Lamictal / Lamotrigine

At my appointment a few days ago with my psych nurse practitioner we talked about going off Zyprexa for good. As of now, I'm down to 2.5 mg. But she wants to add something else after. First, she suggested Depakote, but that was my first "bipolar med" and I gained 60 pounds on it. The other idea- I've gone through trying many meds - was to try Lamictal. This was first suggested to me inpatient, but I was afraid of a rare complication where a rash gets so bad that your skin falls off. My "psych nurse" said you go really slow when you're titrating up on it, to avoid this. I'm not sure when this med change will happen as I'm not sure how long I'll be on this last dose of Zyprexa. (My file says I was already on Lamictal for a short time. I'm not sure why I went off if this is true.)

File: GAF Rating

5/02/2016 File marked with "Current GAF: 30".

From WebMD: The Global Assessment of Functioning Scale rating of 30 (-21) reads:

Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment (e.g. sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day, no job, home, or friends).

A little Fun!

Singing crickets

A recording of crickets in 1992 was slowed down to human speed. The results are amazing! Enjoy!

Big White Bird

Today I was driving and saw a big white bird taking off from the ground. It flew up, then at my car, spreading its wings. Then it disappeared. (Key to prove a visual hallucination.) So clear. Driving is not safe while hallucinating!

Hallucinated Tiny Spider

Sitting in my recliner, I looked down on the left arm and saw movement. For a moment, I saw tiny eyes looking back up at me. A spider. Disappear! Just like that, it was gone. I looked all over, but couldn't find the arachnid at all. This is unlike the big black bulbous spiders I had been hallucinating. This one showed up clearly, then went away just as clearly.

Horrible Day, Beautiful Choir Day

Been having a horrible day. Filled out housing paperwork but my mom who was helping me called the mean worker at my apartment complex. Apparently my mom called her a *****. (Not to her.) Papers everywhere in piles on the table. Are they all there? Are they in order? Meanwhile I was feeling spacey and dizzy and completely confused. I had felt this way all day. My thoughts were confused and slow - full of molasses. The only thing that clears out my thoughts completely is singing in the choir, like I did yesterday. Rule after rule going through my head- vowel shape, volume, diction, meaning of the words, reacting to the other voice parts, not to mention the other members of your own part... A recording was made of the performance at 4:00. Nobody realized that we were being recorded until afterward. We were sent .wav files of the pieces, but I will have to wait to hear it until the person who recorded it gets back from vacation. Oh well. I can't wait to hear it- I thought it went very well! EDIT: Now its a few weeks later and we sang that same anthem this morning. It came out even BETTER than last time. (And I have yet to hear that recording.) I wish today had been recorded. Ah well.

Feeling Anxious - There's Still Time

This week I've been feeling anxious. I feel like the world is falling in on me. I have a ton of important paperwork to finish. I feel extreme anxiety without anti-anxiety medication. I've been posting on this blog once or twice a day for over a week, which my friend, C, says is a sign that I'm moving into an episode. Tomorrow, my youngest has a repetoire class for piano in the morning. In the evening my eldest and I are meeting for Starbucks for his birthday- 20! I just feel like the world is crashing down around me and there's nothing I can do to save it. This is leading to anxiety and anger. One of the people that manages the office at my apartment complex is always mean to me. She got angry that I was in the office a few days ago even though the paperwork I got from them SAID to come in and get a date set. She said, "Call before you come here again," she said. But tomorrow should be okay. I had an interview with the bipolar study I'm in a few days ago. This lady thought I seemed perfectly "even"- not manic or depressed. But this is my manic time of year. Huh. There's still time. Ha!

File: 5/02/2016 Paranoid, delusions, aliens, anxiety, balcony

[PDOC] 05/02/2016

F31.2: Bipolar disorder, current episode manic severe with psychotic features (Active as of 10/16/2015)

F29: Unspecified psychosis not due to a substance or known physiological conditioner (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)

4/20/15: Clt's current symptoms and 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 [history] 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. Clients reports that she tried to overdose to kill herself last night with plans to do so again.

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

10/1/13: 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 resent to PES. [Psych. Emergency Services]

File: Voices

5/19/15

Once a day she reports hearing a voice with derogatory manner, notes it is the same voice that told to OD on pills, she notes she hears the voice and then thinks about what it says. She is not bothered by daily occurence now and notes it is a distraction. She has not discussed coping skills in therapy regarding voice. She notes zoloft has helped decrease her anxiety and is not worrying as much. "I didn't realize I worried so much until I didn't worry as much." She notes she is able to care for her children and herself and recently had stylish new hair cut and manicure. She denies depression, endorses good sleep at night and "wakes rested".

