Checking Off All the Little Boxes

As with any job there are trends that I have observed in the psych field that seem to occur every year. The transition from spring to fall is when we start to see those who are depressed come out of the wood work. Winter is when we see the more at risk population, low income, frequently homeless and those with a history of incarceration. Spring is when we start to see higher incidence of mania and/or psychosis. Summer is a bit of a hodge-podge, but I think there tends to be more family related stress and strife that plays into that. Kids are at home, there are higher expectations for temp workers to find employment and it’s hot. People get grumpy and pissy and irritated when they’re hot.

Let’s focus on that bipolar population, sorry, I really should say it as the population who has a history of bipolar disorder/suffers from bipolar (let’s call it BPD I/II from now on). Like I said above, most tend to go into a more manic phase at this time of year. Not everyone though. Some get the pleasant experience of a mixed episode meaning that they experience some depression symptoms and some manic symptoms. This group tends to be at the absolute highest risk of suicide: feeling suicidal, coming up with a plan and they have the fucking energy to be able to actually carry through with those plans. The sad part is that they have the highest rate of success. I’ll go look up the research again should anyone want to see that. My knowledge is coming from stuff I had discovered in 2007 when I was desperately trying to figure out the world of psych for my first job and then from observations throughout the years. Incidentally it’s also one of the major reason why people who start on anti-depressants are at higher risk for suicidal thoughts and carrying out plans; the antidepressants don’t affect their thinking and emotional state as quickly as they affect the physical symptoms of depression. They get the energy and even some motivation before they actually start to feel better. It sort of mimics what a mixed bipolar episode does for people.

Anyway, the point of this post is that I fall into the smaller group of people with BPD that are more likely to feel depression than mania at any change in seasons. That is partially because I have the type II version which nearly always tend toward depression rather than the hypo mania side. I think I’ve experienced hypo-mania only a handful of times in my life and those episodes are nearly always followed by a pretty strong crash into depression. I normally can observe the symptoms and act on them before they get to the absolute bottom. I start eating healthier, exercise more, attempt to read more, make a good go at trying to get better sleep, and all that good jazz. It’s actually the primary reason why I do any of these, not to lose weight, not to look better in my favorite jeans, though those are all really awesome bonuses.

This year hasn’t been so kind about it. Over the last 6 months I have continued to experience various symptoms of depression despite taking all the above actions and asking my doc for some med changes. What really has sucked is that the last three months I finally got hit hard by the complete lack of motivation to do what I need to in order to keep myself from tanking further. Exercise? Yeah, non-existent. Eating better? Forget it. Wanting to do much of anything? Ha! That’s funny. Feeling good about my job and what I’m doing there? Eh, still some of that, but it’s really damn hard to get myself to not be cynical and wanting to interact with patients much. By Saturdays I’m kind of useless. I try to get as much done in the morning since I developed that routine and if I don’t complete it, I’m fucked.

I wasn’t fully aware of just how bad things had gotten until my husband started to ask me about it. The fact that he was aware and able to ask about it is saying something because he really doesn’t have the awareness of such things that some/many people do. I had given him some reference material when we first started dating and even gave him a pretty clear (I thought) list of symptoms that I tend to experience, subjective and objective. A few months ago when I asked him about it again he told me point blank that he really couldn’t notice the subtle changes over time much at all. He’s never been very good at reading many of those things and whatnot so it’s honestly not much of a surprise. He’s a tech dude, he gets tech things really well and is great at problem solving but when it comes to things that he can’t do much about he is pretty apathetic about them. When it does get to the point that he is completely aware it really is hard for him to deal with. He wants to fix it. He wants to make it go away. But it’s not that easy, probably partially because I really am not good at listening to anything or anyone once I get to this point.

I think it’s probably a bad thing when all the things that I’m upset about in relation to myself are basically check boxes for the DSM-IV diagnosis for depression. Let’s look at this list from NIMH:
Major Depressive Disorder requires two or more major depressive episodes.

Diagnostic criteria:

Depressed mood and/or loss of interest or pleasure in life activities for at least 2 weeks and at least five of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning almost every day

1. Depressed mood most of the day. Worse the last three or so weeks, but been experiencing some since November.

2.Diminished interest or pleasure in all or most activities. Reading? Meh. Exercising? None. Wanting to go out? Eh. I’ve really only gotten excited by a few select things, many of which I’m really not as excited about as I would have been a year ago. Even then it’s a very short-term thing. *sigh*

3.Significant unintentional weight loss or gain. Actually this one I’m not experiencing as much. Some weight gain, but that’s what happens when you go from a 1350 calorie a day diet and exercise to around 2500 and not exercising.

