File: Another Medical Record Page

This is an excerpt of some entries from 2015/16.

01/18/2016. DANGER TO OTHERS WORKSHEET

DYNAMIC RISK FACTORS

*Severe anxiety symptoms/agitation

*Employment instability

*Impulsivity

*Lack of insight

*Relationship instability

*Lack of social support

STATIC RISK FACTORS

*Low socioeconomic status

*AGGRESSIVE OR DESTRUCTIVE BEHAVIOR

*None

04/20/2015

DYNAMIC RISK FACTORS

*Severe anhedonia

*Severe depression

*Hopelessness

*Suicide ideation or intent

**Suicide plan

STATIC RISK FACTORS

*Mood disorder *History of suicide attempts

AGGRESSIVE OR DESTRUCTIVE BEHAVIORS *Suicide Attempt

*Suicide ideation

4/20/15: Clt endorses SI w/plan to overdose on prescription and OTC medications. Clt reports two aborted suicide attempts earlier this evening, one in which she had 30 Benedryl in her hand ready to take but decided not to and once she had 50 zyprexa in hand. Clt was unable to contract for safety with this writer when the crisis plan was attempted.

9/16/15: Clt endorsers SI w/plan to jump for balcony or crash car. Clt reports that early today she was standing leaning over the balcony for "awhile" contemplating jumping. Clt mentions that she thought she may be able to fly and if not she was aware that this would probably kill her and reports "I was okay with that as long as I don't have to feel like this anymore.

General Behavior: Cooperative.

Speech: Unremarkable

Perception: She currently denies that hallucinations telling her to hurt herself but past E-II records indicate a history of [Me] reporting hallucinations telling her to hurt herself.

Thought Process: Mild paranoia.

Mood: Dysphonic [Dysphoria, "difficult to bear" is a profound state of unease or dissatisfaction. In a psychiatric context, dysphoria may accompany depression, anxiety, or agitation."]

Judgement: Fair

Impulse Control: Fair at present

Insight: Poor

Sleep: normal

Appetite: normal

F31.2: Bipolar disorder, current episode manic, severe with psychotic features (Active as of 10/16/2016)

F29: Unspecified psychosis not due to a substance or known physiological condition (Active as of 11/21/2013)

F31.9: Bipolar disorder, unspecified (Active as of 10/29/2014)

F39: Unspecified mood [affective] disorder (Rule out as of 11/21/2013)

DIAGNOSTIC Summary:

4/20/15: Clt's current symptoms and presentation are congruent with previous diagnosis.

9/16/14: Clt's current presentation and symptoms are congruent with previous diagnosis.

11/21/13: Client reports paranoid thinking with delusions. (Thinking people are aliens and endorsing a hx of beliefs that she can fly and that she will not die for long if she kills herself.) Client reports a hx of auditory and visual hallucinations, but none at the moment. Client reports anxiety, related to personal relationships. Client reports that she tried to overdose to kill herself last night with plans to do so again.

10/08/13: Pt presents as preoccupied, possibly7 responding to internal stimuli, hears voices telling her to stab herself, reports some improvement in psychotic symptoms.

10/01/13: Client presents "ramped up" with thoughts of jumping into traffic or "flying off her balcony" w/o specific intent of suicide. She is calm in presentation but she reports that she has felt increasingly "ramped up" over the last 2 weeks. She spoke with her psychiatrist this morning and she recommended she present to PES [Psych ER].

File: More from my medical (psych) record

This is from my medical record, again.

01/16/2016 According to [Me] and past E-II records, she was diagnosed with depression in 1997 when she was pregnant. She was prescribed Zoloft in [City] and went off the medications after she had her babies. She reported that she began to have visual hallucination in 1999. They started to see triangles that no one could see. She began to seek mental health services for her hallucinations in 2006 after she had gone for a walk and nature seemed more vivid and then she saw a little girl on a porch that disappeared as she was looking at her.... and has been prescribed Depakote. She reported that the hallucinations have gotten worse in the last two years. She now hears sounds like radio, a band, and voices saying "Look at me". The voice says nasty and mean things to her and he's become more persistent.... According to the Pre-screening assessment on 10/1/13. "Client self reports that she has been experience and increase in feeling "ramped up" as well as "another voice" telling her that she now knows everything there is to know and she will be fine. She had thoughts of walking into traffic "just because I want to see if the metal from the cars is cold" and "flying off her balcony because there is so much space and she thinks she should fill it". She was hospitalized at PES for 10 days.

