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"Marked impairment in functioning"

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WTF does that actually mean (in regards to mania)? How do we define marked impairment? What's the level? Is yelling at your kids a lot marked impairment? Or do you need to completely neglect their needs because you're too busy with other stuff? Half-assing dinner because you can't focus long enough to make a real dinner? Or is it more like going out every night because you can't even stand still long enough to cook, and you're impulsive? Would a manic person be able to control (without meds) the urge to buy something they want? 

And what about psychosis? How do you distinguish between psychosis and severe anxiety? Like, if you're convinced that someone is actively plotting to kill you, is that psychosis paranoia or anxiety paranoia? What if you've got real things happening, but you attribute negative meaning to it? Like, you hear a voice in the background, and you panic because you're hearing voices, but then you later find out it was just your kid playing with a toy? 

I know no one here is a doctor, and I plan on filling in my tdoc, but these are questions that have been bugging me. Because I'm so all over the place, and now suddenly a bit euphoric with interspersing of sudden anger, and I'm talking really fast, and I can't focus on one thing for long, my husband thinks I'm moving into full-blown mania, but I don't know. I just don't know how to tell the difference. I don't think I'm manic, but I probably wouldn't think I was manic if I was. I don't have the greatest insight in the world. Hence my stopping meds awhile back. I'll be getting back on them just as soon as I can, by the way.


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I went off my meds because I couldn't afford to see the pdoc, and the local clinic with the sliding fee scale only lets you see the pdoc if you take part in their therapy, and the only therapy they offer is group therapy, but my current therapist won't see me if I'm seeing another therapist or am in group therapy, so I need to wait until we move to go to the clinic there where they have individual therapy, but moving is taking a lot longer than it was supposed to. The only reason I'm trying to differentiate right now is because of how concerned my husband is. I really want to be able to set his mind at ease. I don't want him to worry. I don't want him to try to push me into inpatient before we can realistically do that. It's hard to find an apartment when you're in a hospital 100+ miles from where you're looking to move.

Edit: It occurs to me that I probably shouldn't have posted all this. I know this is a pro-treatment site, and as I'm not on meds, it's probably wrong of me to even talk about this. I promise I want to get back on meds; I just can't yet. I would lose my individual therapy that I really feel I need in order to function. 

Edit 2: I'm sorry.

Edited by chantho
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I'm gonna echo Sylvan here.

For some people pro-treatment here is meds only. For others, it's therapy only. And for yet another group, it's both meds and therapy. 

Keep seeing your t-doc. and do what you can to scout out a new t-doc and p-doc where you plan to move.  

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FWIW ... I think "Marked Impairment in Functioning" means different things to different people.  I really don't know how to define it myself but it doesn't seem like there is a list or something DRs or tdocs check off to say 'yes' or 'no.'  I think it is variable.

(Someone please correct me if I am wrong).

Edited by melissaw72
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Yeah, I got my butt to the tdoc today. He said there's definitely some serious elevation going on (obviously) and that he was kind of expecting me to go in the direction of psychosis when I told him about the paranoid ideation and (I don't think I mentioned this here) the conviction that there were bugs crawling under my skin. Since going inpatient is what we really want to avoid, for now we have an appointment with a different therapist in hopes that they can get me quickly into a psychiatrist to stabilize me so I can move. If I get worse over the weekend, he wants me to go to urgent care or the emergency room to try to get meds to last me until I can at least see the therapist. If I have to go IP, sobeit. My husband is going to talk to his supervisor and see if he would be able to get time off if I did have to go IP. But I think I'll be fine as long as this is as bad as it gets. Even if it gets a little worse, I think I have wiggle room for what I can handle with distractions/coping skills. 

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