4.Insomnia or sleeping too much. Ugh, yes. If I don’t take something to help me sleep I toss and turn the whole damn night. I don’t actually seem to fall asleep and stay asleep until sometime after 6 or 7 am. Given that I only got to sleep past 8-9am two days a week until this last week that was pretty significant. Now I get four days a week, but holy crap is it hard to get up. Work or school were pretty much the only things that could pull me from bed from 11am. Now that I am not in school, well let’s just say I haven’t gotten much of anything accomplished this last week.

5.Agitation or psychomotor retardation noticed by others. Anytime I am not at home. Especially if I am with or around people. It’s not as pronounced at work, but it’s been commented on several times the last few weeks. Yay for nearly autistic like repetitive movements to decrease anxiety…

6.Fatigue or loss of energy. Why don’t they have this as number 5 rather than 6? It goes so much better with the insomnia question. Anyway, yeah. This is probably my biggest complaint. I am freaking tired all the time. Doesn’t matter how much or how little sleep I’ve gotten, whether I have plans or things to do or absolutely nothing at all to do, I am exhausted. It sucks.

7.Feelings of worthlessness or excessive guilt. Not too bad, not yet. I’m starting to feel some of this, especially since I haven’t been much interested in doing things I need to like helping around the house. Blargh.

8.Diminished ability to think or concentrate, or indecisiveness. Worse so than usual, yes. Indecisiveness is something I always experience, but not to this extent. Lack of ability to think or concentrate? Oh yeah. I am slow to respond or pick up on what others are saying and am definitely more flighty than usual. The only thing I really seem to be able to concentrate on is a book when I’m reading, but even that is iffy.

9.Recurrent thoughts of death (APA, 2000, p. 356). I don’t think so, though it’s hard to tell since there is a lot of conversation at work about our suicidal patients. What I really want is just to be able to sleep until I actually have gotten enough *good* sleep to be functional again. I don’t know if that counts or not, but I’m leaning towards no. Maybe some of the therapists/counselors I know would disagree, but really I don’t care all that much whether they disagree with me or not. I don’t feel like I’m suicidal. I haven’t actually thought about what it would be like for me to die or even thought about plans. I have discussed what people do that just seem silly or don’t actually work, but that’s about it.

Just for shits and giggles, let’s take a look at the manic side of things too.
Bipolar 2 Disorder, in which the primary symptom presentation is recurrent depression accompanied by hypomanic episodes (a milder state of mania in which the symptoms are not severe enough to cause marked impairment in social or occupational functioning or need for hospitalization, but are sufficient to be observable by others).

Manic episodes are characterized by:

A.A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary) Ugh, irritated mood is one of the major things that my husband noticed. I’m irritable, easily agitated and more and more frequently difficult to get along with. I know that some people actually have irritable or angry depression so I don’t know if this is depression related or not.

B.During the period of mood disturbance, three (or more) of the following symptoms have persisted (4 if the mood is only irritable) and have been present to a significant degree:

(1)increased self-esteem or grandiosity Not so much, no.

(2)decreased need for sleep (e.g., feels rested after only 3 hours of sleep) Definitely not.

(3)more talkative than usual or pressure to keep talking Maybe pressure to keep talking, but I don’t believe so.

(4)flight of ideas or subjective experience that thoughts are racing Is the inability to really control where my thoughts go or what they do part of flight of ideas or racing thoughts? I don’t know that they are racing except when I’m feeling massively anxious, but maybe? Probably not.

(5)distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) Ugh, yes. Too much of anything overwhelms me and makes it difficult to focus or concentrate on anything, but again, this is also a symptom for depression or at least one of the things that tends to come up with depression.

(6)increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation Psychomotor agitation, yes, but that’s also a symptom for depression and anxiety as well.

(7)excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)” (APA, 2000, p. 362). Luckily for me, no. The closest would be buying sprees, but I usually force myself to think about things for a while before purchasing. It also helps that I don’t have that much in the way of expendable cash.

So there may be some hypo-mania mixed in there too, but if so it’s nothing compared to this fucking depression. It’s interesting how easy it is to check those things off right now. Well, it’ll probably be more interesting when I come back and look at this in a few months, but I can look forward to that.

This post has gotten waaaay too long so I’ll just leave it off here. If you got all the way down here, wow, kudos to you. You are now free to return to your regularly scheduled day and activities, whatever those are.

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Yoga and other various exercise things

Over the last few months I have increased the amount of physical activity I take part in. Going to the gym, doing the whole martial arts thing, and most recently I added yoga.