4/30/15

Client notes having depression with AH/VH [audio and visual hallucinations] and heard voice in head telling her to OD on pills which were in her hand. She notes calling crisis line several days prior and was eventually hospitalized at XXXXX. Her lithium was reduced by 300mg. zyprexa increased to 15 mg, trazodone 50mg and zoloft 50mg added. She denies AH/VH, endorses good sleep and feels rested upon waking. "feels better". She questioned borderline personality dx [diagnosis] given in hospital and writer [pdoc/nurse practitioner] disagreed with this diagnosis as well.

Foregetful Lateful

II've been feeling very forgetful lateful. I type weird or double words. I'm tired all the time. My friends say I'm fat (but they're fateer???). I have so much to do that I feel like I can't anymore. I want off. I want a helper with life. So today I'm watching YouTube videos of my kids singing, waiting for maintenance. We were discussing drs calling you fat and I said my Pdoc put that in my file (obese). So they all went "oh yes yes mmm hmm yes you are" etc. But they're a hundred or two hundred pounds heavier.

Tomorrow, I'm going out to do impoartant things with my mom about papers and apaperwork,. I hate it. But it HAS to get done.

File: Mania and hospitalization from 12/19/2013 & 11/26/13

12/19/2013

Client seen today at xxxx for first time and was previously followed at xxxx but due to intensive treatment needs, will be followed by XXX and client was initially confused about the change and confirmed understanding after writer's explanation. [pdoc]

She recently was hospitalized at UM 9C 10/1-10/10 for SI [suicidal ideation], mania, psychosis and had zyprexa increased to 10 mg during admission then was at XX 11/12 for SI, psychosis.

Today she denies AH/VH/IOR/paranoia, endorses stable mood without hypomania or mania, low anxiety and depression energy, & appetite normal no wight changes, sleeps 8 hours, memory is variable and low at times.

She has history of mania with psychosis - VH-sees animals. "cat disappearing." AH [audio hallucinations] "someone talking, music playing" referential delusion-"sun giving me messages, I could fly". Grandiose delusions-I was invincible, could walk into traffic and nothing would happen", elevated and irritable mood-"everything is wonderful", agitation- "moving a lot," occasional thoughts of wanting to stab herself "reported this was a chronic issue that did not increase her desire to commit suicide," or inflict self-harm.

Client is not sure why she had episode this fall or last fall because she notes medication adherence and also remarked the last year in November, she had another manic/psychotic period and thinks the fall may be a bad time for her. Per [hospital] admission note during her two weeks prior to hospitalization, client was posting multiple blogs [I just have this one blog.] and writing more, internal restlessness, almost jumping off balcony, increased pressure to talk and stay up past midnight on phone with friends, racing thoughts, low concentration, increased energy, appetite decreased, mildly decreased sleep....

11/26/13

CURRENT SIDE EFFECTS< ADHERENCE ISSUES AND PREVIOUS MEDICATION TRIALS

latuda trial - akathisia, w 20mg dose

fanapt - tachycardia w 4mg dose

depakote - weight gain, worked well

seroquel - itching

nortriptiline

abilify - akathisia

geodon - induced asthma attack

saphris - "internal hallucinations"

File: Nurse Practitioner Notes of 2014 (Psych medical record)

Various reports during 2014/2015.

7/16/15

"I can't find enough things to do with my kids this summer."

Client endorses stable mood, good sleep, normal appetite, denies depression and anxiety, notes VH-sees cat, saw her daughter at end of bed last night while awake and she wasn't in room, endorses tactile hallucinations- felt her daughter touch her foot but she wasn't in the room. She notes it takes her a few minutes to process and realizes it is not real and does not think this it is bothersome, doesn't think this is prodome to manic episode. She does not want to change meds today. ..... and enjoys spending time with other friends at Starbucks. She recently received new tattoo, and explained the significance for hope when someone feels suicidal. She denies SI. [Suicidal Ideation]

"I made it through November."

12/3/14

Client notes stable mood, denies depression, anxiety, akathisia, denies SI.

She is able to care for her children and drive them to their activities and support them emotionally.

....She called crisis line, spoke with DBT therapist and a supportive friend and used ativan once when highly stressed. She continues with group DBT and individual.

10/29/14

Client "almost" back to baseline, endorses stable mood, denies depression, anxiety, denies SI [suicidal ideation]

Client has resumed zyprexa 10mg after trials of Latuda with akathisia and Fanapt with tachycardia over past several months.

She endorses being able to take care of her children, is receiving help for SSD [social security disability] application, has weekly therapy DBT and finds it valuable

"I want off zyprexa"

Client notes being stable "for most part", notes 3 days last week when she smoked which she normally doesn't do and thinks she was being impulsive. She notes mild anxiety, denies depression.

She denies AH/VH [audio hallucinations/ visual hallucinations] now and notes that she has experience these symptoms without being manic and notes a past psychiatrist was not sure if she had schizoaffective vs bipolar disorder.

Client has elevated triglycerides and has been on zyprexa for 2 years and would like to change meds- all past meds reviewed and she agreed to try Latuda.

She endorses having family/friends who see her often and notice changes in her behavior and she notes changes in herself too.