Category Archives: Psychiatry

Tardive Dyskinesia

Some of you probably know what this is.

I may be developing/have developed this.

For those who aren’t familiar, tardive is a potentially permanent side effect of antipsychotics. Presents as minor mouth tics, muscle tension and generally feeling physically uncomfortable. It’s on wikipedia, you can look it up if you’re interested.

Anyway, I’m apathetic now. I just am so used to shit hitting the fan I don’t care that it’s raining shit.

I hope any of you reading this will never run into this condition. It’s a nasty bit. And any of you who have switched antipsychotics know that the process can be very, very harsh.

Good luck,

unconstructed

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Psychiatric Medication: A Primer In Medical Frustration

Imagine you have something like leukemia.

In order to know you have that the doctor has to in effect prove that you have it. Which can be done (though I know nothing of the complexity involved in diagnostic).

Now think if the doctor had to diagnose leukemia without modern instrumentation, so he’d have to just watch you and see what happens.

Look up the signs and symptoms of Leukemia and take out all those that require physiological testing outside of visual analysis.

http://en.wikipedia.org/wiki/Leukemia#Signs_and_symptoms

“All symptoms associated with leukemia can be attributed to other diseases. Consequently, leukemia is always diagnosed through medical tests.”

So if you don’t have medical tests, you have nothing to go on.

Now think about the brain. How do we know what part of the brain does what? Two ways that I know of are analyzing case studies of people who had brain damage at a specific location and look for deficits or stimulate that part of the brain and analyze what the person says he or she is experiencing.

And that’s just the low level analysis.

Consider than how difficult it is to diagnose something like bipolar, which is diagnosed via the DSM IV (or V if it’s out yet).

 

  • The presence of a hypomanic or major depressive episode.
  • If currently in major depressive episode, history of a hypomanic episode. If currently in a hypomanic episode, history of a major depressive episode. No history of a manic episode.
  • Significant stress or impairment in social, occupational, or other important areas of functioning.[13]\

 

How many of those do you think can be explained via medical testing? The answer is, at present, none. The other problem is that it’s not at all clear that bipolar II has the same cause in all cases.

So we now approach medication.

In our leukemia example, there are treatments that attempt to control it to the point of remission. Granted, this is very very hard to do and leukemia is a terrible disease, however…

How does a psychiatrist pick a drug for bipolar II?

He can’t. Or at least, he can’t obviously pick one. Except possibly in the case where only one medication exists for the specific noted behaviors. In bipolar II this is not the case. Further consider that a few of the major drugs for bipolar were originally used for epileptic patients to keep their seizures controlled or at least lower the occurrence.

This is not to say that psychiatric intervention doesn’t work. I myself am currently on a medical cocktail that seems to work (although lately I’ve been experiencing a level of depression that I haven’t felt in a while…).

But I’m on Pristiq, Wellbutrin, Lamictal, Provigil, Adderall, Cogentin and Abilify.

That’s a lot of meds.

Now what do I do when something goes bad like it has recently?

All of those drugs are working to keep my bipolar in check.

So how do you figure out which one is failing to help? Or how do you switch out one med for another?

It’s not easy. On the patient or the psychiatrist.

This becomes extremely frustrating.

And this is all without mentioning the fact that many of these medications have extreme side effects. In many cases the patient has to decide what they’re willing to live with. Do you accept the possibility of Tardive Dyskensia? Or do you accept psychosis? Do you accept the possibility that one of your drugs will stop working, because at the moment it works pretty well?

These are all hard questions.

And I don’t know the answers.

 

unconstructed

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It’s just in your head

Mental illness is a condition. We must remember that. A recent comment on a post led me to make this a post, since it was getting a bit long for a comment and contained issues that I wanted to express to the general public readers.

Some people have “pulled themselves out” of depression. But what does that mean?

If you pull yourself out of mental illness and get back to normal functioning… I don’t know, I’d be hard pressed to call that mental illness. Sure, you might be able to get to some form of function, but completely recovering by yourself to the same place you were before in my opinion is not mental illness.

