty for a bit. I’ve been very overwhelmed by a lot of the things that have happened this year, and several more big things are scheduled to go down this month.

In the meantime, take care of yourselves! I’ll be doing the same.

One Good (Manic) Turn Deserves Another

The last thing my (ex) therapist said to me (jokingly) was,

“…and I never got to see you manic!”

In my depressed state I shrugged and replied,

“it is rare these days… euphoric mania, anyway. It hardly ever happens anymore, frankly I can’t even remember the last time it did.”

Little did I know, within a week I’d be hunkered over my chest of drawers urgently rearranging my shirts because, well, is it better for them to be grouped by print or by sleeve length?? And, no, no, no, the underwear needs to be arranged in descending order of favoritism and then by color!

As much as I would like to say I saw this swing coming, I would be lying to you. Generally I would say I have a tendency to become manic in October, however I find that when I say that ahead of time it never actually occurs.

This time around I think I would like to blame the aggressive head cold that has been going around for my lack of catching the warning signs. Normally euphoric mania comes on largely in a physical way for me first, but I can’t say I felt any kind of awesomeness, electric humming, or skin-crawliness that I normally experience until much later on. This time around (because of the cold) I felt sinus pressure, ringing ears, a sore throat that lingered on much longer than I anticipated, and initially much more lethargy than I normally would when mania strikes. By the time I started to realize things were getting out of control it was a bit too late to divert it.

Of course, in hindsight I can say, “ahhhhhh, ok,” to the series of odd and rather impulsive actions that led up to my frantic laundry situation and subsequent hours of laying in bed awake, chest pounding, having rapid conversations in my own head. One would think I might have had a clue when the series of somewhat depressing situations I’ve found myself in lately became increasingly hysterically funny to me, or when I stopped each of five consecutive movies I was trying to watch halfway through because I no longer felt interested (and then the only movie that did hold my attention was The Silence of the Lambs), or when I cut all of the instances of the number “2” out of a cosmo magazine to see which one was “the best,” or when I spontaneously maxed out my credit card buying tickets to see The Who. I was even having trouble writing, many of my sentences were coming out backwards.

Contrary to popular belief, these are not things I normally do. I’m the kind of girl that usually just likes to wad her shirts up in a ball and shove them in the drawer, or look at the prices and fluid ounces of every bottle of shampoo in the store to make sure I am getting the absolute best deal before buying one. I know I usually claim I don’t do the “spending” thing with mania, but apparently this was an exception. (Boy, I hope I’m not inadvertently picking that habit up!)

To be fair, I think normally these are things my boyfriend would probably notice, however he was out of town for work all last week.

The episode seems to have peaked Saturday night and then turned to the dark side, leaving me experiencing four swings of “crazy girlfriend” type, hostile-agitated-mixed chunks appearing between mildly euphoric moments throughout the day.

I’ve been having trouble getting my thoughts together long enough to complete anything I’ve been trying to write, but I have a few ideas that I hope to get down soon. Thankfully I have been lucky not to experience any psychosis in the last week (knock on wood), however the sort of hostile, “I hate you” mood swings I’ve been having haven’t exactly been a walk in the park either.

I have my intake appointment with my new psychiatric clinic on Friday (hooray!) and though they are usually somewhat grueling, I will be happy to have someone around to help me untangle the big ball of emotional spaghetti in my brain again.

Complication Damage Control

After last Friday’s realization (regarding the delusional state I’d been overtaken by) I contacted my psychiatrist. He prescribed me the ODT (orally dissolving tablet) version of Rispiridone as I haven’t been able to stomach lactose recently and lactose is an inactive ingredient in several (if not most) psychiatric drugs.

The lactose acts as a base for the medication to be applied to in most tablets, but usually isn’t used in extended release tablets, capsules, and orally dissolving tablets. I figured this out after a delirious game I played last week called, “why are certain drugs making me vomit?” The result? The vomity drugs were the ones that contained lactose as an inactive ingredient. I was not surprised, since I haven’t been able to tolerate lactose in food for over a month now.