I have found them all to be rewarding, all in their own ways. At the gym I get to just completely zone out and do my thing and not have any interaction with anyone else. Some would argue that’s not the greatest thing to do since I don’t push myself as hard as what I need to, which is true, but at this point I’m just happy I’m making it there again and getting satisfaction from what I do.

In martial arts I’m learning so many new things and discovering a whole different kind of satisfaction from slowly becoming more proficient in what I am learning. I enjoy learning things that make me feel a little safer in that if something were to happen to me physically, I most likely would be able to react in a way that will help me as compared to freezing. I am learning *how* to punch and kick and whatever other strikes or defenses you can think of. I am learning how to fit things together and all these other awesome things.

Lastly, with yoga I am learning more about focusing on my body and releasing my thoughts and just experiencing that moment, that breathe, that movement. I am able to feel the difference between how I am doing each day and also to not judge myself or my body. Some days I can easily hold a pose, warrior 1 or dancer, or I can easily move through sun salutations or other vinyasas without shaking limbs. Other days I require more patience with myself. And some days I need to recognize that I need to modify the pose or the vinyasa and make them easier on myself.

I feel that in working on all these different things I am slowly starting to round out how I experience life in my body and mind. I am becoming healthier, making better choices for myself and working on learning some sort of balance. It is hard in some ways in that I am often doing these alone when I would like to share what I’m learning with my husband, but I am also grateful in some ways that I’ve got my own things. I write a wee bit, in my blog and occasionally journaling, and exercise and do yoga, work on various craft things and am interested in different studies. Nathan does martial arts, (sadly on days that I work) plays video games, builds things whether legos or tech toys and programs things and studies those sort of things.

It’s good to have that balance and different interests. But… I look at all sedentary activities that both of us participate in and can’t help but think that we both need to be more active. It not only is good physically but also mentally to participate in different activities. Our minds and bodies like variety, need it even, in order to grow and change and become more capable. I also can’t help but look at it from the perspective of a nurse – a variety of physical activities helps the body maintain itself better, encourages better sleep, maintain hormone balance, cleans out toxins and requires “new” blood and oxygen be sent to parts of the body that don’t get much use in day to day activities and therefore are sort of forgotten or stagnant. I think that’s actually why I enjoy the variety of physical activity that I currently partake in. They each get me moving in different ways and activate different parts of my mind and body.

Best of all, there are restive and restorative forms of all of these. There’s finding “the zone” when running. Katas in martial arts where the body acts while the mind quiets. And in yoga there are options for what kind of rest/restoration I need – gentle yoga that’s still movement, hot yoga where I am only focusing on finding balance within the poses and nothing more, or the quiet meditation of restorative yoga where I slowly stretch and relax my body until I find a stillness in each position. Any of the practices are good and serve a purpose. I’m a bit more partial to the restorative yoga, but that’s probably because I just got home from participating in it.

Now on to homework I’ve been putting off. And maybe the gym later. I’ve got some new work outs to try that a friend gave me and I’m interested to see if I can do them and get the full number of reps she suggested.

New experiences at work

Hello there. I have left this blog inactive for too long. This is probably not the greatest topic to start up again with, but I have to vent somewhere.

I started working at a locked psychiatric acute treatment unit a few months ago. I’ve been working in psych for years. Five years I think. I’ve been in some pretty funky situations with people threatening all sorts of things, people out of control, and people acting out against others. However, I’ve never really been in a situation with someone who is not just actively planning suicide, but acting out on it.

Well, tonight that changed. I was just getting ready to leave work. Grabbing my purse and going out to grab my jacket and all that good jazz when one of the room call lights goes off. Since there were only two other staff in the facility and one wasn’t in the office I went out to see if they needed some help. Turns out the counselor found one of our patients in her room trying to hang herself with a part of her blanket that she tore apart and was trying to loop around the door handle. She had tried to block the door from opening with her body (why the doors open into the rooms and not both ways is still beyond me) but luckily it’s hard to block a door with your body if you’re not propped against something.

I think the thing that stands out to me the most is that she had written a suicide note and had it right there on the desk. This wasn’t a call for help, this was an outright attempt. A pretty good one too. I’ve had patients threaten to hurt themselves and declare they were actively looking for ways to do it, but they never actually managed to do so. This gal, she planned it well. She waited until right after a check (every 15 minutes due to risk) and tore the blanket, tied it, and arranged everything. Lucky for us, the counselor went to talk to her earlier than the patient had expected.