Clinical Depression is mental illness.

Mental illness is by definition highly debilitating.

“In addition, for a diagnosis of major depression to be made, the symptoms must not be better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.”

http://psychcentral.com/disorders/sx22.htm

One of the problems with depression is that people treat it differently than bipolar or schizophrenia, because for one reason or another only bipolars and schizophrenics are “crazy”.

For many people I would argue that they cannot get out of it themselves. I mean, think of a broken leg. Ya you can let it heal, but you’ll often be debilitated for life because of very badly healed bone.

People often do not treat mental illness and “physical” illness the same way. For some reason antidepressants are a “crutch” that isn’t necessary, while a physical crutch is at least temporarily necessary if you want to be able to deal with anything more than laying down. Antidepressants are more like a wheel chair in many cases. A paralyzed person can work without a wheelchair, but it’s damn near impossible. I don’t see why people assume depression or bipolar or schizophrenia is necessarily different.

There are cases of temporary mental illness, that is, mental illness that seems to be healed after a certain amount of time. And I do believe that can be real depression. Just like pneumonia is a temporary illness if you get it dealt with, in some cases depression can be temporary.

We must be careful though. Depression is not just the feeling or the apathy. If it is truly a brain chemistry issue, fixing your own physical brain is extremely difficult or possibly impossible. Depression can entail a lot of things that are very hard to deal with. In my case (with bipolar) I had psychosomatic aphasia and paralysis. I also have Tourette’s and OCD. Those two are often comorbid.

Attempting to deal with it completely by yourself is what people usually do before they get help. No one wants to think of themselves as mentally ill. You have to get to the point where you can’t get out of it yourself and are willing to admit that you’re ill. Or to the point where you’re a danger to yourself or others.

I really am not trying to single the commenting person. First, the position given was vague and I don’t want to impute intent or meaning when I’m not completely sure. Also it’s a common position and should be addressed to everyone. I’m not mad about what the person wrote. Honestly it gave me the inspiration to write this post. And I certainly do not impute all these beliefs to that person, I’m relatively sure that person didn’t mean everything that I wrote down. It just reminded me and I wanted to write out the possibilities thoroughly.

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Emotionally Unstable: The Myth Gone Bad

Is it just me or do people cringe most or get most annoyed not by longwinded argued points, but by assumptions and off-hand remarks?

I was just watching this:

Slut Shaming

The part that got me didn’t have anything to do with the girl. The part that ticked me off was the off-hand remark about kids being emotionally unstable.

Let’s think carefully about that word for a minute.

What does it mean to be “emotionally unstable”? Does it mean the person is just a little away from the average in emotional scale?

No. He doesn’t give us that option.

He links it directly to “medication” going around. And somehow that is an explanation for more kids being emotionally unstable. This argument can be used to belittle clinical conditions. Granted, so can overprescribing medication. But we can’t merely say that all the growth is from the psychology of children changing or overprescription.

What about those children who wouldn’t have been found in the past? How many autistics went unhelped because it just wasn’t diagnosed or hadn’t been studied fully and so it was determined only by very obvious signs. What was a schizophrenic before the term came around?

He was just crazy. Mad.

Bipolars? Mad. Depressed? Lazy. Fibro? Liar. ME? Weakness. Autistic? Mad. Aspergers’? Weird or Neurotic

With better diagnostics and more studies shouldn’t we expect more children to be helped by medication and therapy? I know a young child who was diagnosed early with Asperger’s Syndrome. Did you know that there is a higher rate of suicides in Asperger’s children than those who do not have the condition? His mother was able to get him into special help so that he could learn to socialize with other children despite his socialization problems related to Asperger’s.

This very well may have saved his life.

People want to believe that mental illness really isn’t there. Especially in those illnesses where it isn’t extremely obvious due to hallucinations or the like. They want to think that this isn’t real. I’m not sure if this is so much because they can’t see it or because they just can’t conceive it and don’t want to believe that it could actually affect someone such that their actions are severely affected.