Had this not been an issue, I would have just taken my typical emergency dosage of rispiridone right away… but at the (very slow) rate my stomach has been healing I have been doing everything in my power not to upset it and in conjunction, not further upset my mental state.

By the time my psychiatrist and I got this plan sorted out it was already late afternoon on Friday and I had spent most of the day with my hands clenched on either side of my head. I don’t know if I was hoping to squeeze out the delirium or if I was simply trying to make lemonade out of lemons, but I figured if I could wait until I got the prescription filled everything would be relatively ok.

Of course, that was assuming any of the pharmacies in a five mile radius of my apartment had the ODT version of rispiridone. Not one did. I called them all, and yelled at the technicians who worked at most of them. The best they could do was have it by monday and I didn’t know if I could make it.

I also didn’t know what the alternative would be. Would I have to go to the emergency room again? I’ve already been to the emergency room four times in the last six months, and I was even more concerned that doing that would result in being given more medication I would have no control over, having more bad reactions (triggering uncontrollable vomiting), and starting over (again) in terms of trying to give my stomach a leg up.

I trudged through the weekend by being about 10% mentally present in everything that took place and trapped in my own head, full of a horrible amount of noise, the other 90%.

The noise. Every time I mentioned it I imagined myself with the snarled, green face of the Grinch who stole Christmas.

I have tinitus (ringing in the ears) anyway, but since starting up wellbutrin again the ringing has become exponentially worse. When I feel alright I can kind of ignore it by pushing it to the back of my mind, but when I don’t feel alright and all of that stuff near the back of my mind gets giant neon signs shaped like arrows pointing at it, the ringing joins hands with the other noise (negative thought chatter, obsessive thought loops, and internal radio station playing the first ten seconds of five different songs in a loop in my brain) that takes place when I become agitated and though bad enough on its own, it easily combines with ambient noise to form a wall of noise I can’t get beyond.

When I get trapped like that by the noise, that’s when things get truly dicey. I become very desperate and impulsive, and when I’m already in a suicidal state I fall into red-alert really quickly.

The first thing I did yesterday was contact my psychiatrist and negotiate reducing the wellbutrin dose in hopes of helping the ringing. Today I can say that this change has helped, so I am really feeling relieved in terms of that already.

I have also still been having a significant amount of nausea, dizziness, and blurry vision that did not improve after stopping the seroquel. I am hopeful that this might be linked to the wellbutrin and by lowering the dosage I can get a reduction in these symptoms.

After procuring and taking the ODT rispiridone last night I must say that it was probably the most awful thing (well, medication) I’ve ever tasted and even this morning it made my taste-buds act funny.

Despite that fact I woke up after a night free of nightmares (something that hasn’t happened in several weeks) and even though I hear a little, high-pitched whine, my mind feels considerably less cluttered. I generally consider the typical tablet form of rispiridone to provide relief in the form of a foggy stupidity, but I feel much more alert today than I expected. I can’t say for sure that this is only due to the rispiridone because I am also taking half as much wellbutrin as I was two days ago, but either way I am very glad to get some relief.

The bad side? Welllllllll… my hands did start twitching uncontrollably after imbibing the rispiridone last night, so I need to spend a little more time talking to my healthcare team before I could consider attempting to take it in an every-day fashion (and not as needed as I have been) but just the fact that I have something I can take in an emergency at this point makes me feel significantly less stressed.

These mixed episodes with psychosis have usually come on in waves for me, so even though I feel good about making it through one I am not going to try to fool myself into thinking this is the end of that super fun delusion time. I’m just hoping that if I can continue to be gentle with my stomach and not rock the boat, the waves that come next might be a bit less severe.

Fixation Without Representation

As I went through my belongings in preparation of moving the last two weeks I found a letter that confirmed my suspicion. It was something of an intervention letter from my best friend in high school expressing her concern (and rightly so) for my apparent fixation and total inability to focus on the present -one of the symptoms that contributed greatly to my subsequent (first) psychiatric hospitalization.

