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: 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].

Ativan & Anxiety & Memory

Last night, and several nights before, I'd been feeling anxious. Racing thoughts. Bad thoughts about things being after me. Mostly, I feel guilty. Very guilty about failing at life. I try to distract myself by watching "Nova" on tv, or reading, or doing the coloring, but sometimes all of that is only a Bandaid. Last night, I took Ativan and that seemed another layer of Bandaid, but it did help. The problem is that I'm going to run out of that one of these days and I'm sure my therapist or pdoc will think I'm dependent on them even though I CAN sleep without taking any. I just hate the anxiety lately. The thoughts swirling. I would've taken a walk last night but it was night time. I haven't been able to take my daughter out for photography. She just doesn't want me to take her picture, even though I think that would be very soothing. I like the photos I've taken of her over the years. I'd have to make an album of only her to link here, but at any rate, they are nice. She is very expressive!

I'm afraid I'm going to lose things. Not only my keys and phone, but my photos that Ive already taken. I would feel SOOOO bad if they disappeared! I have them saved online, but that's not the point! My phone, my ipod, my keys, and things I've written down, important papers for the kids about school... all I feel I might lose... my purse... I feel they will walk away at any moment. That I can't keep track of where they are. I am constantly making mental notes, but doing that weakens them somehow?!

So I end up posting on a bipolar bulletin board that I frequent talking about how anxious I feel and they suggest yoga or pottery or the like. I am at Starbucks right now with my friend being one-year-olds on laptops: We play NEXT to each other, not WITH each other. After this, I go home and meet the kids after school.

My memory is a little bit better, but maybe only because I have been forcing myself to make mental notes: "Keys are in your coat pocket; cell phone is on the table next to you". Still, sometimes, I'll have a thought and go to write it down and lose it before its written down.

Speaking of bad thoughts at night, the Zyprexa has taken care of the intrusive thoughts, and this is why my pdoc doesn't want to lower the dose of Zyprexa. It has made me gain a few pounds, and I'm trying to watch what I eat.

Crying. So Mixed Up.

Went to movies with My youngest. Feel anxiety.  Feel restless.  I need to take my Ativan.  When I feel this way, I feel the need to get out of here.  I can't stand being in my body.  I feel very uncomfortable.  I need to hurry through whatever I'm doing.  I can't get my food eaten - it comes to a standstill because I can't possibly go that quickly.  I should take my Ativan but I'm at a restaurant and that means I need to drive.  I am already bouncing a lot.  It's a feeling like I need to run outside of myself.  I would've thought this feeling would be gone by now.  I still need to do an errand after this.  Kids have the day off hence why I'm going to the movies. Need to scream but when I take the Ativan I feel very slow and like I want to sleep for hours.  What a choice!!!  I start to take a drink of my diet Pepsi and I need to be done when I just started.  I have no patience!  It almost feels like mania but without the need to talk.  I'm just very uncomfortable.  My legs are shaking again.  What a choice!  I have to drive after this and getting a DUI would be very bad.  

I got home and my mother's idiot husband began giving me his holier-than-thou-fuck-you face.  I had visions of last time I went to the psych ER over something similar. He was yelling at my daughter that her room needs cleaned right this minute (because family is coming over tomorrow  for Thanksgiving).  The attitude, the indignant face.  The fact that he annoys me to no end!  Last time I was in the ER was because I fell into a puddle of sobbing.  I am not doing that now but I am having those feelings of wanting to kill.  The situation at least but I can't stand when people treat my children horribly and then dismiss me.  I hate it.  Plain and simple, I hate it. I am already not feeling well.  Thoughts are going downhill.  I managed to take my youngest out to eat after a movie but as you read above my sense of reality is askew.  Oh dear.  Is Ativan my cure-all?  Why couldn't the Saphris have worked?  I can clean my room as that seems to be-all around here.  Not that it's really that dirty.  One of my best friends seems to have shut his phone off all day.  I want to cry and scream.  I'm scared.  The back-up beeping of the truck a few doors down is stabbing bloody holes in my ear.

I called the psych ER and they talked with me.  I cried as I talked.  That's the first time in months that ive even remotely felt sad. I cant stand this. The ER woman Said to call my psych dr.  So now we're waiting for that.  Could be 2 or 3 hours.

I feel like I do t know what is coming next.  I'm crying.  I was crying on the phone to my psych dr.  She said I need to get through this feeling with Ativan.  Twice a day.  That and getting away from my mom's husband are the only ways to cope.  She said to go to the hospital of I have feelings of needing to kill people.  Right now I can't stand being in my own body.  I cried to my pdoc on the phone and I'm crying now. It's been so long since I've cried.  And I feel like my only choice is to take Ativan and hope I feel better.  That taking Ativan is my only choice and that means I can't do anything or go anywhere unless I'm with a friend who drives me.  I feel like I don't know what is coming next- I don't know my own mind.  And it will take a week for the Saphris to get out of my system.  My friend who usually is around isn't today.  I'm talking to him. Crying.  he's in another town.  Another friend is picking me up.   Yay!  I think it's time for Ativan.  Tired of crying. Hopefully no more to add but we'll see.  I could really use a hug.

The nurse at the ER and my pdoc both said that I should get out of the house.  So I go to walk out the door and get the evil eye from my mother as she stomps up the stairs.  I yelled up after her that my doctor ordered me to get out by myself.  I don't think it helped very much but damn it I need to take care of myself! Having visions of bloody wrists. Mine!  The bookstore has been good.  Mocha coffee with very little chocolate.  Side of ice water.

I rode the escalator up to the second level of Barnes and Noble.  I searched for books on bipolar.  The same usual suspects: Cheney and Jameson.  I walked to the balcony between the down and up escalators.  I looked over.  I heard a man's voice say, "Don't do that; that's dangerous.". Behind him was his 2-year-old son.  I left the area to look for the afford-mentioned books only to return to the circular glass-and-metal balcony again.  Looking down, I was mesmerized by the people who could not see me.  I saw my leg reaching up and over the glass wall, then, of me falling down down....  I remembered the bloody wrists and hands. Completely covered in blood from elbows to mid-fingers. The thought comforted me. I saw myself climbing over the balcony; it was as if I could not stop myself. I drew my leg up... My mind was now not mine.  And yet on Ativan my brain is askew.  Caught between insanity at home and the supposed need for the psych ER.  Ativan is keeping me together- at least I hope.  A friend online who is also bipolar suggested that I'm in a mixed episode.  I won't discount anything.  The lighting of the store is wintry and crisp.  The book shelves are all taking on a surreal form.  The world I am in which is a dream.  This is called derealization and I know it's not good but I am here nevertheless.  The only thing that can save me is Ativan.  Drug me so I can't move.  Well guess what? I can still move!  My thoughts are still here.  I just feel less anxious.

This internal feeling is unbearable! Tried to cut. Nothing sharp enough. I just want this feeling gone! The cutting can deliver me from this horridness! I want to take pills. Anything! I did the ice- held it in my hands. My hands hurt. Distraction. I still can't stand this feeling! Nobody at the per gets it. My pdoc thinks I need to just get through it with Ativan. I took the Ativan!!