Think about the death penalty.

Why is it that we want/have wanted a “humane” death penalty at one time or another? I propose that it has nothing to do with the executed. It has to do with the executors. By that I mean not only the operators of the machine but also  all the people of the area that were for the penalty being used. And I would argue it has nothing to do with their sense of conscience.

It’s because we don’t want to see death.

We want death to be quick and painless (or as painless as possible) because we can’t think about death for more than a few seconds in real life.

I thought of this when watching Green Mile during the botched execution seen. One of the executors didn’t wet the sponge on the victim’s head to allow for a quick death. A lot of people are watching him be killed/executed. But when it goes to long, and death stares them right in the face, they run like hell.

And perhaps this is part of the mental illness myths. We don’t want to believe they’re that serious. We don’t want to believe that that could happen to us or our children and that we or our children have no control of that? What do we do about a disease that we can’t see and has no complete physical understanding?

The unknown stares back at us and it is a darkness which we want no part in.

Well, I don’t get that luxury.

So I’m bringing my own dry sponge.

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Unfairness and Disability

Reality can hit the disabled quite hard. While many countries have developed methods to make sure to include the disabled as much as possible in everyday life, it doesn’t change the fact that the individual is disabled.

For example if you are paralyzed from the waist down, there is a lot of assistance you can make use of. However this doesn’t change the fact that you cannot move your legs in the normative fashion. Being disabled means precisely what it says regardless of what assistance measures can be given.

There are things an able bodied person can do that you cannot.

I think anybody who complains about measures to help the handicapped or disabled, or those who promote the idea of idiotic statements like “handicapable” should remember this.

You may be angry that the handicapped get nice parking spaces, or that the blind or deaf have assistances. Or in my own case you may be angry that I am allowed to take less than the minimum number of classes and still be a full-time student. But remember…

The blind still cannot see.

The deaf still cannot hear.

The parapalegic still cannot walk.

And I still cannot manage the number of classes that the average student can, and I still pay the same fees the average student pays.

It’s very hard to see the disability related problems unless you are often in contact with someone of a disability. For example, how long does it take you to shower? Imagine how much longer that would be if you didn’t have the use of your legs. How hard is it to justify why you need a crutch if you break you leg? Imagine how much harder it is to justify why you need antidepressants when there’s no physiological test that instantly shows that you have clinical depression.

I ask that people would think about any “unfairness” by accessibility options given to the handicapped and compare it to the true unfairness of being handicapped.

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Quick note on mental health diagnoses

I thought of this when I read this blog’s entry on bipolar diagnosis..

http://counselorssoapbox.com/

I think he makes some very interesting points, and this guy knows his stuff from the counselor/psychologist point of view, so definitely if you’re interested in that he seems like a good guy to follow.

What I personally want to talk about is behavioral diagnosis.

Let us, for lack of better terms, draw a line between “physical” illnesses and “mental” illness. Physical illness usually invites us to consider a cause. A broken leg, for example. The cause of the pain is the broken state of the leg.

With mental illness however we don’t diagnose this way. We look at a patient and classify his behavior. Why? Because the brain is notoriously complex and we don’t always have the luxury of time.

Does this make the diagnosis any less real? Any less relevant? No, of course not. Just because we don’t know the combination of things causing these high level behavioral problems doesn’t mean they don’t exist.

And even if we could diagnose directly, how do we use that information? In the end, we have medications that help with certain conditions. These conditions are defined behaviorally. We won’t have medicine where “if neuron 17 is firing too fast we administer N17-Fire-Slower-XY” (all medications need excessive letters).

If someone is depressed, an antidepressant may help. One of many antidepressants may help.

And unfortunately at times none of them help.

I just think the behavioral vs physiological diagnosis leads people to come to the conclusion that mental illness isn’t really there. And that should be corrected. Hopefully someone will benefit from this.