Bipolar Plus

Schizoaffective Disorder

I posted the above link back in 2013. I've been hallucination quite a bit in the last month. I've read up on the symptoms of schizo-affective disorder. It all sounds like me. From the hallucinations to the moods. Its not just hallucinations on top of bipolar disorder. From in the link above: Common signs of the disorder include hallucinations, paranoid delusions, and disorganized speech and thinking. Schizoaffective disorder is defined by mood disorder-free psychosis in the context of a long-term psychotic and mood disorder.[2] Psychosis must meet criterion A for schizophrenia which may include delusions, hallucinations, disorganized speech, thinking or behavior and negative symptoms.[2] Both delusions and hallucinations are classic symptoms of psychosis.[9] Delusions are false beliefs which are strongly held despite evidence to the contrary.[9] Beliefs should not be considered delusional if they are in keeping with cultural beliefs. Delusional beliefs may or may not reflect mood symptoms (for example, someone experiencing depression may or may not experience delusions of guilt). Hallucinations are disturbances in perception involving any of the five senses, although auditory hallucinations (or "hearing voices") are the most common.[9] A lack of responsiveness or negative symptoms include alogia (lack of spontaneous speech), blunted affect (reduced intensity of outward emotional expression), avolition (loss of motivation), and anhedonia (inability to experience pleasure).[9] Negative symptoms can be more lasting and more debilitating than positive symptoms of psychosis.

Then it goes on to define the basic bipolar symptoms of mania and depression.It seems to you could call SZ (schizoaffective) "Bipolar Plus". (Literally, bipolar plus schizophrenia.) If this is not me, I don't know what is. The medical records from the psych ER that I've posted here could confirm a lot of this.

Jeh neh fehrrrr!

I was sitting in Starbucks this morning and heard my name whispered loudly, clear as day, over the din of the other customers. I've been having a lot of visual hallucinations lately, but not so many audio. My next appointment with my psych nurse practitioner is October 5th. God I hope she doesn't increase my zyprexa! I'm hoping she will DEscrease it! In case you're wondering, these types of hallucinations don't scare me at all. Well, the spiders a little because I imagine them crawling into bed with me later, but the voices? No not a bit.

How cannabis affects the bipolar brain

How cannabis effects the bipolar brain

It makes you hallucinate! We knew that.

From the above article

Clinicians have hypothesized several contributing factors including “heavy usage, length and age of users, and psychotic vulnerability.”6 In the report by Johns,3 it was felt that adolescents are more vulnerable to the mental effects of cannabis because they may “experience emotional problems that cue cannabis use” and secondly, regular use may “interfere with learning and personal development.” Although our patient had no genetic predisposition with a negative family history of any psychiatric illness, he did start smoking cannabis during his adolescence. As there is an increase in the use of cannabis among younger individuals and a rise in schizophrenia in this younger population, we must be aware of the potential harm of cannabis abuse.23 During his first psychotic break, he presented to the clinic with delusions of being persecuted, auditory hallucinations, and grandiosity, which have been well documented as prominent symptoms secondary to cannabis abuse. He soon recovered without any use of medications. The only insightful data we could gather about his vulnerability, aside from age of onset with cannabis use, was from his MMPI. The report gave evidence as to the nature of his personality. This was an individual who had elements of paranoia, grandiosity, risk of addiction, and antisocial traits. According to Regier et al,15 83.6 percent of individuals with antisocial personality disorder also have comorbid drug misuse. It seems that Mr. X’s cannabis use heightened these personality characteristics and may have been a contributing factor to his psychotic break. After his first discharge, he was nonadherent and did not follow up with the university psychiatrist. Review of literature has shown that cannabis use was consistently associated with relapse and nonadherence to treatment in psychotic patients.24 This makes it difficult to manage these types of patients with increasing relapses, hospitalizations, and progressive worsening of symptoms.

Spiders After Me

I've been trying to post this but my phone wouldn't let me. Had to log into the desktop. I feel like there are hundreds of the black bulbous spiders out to get me. Me. Just me. As in they have a plan. An organized plan. How am I going to sleep tonight? Already something bit me a few days ago on my leg in bed. Why do I keep seeing these spiders? I don't think its just that its Fall. No no. There's a bigger answer than that. Oh yes yes yes there is. They are after me.

Today was Weird

Today was weird. As I was driving home through my neighborhood, suddenly a man was sitting next to me in the passenger seat. He disappeared quickly. At Victoria's Secret with my friend, I had a revelation. Second one that day. Earlier I had realized that to park at church (tiny lot), all I have to do is do like the people who live on the street the church is on: Put our cars in our pockets and take it with us! So simple! (Except that they would be too heavy to carry!)