The irony was that as I read the letter, I was experiencing a mixed/depressive episode (something my psychiatrist has nicknamed the “three quarters” episode comprised of three quarters depression and one quarter mania) with very similar symptoms as that first big episode.

I can’t claim to be an expert on the human brain or the human heart, or even to know much about which of my symptoms “lend themselves” to which diagnoses… what I can say is that in the realm of what I experience, fixation has been a big problem for me and has greatly contributed to some of the most torturous episodes I’ve ever experienced.

So bipolar, OCD, anxiety… it all feels irrelevant. When my mind and my emotions are one train on one track it seems futile to try to categorize the details. All I know is that the train is headed one way; toward self annihilation.

The fixation issue seems to come about most often when I find myself under a particular amount of scrutiny or rejection. While there are times someone might say,

“You’re being irrational and fixating on things,”

I can usually gladly follow the logic around how the person arrived at that conclusion. Being able to understand where that person is coming from, I can say, “why yes, I am doing those things. Thank you.”

The trouble starts when I am being insulted (and perhaps finding out about it later) or people seem to be going out of their way to attack me (or manipulate me) and I can’t find the logic in it.

An example I can throw out is from the first time this really took place, when my ex-boyfriend was stringing me along while dating another girl. His actions and words did not match whatsoever, and all I wanted, all I longed for, was to understand why.

My mind begins to obsess over every little detail. Every contradictory or accusational thing that has been said echoes over, and over, and over again in my mind, and the only course of action I can seem to take is to argue and plea my case against them.

This month I received some extremely bizarre (and untrue) accusations about myself that left me in the same position. Why would my ex-therapist (among others) act so nice to my face, and then write such bizarre accusations about me in her files? Why would the people I am trusting (the situation involved several others I’m not at liberty to disclose at this point) go out of their way to screw with me? How does attacking someone having a decidedly hard time help anyone?

The voices of all of these people banded together in my mind and took turns bashing me. Every second of every day it was all I could think about, and it was all I could do to argue with each voice, to try to contradict it, to try to stand up for myself… knowing my efforts were truly fruitless and that the voices wouldn’t listen, and even if they did, the relinquishment of their manipulation would only take place in my head (and not in real life).

This is a big part of the reason I couldn’t blog about anything. Every time I tried to write a blog post, I could only get one or two sentences in before the pleading would spill out of my head through my fingers into the computer. I was desperate to focus on something, anything else, but this was one situation where writing only fed the beast. I tried at one point just to write a personal piece about what I was thinking, the arguments, and what was happening. I stepped away from the computer seven hours later and still felt I had barely touched the tip of the iceberg.

Through all of this obsessing, I was angry. I was depressed. I couldn’t sleep because it was all I could think about. In a matter of days I was whittled down to a sharp point, extremely reactive to everyone and everything around me.

If the topic of suicidality in our culture is taboo, the topic of homicidality is taboo to the 10th degree. I realize this, but honestly the issue of homicidality is also one that will send me straight to the hospital much more quickly than most lingering thoughts of suicide will. It is something I have to deal with, and in these sorts of situations (mixed episode, feeling like my back is up against the wall, feeling like I am being attacked from all angles -including from within my own head) I become extremely concerned for the safety of the people around me. When I have spent all of my energy talking back to these angry, accusational voices… I don’t have much energy left to funnel toward self-control.

In a sense, I got lucky. Having that “three quarters” episode meant that I only really spent 1/4 of my time in raging attack mode, and these outrageously angry moments came at me in waves book-ended by the other 3/4 of my time in severe, suicidal depression. If those rage waves would have been any closer together (or longer in duration) I would have opted for hospitalization without question. As it was, I was on the fence… and only because I was supposed to move in a matter of days.