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Just a crutch

Is psychiatric medication “just a crutch”?

Yes. Under a specific definition it is.

What is a crutch? What is it for?

It helps you keep walking. It helps you keep moving. You can’t address the problem directly (magically repairing bone) so you take an indirect step where longer term medication and intervention eventually works out.

Some argue that psychiatric drugs are just a crutch.

Tom Cruise among them.

But I have to ask. Would you really take a crutch from a guy and tell him to walk it off? And seeing as a good chunk of mental illness is chronic, would you take a wheelchair away from a parapalegic and tell him to walk it off?

If I could directly fix my brain chemistry, I would. Problem is I can’t. The next best solution is to make things livable.

So are psychiatric drugs just a crutch?

Yes.

And please give me my crutch back, I need to get to work.

–Unthought

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Relationships and Mental Illness Part I: Romantic Relationships

I want to address a concern of mine about relationships with one (or both) individual with a mental illness.

First I need to make this clear. It is legitimate to not pursue or end a romantic relationship because the mental illness is either too much to handle or is just making the relationship work is something you cannot imagine doing long term. We always have a right to end a romantic relationship if we feel it cannot be sustained.

Beyond that, how does mental illness affect relationships?

Well, I’ll start with the most physical and end with the least.

In a romantic sexual relationship, there is at least one side effect that can really make things difficult.

That is the problem of loss of libido or the nearly absurd increase in libido.

Both partners should realize this is a problem for the other. The mentally ill partner does not, in general, want this to be the case. Not being able to meet a partners sexual needs is a very frustrating issue on either side. We must understand that this is not of the volition of the mentally ill but rather something outside of their own control. And we must understand that it’s very difficult to accommodate a partner whose sexual needs seem to change drastically.

In my manic phases I suffer from hypersexuality. Some make the absurd claim “Wow, that must be nice”. It isn’t. It is in NO way a nice feeling. Especially when one has no outlet outside of oneself. This has nearly driven me mad as a single male, and if I were not single it would still drive me mad as it would be a bit much for any normative sexual person I think…

Similarly there’s the issue of sexual dysfunction. Anorgasmia I think is one possibility. This would be incredibly frustrating as you can probably imagine. If you love your partner you want to do your best to fulfill their needs, at least up to a reasonable standard, and being anorgasmic or having a partner who’s anorgasmic is frustrating.

I will write part II either today or tomorrow. Until then this is Unthought, signing off.

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Self-Medication: Why?

Self-medication is often misunderstood. I’m at a loss of how to articulate the misunderstanding well, but here goes…

Self-medication is just what it says, but there’s a deep meaning to what it literally says.

Imagine you were on crutches and they broke. You would try and find something to support yourself, even a tree branch if nothing else. A tree branch isn’t a good fit and it’s not terribly safe, but you need to move.

In the mental health case it’s similar. Alcohol is often used within the legal realm of self-medication. Is it a good idea when you’re on meds? Of course not, you’re destroying your liver when it already has to deal with the medication you’re throwing at it. But that’s not how people think. In the end, when the short term is bad enough it will take over long-term interests.

We live in the present. We cannot live in the future. There are certain things that people are just not willing to accept.

Tomorrow I’ll write something about medication and how it works out in practice, but for now I’ll just say that relative to the previous unmedicated position, medication is sometimes a godsend. But it’s not all encompassing. And it has the potential to cause its own problems. When your libido tanks, what do you do? What do you do when your mind is clouded. You get anxious, you get scared, and you don’t want to think about it or live in that understanding of the world, so you use alcohol or something else to keep moving. Of course it’s a bad idea, and anyone with a mental illness who’s read anything about the subject knows that. But that’s not the point. I can say you’ll have a 7 course meal in a week if you have nothing to eat or drink before that, but thirst and hunger are very difficult to bend to the long-term interest idea.

And that’s just one thought unthinkable. Be back tomorrow for another thought.

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