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bipolar psychosis - can you avoid inpatient?


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So I'm doing a PHP and someone complimented me yesterday on how much better it seemed like I'd been doing since the IP stay previously (about three weeks ago by this time).  My comment was, "at least the walls aren't talking anymore."

Sadly--can't say that as of late last night.  I was in bed getting ready to fall asleep early-ish (9 or so), when I decided I had to dump some thoughts from my brain and found myself out at my laptop talking about my day (that blog post still is up, though lonely without feedback!).  I type the vast majority and then started getting some very quiet "background noise mumbling."  When I started listening, I head phrases.  Weird, like last time, they were fairly friendly voices - things like you can do this or we'll be with you when you wake up or we're here for you.  Needless to say though, unbelievably frightening because the only other time I've had a talking wall/voices from outside my head was when I was inpatient.  They at least weren't the voices of people I know, which would continue to confuse me. 

My PHP has an emergency on-call number, so I dialed that number to report it and figure out what I needed to do (in part b/c I'm supposed to drop from 5mg to 2.5 mg abilify--but his solution on that was beyond logical, of taking the 2.5mg and then bringing the other 2.5mg in in case that they want me to push through the akathisia and keep taking it).  I also mentioned I was scared the voices would continue if I tried to go to sleep, so I tried to get a sign off on a sleep med increase.  He had understandable reasons against most of what I take, so we landed at a compromise of 50mg this time.  I did mention that when it was at its worst, it made me suicidal really quickly, but that I felt safe, just incredibly depressed. 

The weird thing is that although the voices existed while I was finishing my post and as I went back to my room and curled up under the covers, crying and hoping they would go away, they did actually stop right after I called the main emergency number to page the psych resident on call.  And they didn't pick back up after the call.  May have been because I crashed fairly quickly, but who knows. 

 

That's a long lead-in to a less lengthy question....if you've expressed bipolar (or depressive) psychosis, have you automatically landed yourself IP?  Or is it possible that when I tell the PHP the truth in five hours, I'll be able to remain in the unlocked area of the building?  I really don't want to land in another hospital, even though I like this one better.  I'm just hoping that there's a way to make it work OP, even if it means I have to beg my dad to come down to watch me or go up to their home.  I don't consider myself a suicide risk, though I felt more desperate than I did the first time.  But I've never worked with psychosis on an outpatient basis. 

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This happens to me when I am really stressed out and over-tired.  I could hear nothing for a few days, then all of a sudden they start up.  When I think back like what was any if at all stressful over the past few days, I'll usually think of something, and then think how it must have been more stressful than I thought.

3 hours ago, dancesintherain said:

So I'm doing a PHP and someone complimented me yesterday on how much better it seemed like I'd been doing since the IP stay previously (about three weeks ago by this time). 

I think I really understand why this could have caused you stress.  If it were me, being told this would really stress me out if someone said I was looking better than I was a few weeks ago. 

The reason I would be stressed is because for whatever reason, if someone tells me I'm looking good/I seem to be doing well, I get scared because I know I still need help, yet here I am being told I look better than the past few weeks.  And if someone tells me I seem better, will the DRs notice that too?  Will they treat me like I am doing better (I can't phrase what I have been trying to but what I mean is that when anyone sees me as doing better, I worry because what does the pdoc think?  I know I'm not doing better, and still need the help to the degree that I am getting it).  And being told this (for me at least) is just something else to worry about on top of everything else I'm dealing with.

3 hours ago, dancesintherain said:

The weird thing is that although the voices existed while I was finishing my post and as I went back to my room and curled up under the covers, crying and hoping they would go away, they did actually stop right after I called the main emergency number to page the psych resident on call.  And they didn't pick back up after the call.  May have been because I crashed fairly quickly, but who knows. 

I understand this too.  When you talked to the on-call pdoc resident, I think he validated you in that something was still wrong, and that you still needed help.  Does that make sense?

I get the same way when I am told I seem to be doing better.  I am afraid that pdoc will see the same thing and I would lose the availability (?) of treatment I have, and might be told less appts, or whatever (I think you know what I mean?)  And then the next appt I will be a mess because I was be so stressed out about being told I looked better when I knew I wasn't. Fortunately my pdoc doesn't think that way.  And I hope yours doesnt think that way either.