Personally, I think the sort of rapid cycling I experience makes hospitalization a difficult prospect because my mood can change several times just in the time it takes for the intake procedures. At the same time, when it cycles and I am in an impatient unit I quickly get the boot, which doesn’t help because it can quickly cycle back into a dangerous place (within minutes, hours) of being discharged. I’ve experienced a lot of frustration around this phenomenon and because of this it isn’t unusual for me to feel more upset upon leaving than I did when I checked in.

Through all of this, my psychiatrist has really been one person I feel that I can trust. He suggested I go home and wait it out, and I spent the vast majority of my time confined to the apartment until the rage waves subsided and switched exclusively to depression (minus the insomnia).

The end result felt a little counter-intuitive, because what ultimately seemed to help me move past the fixation (and I say that but it still comes and goes) was not talking about it. Not writing about it.

I mean, I tried those things at first (talking about it and writing about it) because those are two things that have always helped me feel a sense of relief in the past about things that were making me anxious. What I experienced this time around though was that talking about the situation with my therapist (for example) only led to his voice contributing to the ones in my head. Every time I was talking about it, I was thinking about the situation more and more, which left me stuck in that “thought loop”.

Writing was equally as fruitless. I tried as hard as I could to outline an argument for myself, to make sense of the pieces I had, and it only left me with new questions to fixate upon. Every word was like a dagger, and seeing them all clumped together gave them more momentum.

Apart from my medical support team, I only told three people what actually happened. I avoided everyone else (for fear they would ask about my current state) until I felt comfortable allowing one or two people to try to draw me into their world of the present. Funny anecdotes about their jobs, or their cats, or whatever. Tiny tidbits to focus on besides me.

Those tidbits made up a gateway, and the moment I fell through the other side was the first shower I took in the new apartment. I was messing with the shower-head spray mechanism and accidentally turned the spray into a high-powered water gun that hit me in the chest and almost knocked me over. The sheer impact and surprise of the situation made me laugh out loud uncontrollably (imagining myself and Kramer with his industrial power shower head)… and for the first time in weeks I breathed a sigh of relief.

Ultimately I’m still not ready to talk about the incident that triggered this whole fiasco (I don’t want to re-start the fixating thought-loop), and though I’ve had a day or two where I’ve been able to come up for air, I’ve noticed some of the mixed symptoms returning in the last 24 hours. Luckily I have an appointment with my psychiatrist this afternoon and an entire blank canvas of an apartment full of possibilities.

When Six Hours Feels Like A Triumph

Last night was the first night in three weeks where I slept for an entire chunk of six hours straight. I’m taking this a s a sign that I am finally moving out of the danger zone (hooray!).

The mixed episode I initially experienced (something I plan to talk a little more in-depth about later this week if I can get things going) gave way to serious depression… at which point my boyfriend and I had to move everything we own to a new apartment. The move was the reason I was trying so hard to stay out of the hospital in the first place, so I generally opted to confine myself to the apartment instead. Thanks to some exceptionally wonderful people in my life we had a lot of help with the move which was a definite plus since I had become little more than a mindless walking husk at that point; beyond exhausted but unable to get any rest.

If anything, the lack of sleep has been a big indicator of how bad things had really gotten because not only am I a big time sleep fiend (I can typically sleep 12-14 hours easy not depressed), but also because my psychiatrist has been ramping up my quetiapine dose (a move notorious for groggy oversleeping) and I somehow began sleeping less and less.

I am still a little out of sorts (I just ate some eggs out of a pie pan for lack of being able to find a plate in any of the boxes in the new place) but after getting a taste of sleep (and a peek at the big blue sky out my window) I felt decidedly less wretched upon waking this morning than any of the last 20+ recent days. Though I expect things to fluctuate throughout the day (it generally does for me) having even one moment of relief is enough of a kick in the pants to keep me going.

Thanks for all the kind comments and messages I received while out of commission! Though I haven’t been able to reply to any of them individually I just want you to know that your words have meant a lot to me during a very distressing time. Receiving supportive words from people while experiencing paranoia and delusions was one of the things that really helped me discredit a lot of the negative things my mind seemed to be generating, so thank you, thank you, thank you again!