The good thing is that we worked well as a team. The RN took lead and the counselor and I were able to act on directions calmly and without tripping over each other. The other patients remained safe and most didn’t seem to even realize something funky was going on. I don’t know if that speaks to our handling of the situation or to how low functioning this particular group is.

I hung around until our program manager could come in since I have to be back in at 6 am and didn’t really get much of a debrief. I guess this is probably it for now. I don’t feel that I need it as much as the counselor does (did?) as she was the one who found this patient and interrupted her. I can only imagine the emotions associated with that, the number of questions, “what if…” that would come to mind. I’m sure she’ll get the debriefing she needs – our program manager made sure to ask how she was doing during their first phone conversation.

Regardless, I’m bringing some chocolate in for both of them and my manager. They deserve it for how well everything was handled and for remaining calm and collected while still at work. I already have my chocolate so it’s only fair that I make sure they get theirs too.

Post a day – Quiet Time

I’m still tired from yesterday, definitely in need of some recharge time. So of course this topic comes up from the post a day blog – When You Need Quiet Time, Where Do You Go?

I have several places I go, all having their different purposes.

If I’m in deep need of pampering–not in the sense of wanting to look good or pretty or even feel well treated, but in the sense of needing to feel like I’m worth receiving a service rather than always being the one to give a service–then I will often schedule myself a massage and try to relax. Or, if I do not have the time or money for that, a bubblebath with an entrancing book and lovely music is the next most fantastic thing. I can really even manage some of that sense just by finding myself on the floor of the tub during my morning shower. Feeling the water wash away whatever I allow myself to release can be enough to get me going for another day.

Honestly though, if I’m truly in need of some quiet time, to me that means time with no other souls around for miles. I live near the beautiful Rocky Mountains. By near I mean that their shadows cover my apartment before the sun has fully set. That means the opportunity for finding places where it at least doesn’t feel like anyone is around is high and I can even engage in several different “quiet” time scenarios. Recharge time for me isn’t always quiet. Sometimes it’s a clash of sounds and sensations. Driving with all my windows down through the winding mountain roads with my music blasting and the feel of the moon on my skin is just about one of the most absolutely therapeutic things I can ever do for myself. Finding a spot that is undisturbed by any others and grabbing a notebook and pen(s) from somewhere and then immersing myself in the silence that is a mountain night is exactly what my soul cries for. I can disappear into my mind and thoughts and heart for hours and hours – at least if it’s warm enough!

Honestly, just typing and imagining this is enough to help settle my soul and mind. THe human mind is quite impressive in that it is able to see and feel and remember so much from particular experiences, especially ones that have truly influenced us as individuals. And for me, those mountain drives are the things of dreams and memories and desires.

Funny enough, I can also find quiet time in some of the most crowded places – a Starbucks or mall or whatever can be very soothing to me… Assuming I’ve my headphones and pen and paper and the chance to completely disregard and ignore the entire world around me. This is something I discovered nearly three years ago when I was mobilized for a year to the desert of Southern California. I knew no one. I was around no one. I had no desire to get to know anyone. It was the loneliest and most introverted and internal seeking year of my life so far, which is sort of saying something. The loneliness was something I quickly got used to and eventually even managed to crave and desire nearly as much as my mountain drives. The introversion and looking into myself was what helped me to recognize that I was not happy, that I was trapped and in the midst of a desperately abusive relationship. And the time to think and just be with myself gave me the chance to learn to that I could do without others and therefore did not need to subject myself to that man and what he represented to me.

Essentially, it helped me to discover and re-establish myself as an adult. Not someone who doesn’t make mistakes. Heaven help me if I ever get so delusional as to believe that I don’t make mistakes. But as someone who is willing and able to learn from my mistakes and maybe even the mistakes of others. That is enough, in my opinion. At least enough to be getting on with now.

Ironically enough, despite the fact that I absolutely adore and love my fantastic fiance, I cannot be “alone” or have true “quiet time” if we are near each other. My attention goes to him and I am too concerned about him and what’s going on and what he may need in order to truly disengage myself enough to start recovering. I think I’ve described this to him, but I’m not sure that he understands. Even now, he’s playing a game on his computer and I’m typing here and half my brain is distracted by wondering if that throat clearing was because he’s feeling like he’s being ignored or is bored but doesn’t want to interrupt me. However, I also know that it’s quite possible he merely needed to clear his throat. If it were anyone else, I wouldn’t give a damn and just assume it was throat clearing. But I do not want to ever appear to be ignoring him. That is not love. But that is also a completely different post.

Before I manage to get too much more off-topic, I believe I will leave this one as it is.

Peace