3 hours ago, dancesintherain said:

That's a long lead-in to a less lengthy question....if you've expressed bipolar (or depressive) psychosis, have you automatically landed yourself IP?  Or is it possible that when I tell the PHP the truth in five hours, I'll be able to remain in the unlocked area of the building?  I really don't want to land in another hospital, even though I like this one better.  I'm just hoping that there's a way to make it work OP, even if it means I have to beg my dad to come down to watch me or go up to their home.  I don't consider myself a suicide risk, though I felt more desperate than I did the first time.  But I've never worked with psychosis on an outpatient basis. 

When I had bipolar and was starting to have psychosis (before SZA diagnosis) I didn't go IP unless I asked to or ODd which landed me in the ER. (FWIW ... different though when SZA)

(in bold) Not sure what you mean by telling the truth in 5 hours? 

(2nd bold) I think it will work with OP as long as you tell them the truth about everything.  I think you'd be hospitalized IP though if you told them you were suicidal and ready to act on it.  and if you have to beg your dad to help out, then that would be a great idea, IMO.  Actually now that I think about it, that would be ideal.

(3rd bold) I think being in PHP now, is a great time to work with the psychosis while you have a lot of support.

If people tell me in general that I'm looking better, I say something to the degree that "that is thanks to the medication" or something similar.  I hope you start to feel better soon.

 

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Melissa, thank you so, so much for all the insight and helpfulness. It makes complete sense, not to say other options aren't possible.  But given that I replied to the you are doing a lot better with "at least the walls aren't talking" (which is the only way I felt better), it seems like having that kick up because of stress makes sense.

by tell them the truth in five hours--our program starts at 9:30 which is about 5 hours after I wrote the post.  I have to be honest both because it's the only way I'll get through this and also because the psych emergency call resident will have given a copy of the report and recommendations to them.  They have access to our files and make a note in them.

i think ill preemptively call my dad to see if that's an option.  I don't want to ask in the long run, but if I have to, I will.  He had previously volunteered for laundry purposes so I think he is still available.

thanks again for all the help--it's invaluable.

Edited by dancesintherain
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6 minutes ago, dancesintherain said:

Very much so.

just checked with my dad (not ideal but he's free) and he's willing to come down if needed.  So I have that bargaining chip plus the 24/7 psych resident emergency line that I've already demonstrated I'm willing to call.  Hopefully that will be good enough.

That is great about your dad helping out!  I think (IMO) having your dad help out would be enough, as well as calling the resident emergency line.  This happened to me (different situation) when someone else had to watch me/keep an eye on me.  My pdoc at the time had to see and talk to the person helping out, about whatever (I didn't hear everything), to make sure she really was going to help, and not make things worse. 

NOT saying that your dad is unreliable/make things worse, just saying that my pdoc at the time had to be careful with me on his end so he didn't get screwed if something did happen to me while in her care.  He was taking extra precaution.  It was a different scenario, but overall that was what had to happen before I went somewhere with someone who would be helping me out.

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I wouldn't worry too much. Residual psychosis is common and I doubt they'd hospitalize you unless you were a danger to yourself or others. I don't get really strong auditory hallucinations but I have delusions, sometimes even when I'm not deep in an episode. No one has tried to lock me up for that.

edit: unless the delusion is leading me to hurt myself, then it's hospital time.

Edited by aura
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I've done PHP and IOP for 4 weeks and I never saw anyone get readmitted, no matter what crazy stuff they said. It did get them some more group attention and maybe another extra 1 on 1, but no one got readmitted IP. One did get kicked out, but that was for being disruptive to the group.

A lot (I think) has to do with what you want. If you want to stay PHP and can demonstrate you have good coping skills, why lock you back up? The goal is to help you learn how to deal with your disorder, and IP isn't very good for that IMO. I was IP before doing PHP and IOP voluntarily, and I got far more useful help from PHP/IOP than IP.

You leveraged your resources appropriately (to me) so just make sure you reach out when you need help (like you did.)

