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5150 for homicidal fantasies?


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Hi all,

Sorry if this is long...

 

I'm wondering what my tdoc's rights are as far as forcing me into IP goes? I'm in NC.

 

I can't afford IP right now, but i definitely need my tdoc's help. I'm just afraid that she'll take what I say the wrong way.

 

So, here's what's going on at the moment:

 

About a month ago, with my pdoc's approval, I began to lower my dose of Abilify. I started having some suicidal thoughts, which I decided weren't a big deal, but then I started having a bit of a homicidal "fantasy." I call it a fantasy, because it wasn't like a thought implanted in my head, and it wasn't a voice either. I've dealt with those before. This was different. It was my own thoughts about killing a specific person a specific way, and to top it all off, I had the means to do it. It scared me, so I re-upped my abilify.

 

Thankfully, I'm now away from the specific person, but, I'm still having the fantasy... Sometimes I even feel regret for not doing it when I had the chance. So far though, I only feel the regret for not doing it. I haven't started to formulate new plans in ernest, but I'm afraid that I will.

 

I don't think I'm really a danger to anyone. I don't think I would ever hurt anyone. I just want the fantasies to stop. They only really happen when I'm laying in bed trying to fall asleep. I've tried listening to music to block the thoughts, but that doesn't work. And I can't wait to go to sleep until i'm exhausted, because I'm verging on a manic episode at the moment. I need sleep, and it seems like the only way that sleep comes is when I'm fantasizing about killing...

 

So,

 

Does anyone think my tdoc would force me into IP for this? 

 

Does anyone have a good way of stopping these kinds of thoughts? 

 

Thanks for reading...

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After Sandy Hook and Newton, and the President of the United States reassuring MI professions that its more than okay to report potentially violent patients to law enforcement authorities, what do you think someone who pays malpractice insurance is going to do?

 

But as far as stopping the thoughts, that's what the MI professionals are there for.  There's a reason that they always ask if you feel like hurting yourself or anyone else, its a very serious symptom.  If you are worried about your rights, get legal counsel and an advanced directive drawn up, and possibly power of attorney given to someone you really trust.  After that, seek treatment.

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I can't second-guess what your tdoc will say or how she will react, but I do think that talking to her about this will bring you some relief.  It sounds like a big burden to deal with these thoughts on your own, and your tdoc and pdoc can help you figure out how to address them and what you need. 

 

What if simply talking about the fantasies or making a med change could really help you?

 

My advice: Be honest with your treatment team.  If you are on the verge of a manic episode, it is wise to seek treatment sooner rather than later.

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If you are ramping up and on the 'verge' of a manic episode PLUS you are ruminating and obsessing about murder of a specific person than I think you need a lot of help.  Immediate help. 

 

Currently you have insight, and self control.  But if you were in a full mania you could lose that perspective and be a danger to yourself and others. 

 

Have you called your pdoc and asked for immediate assistance, a rescue med?  a switch or addition to your AAP?  Does lowering or eliminating the Adderall help?  I think you need pharmaceutical help right now, out patient or inpatient.

 

If you cannot get things under control then you should consider a voluntary inpatient admit - your pdoc can arrange it. 

Edited by bpladybug
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You're on a very healthy dose of Adderall. Have you discussed lowering it? Especially if you're on the verge of mania. I have to stop taking Adderall every time I feel like I'm getting manic. Sometimes stopping Adderall really helps me get things back under control.

 

As far as the thoughts go, you should tell your tdoc (and pdoc). I know if I told my pdoc/tdoc they'd listen to more than just my words. They'd also use their experience and past knowledge of dealing with me to help them decide if I needed to go IP or not. You may not need IP. You may need a med change. Call them both. You evidently have trusted them in the past and you should do so now. They're trained professionals. Trust their judgement. 

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I'm only taking 20mg's of adderall a day at the moment, because I felt the mania coming. 

 

I sent my tdoc an email last night, but I won't be able to get in to see her for a couple of weeks. I haven't tried calling my pdoc yet. I know I should, but she isn't really seeing me any more. I'm about to move away and had my last appointment with her about two months ago, but I'll call in on Monday and see if i can get an appointment with at least someone in the office.

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When you call your providers, be sure to tell them you are having an increase in homicidal thoughts and that this is urgent! Those words should help triage you more appropriately if the homicidal thoughts are new or increased over past.

 

You might also consider consulting community mental health center(s) in your area or whomever handles the crisis services for your areas. Sometimes they can get emergency/urgent psychMD appointments for rescue meds for things like psychosis and homicidal thoughts.

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Just an update: the fantasies have stopped. I'm manic, but my pdoc doesn't think I need ip. I have an emergency appointment with her Tuesday. What do y'all think I should ask for to stop a manic episode? Zyprexa?

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Really glad to hear you've gotten some relief from the homicidal thoughts! What a relief that must be.

And great that your pdoc can get you in for an emergency appointment.

 

If you have good or bad prior experiences with any of the atypical antipsychotics, that would be a good thing to make sure your pdoc knows.

 

Like geodon made me feel like my forehead was falling off (that's really the only way I can explain that)... and slurroquel, godsend that it has been for me, knocks me out cold and squelches anxiety really well.

 

But I've never had mania ever, so I'd say make sure your doc knows your med history and let them decide.

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I think my mania is over!!! I slept six hours last night, and even took a nap today :) I'm still gonna see my pdoc Tuesday though. I'm going to ask for something PRN for the next time this happens. Thanks for the help everyone!

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