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Thanks Melissa, aura, and dtac.  It seems their philosophy is similar to what you all mentioned in terms of keeping in the community whenever possible.  She actually said that she wouldn't have required it, but would have requested i try to find someone to keep me company for the weekend (or longer but I can't really pull off longer).

it was actually an interesting appointment.  My anxiety became quite apparent when I was talking about how confused I was about having supportive voices and such things and that I thought they would have gone away and that it was weird they stopped when I asked for help.  Her comment is that sometimes our brains really pay tricks on us and aren't really showing signs of psychosis.  She said that she thought given how short things were that it was more likely to be a trauma and anxiety thing (namely that I was so traumatized by the IP stay that my brain defaulted to what it was experiencing then when I didn't feel like I was improving).  I hadn't actually heard of this, but it made sense.  It also to some degree might explain why they were somewhat "cheerleaders" instead of being so negative.

she said if I was really concerned, we could treat it as psychosis and add something else, but to her it seemed a bit excessive given the fact that I'm already on 400mg of seroquel and considering going down to switch to latuda.  I said I was okay if I could continue to have the 50mg of Benadryl in my back pocket for knocking me out. She said I could and it's probably the kind of med she would add on if needed anyway.  But that if I'm taking the Ativan and seroquel, she would really rather that I didn't.  

So...not psychotic?  Trauma response plus anxiety kicked in?  Not to say I wasn't psychotic earlier--neither they nor I think I wasn't.  But that this 45ish min experience might not have been.

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Stress and anxiety cause all sorts of crazy reactions. I've been under a lot of stress lately, and I started hearing music and talking in the back of my head, 24/7. Went to my tdoc and pdoc about it, both agreed it's related to stress and worked with me on ways to bring it down. Also sounds like you like to analyze things, like me. My tdoc gets on to me constantly about over-analyzing stuff and that it's probably a not-insignificant amount of my stress. Whatever. I'm analytical, and it probably does get me into trouble ^_^

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47 minutes ago, dtac said:

Stress and anxiety cause all sorts of crazy reactions. I've been under a lot of stress lately, and I started hearing music and talking in the back of my head, 24/7. Went to my tdoc and pdoc about it, both agreed it's related to stress and worked with me on ways to bring it down. Also sounds like you like to analyze things, like me. My tdoc gets on to me constantly about over-analyzing stuff and that it's probably a not-insignificant amount of my stress. Whatever. I'm analytical, and it probably does get me into trouble ^_^

I agree with stress and anxiety (and lack of sleep) causing the voices to come on.

 

Sometimes I like to look at things from different perspectives.  Maybe it is analyzing, but IMO I don't think it is over-analyzing. 

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I think there's a difference between full-blown psychosis and some psychotic elements from time to time. I have mild auditory hallucination - usually nonsense - when I get stressed, but I don't think of it as psychosis. Psychosis was when I was fully convinced I was communicating with God and angels and what not. It all exists on a spectrum.

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Thanks again friends.  I'm glad to hear the idea doesn't sound completely crazy.  It was absolutely terrifying (literally) when they came back and almost sent me over the edge.  To be honest, had I not had access to the psych ER resident, I might have dumped myself in an ER again, but for the absolutely miserable experience I had last time I was in.  I'm not sure what I would have done instead as a result.  I'd still be alive, but probably wanting to not be.  I don't know why it's so terrifying--maybe this time because it links to the crazy IP stay and the overbearing IP pdoc and the sense that I lost all control over my own life and treatment.  We decided during the appointment with the four levels of psychiatry people that that particular hospital stay counted as a trauma because of the combo of how bad I was and how poorly I felt it went.

i appreciate the idea of a spectrum also.  It makes sense. I just really, really, really, really hope it doesn't come back again.  Is that enough reallys?

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I hope it doesn't come back too.  But if it happens to, you know what to do now that works for you ... call pdoc or (on-call resident or whomever else is covering) if after hours, and explain everything, working with the pdoc on-call to help you decide how to tweak meds to get you through the night until you can call pdoc in the morning.  And seeing that that works, IMO you might not land in the ER/IP.

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We're currently extremely frightened about disclosing this kinda thing too; Recently been rehomed, my psych team are taking the "ehhh, settle in, it takes time, we'll be in contact sometime in August, y'know?" approach to "help I really need urgent support" and.. Yeah. Figure we're going to have to disclose some things we were hoping for more guarantees of confidentiality (hah) before disclosing. Like the delusional episodes. They were already aware of the hallucinations, or at least, one occurrance, and didn't seem overly fussed. I think the delusional stuff may rattle a hornets nest though; or get me what we need. I dunno. I hate psychs, hah. But. We in general can't survive like this.

Thinking we're going to get the "eh, stress does things to ppl's brains, w/e" response. Which.. Could be good or bad; Being dismissed in such a condescending manner sucks, but we have no desire for hardcore APs either. ¬_¬

Tri

Edited by WinterTidings
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I hear you Tri.  It freaked me out that I might end up inpatient (including have the symptoms freak me out) because my most recent IP experience was rather bad.  Not horrible, given stories I've heard here, but still bad. 

I'm sorry the disclosure is so frightening, but I get why it would be.  On the other hand, it's really critical if you want to make the scary symptoms go away (as you probably know already).  I hope that you all are able to talk about the symptoms.  I actually didn't mind the stress does things response just b/c I didn't know that was a possibility.  Knock on wood, it hasn't come back.  But I know my doctor also said that if I wasn't comfortable accepting that, she'd be willing to prescribe something different.  I figured I'd give her theory a go and got a call from OP pdoc that he liked her approach also. 

The "we'll be there in August" approach to "help I really need urgent support" is ridiculous.  The only possibilities I could think of though would involve an ER, which could risk an IP stay.  If you need it to stay safe, though, please do keep it in mind.  I was gently talked back into that mindset by one of the nurses at my PHP by her description of their IP as opposed to the one I was in.  Do you all have any choice about where you'd end up? 

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20 minutes ago, dancesintherain said:

I hear you Tri.  It freaked me out that I might end up inpatient (including have the symptoms freak me out) because my most recent IP experience was rather bad.  Not horrible, given stories I've heard here, but still bad. 

I'm sorry the disclosure is so frightening, but I get why it would be.  On the other hand, it's really critical if you want to make the scary symptoms go away (as you probably know already).  I hope that you all are able to talk about the symptoms.  I actually didn't mind the stress does things response just b/c I didn't know that was a possibility.  Knock on wood, it hasn't come back.  But I know my doctor also said that if I wasn't comfortable accepting that, she'd be willing to prescribe something different.  I figured I'd give her theory a go and got a call from OP pdoc that he liked her approach also. 

The "we'll be there in August" approach to "help I really need urgent support" is ridiculous.  The only possibilities I could think of though would involve an ER, which could risk an IP stay.  If you need it to stay safe, though, please do keep it in mind.  I was gently talked back into that mindset by one of the nurses at my PHP by her description of their IP as opposed to the one I was in.  Do you all have any choice about where you'd end up? 

The one team member who hasn't gone on holiday on our main/only psych service (Autism related) and has said she'd be the go-to contact for me & carer during the period of moving back into the City gave an equally unhelpful response, but on reflection she probably hasn't been filled in on the facts; Still, that response is.. Yeah. They all messed up. I'm hoping that spreading our cards clearly on the table is going to make them sit up and take notice. It's just making sure they're not too alarmed, y'know?

And.. As for treatment, we mostly want it for the Bipolar stuff, the psychotic symptoms.. Are fairly rare (..though the frequency has been escalating during past 4-month crisis, unsurprisingly), and I know antipsychotics are by and large nasty meds. So.. I dunno. It's not a primary treatment priority as "my partner/carer can't be on Suicide Watch 24/7 forever, they have to go back to their own life in the next week or so, and we have f'all treatment for this and care service doesn't seem set up to take that kind of observational task".

One of our major worries is the fact that our first hallucinations started in the same MH crisis that ended up with us splitting into multi; Psychologist already said that a lot of psychs would see that as either DID or psychotic already, so not looking forward to being medicalized/scrutinized as individuals. But. Eh. We've gotta disclose to get treatment/etc, and.. We need the treatment. Hoping mood stabilizers will do what years of antidepressants never did, so a BP# dx is a priority. (if we're disclosing this stuff, I'm guessing it'll probably go down as BP1, unless they totally go down the "nope stress" route?).

Wynn

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13 hours ago, dancesintherain said:

Do you all have any choice about where you'd end up? 

No, I wouldn't.  The hospital I go to only has an acute care psych unit (AFAIK) so the max days is probably 3-4.  I haven't been there for about 10 years though, so things could have changed.  But overall, I wouldn't have a choice where to go.  And if I ended up needing a long-term IP place, I would be sent elsewhere, which I wouldn't have a choice of either.

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That's sad Melissa.  My area has about 5-6 options, but unfortunately I landed at one I wasn't comfortable with.

Wynn, do you all get any choice (assuming it's voluntary)?  (If it's involuntary, I don't, but I've never hit that problem.)

I completely hear you on the difficulty of providing all the information but not freaking them out too much.  Do you have a "supportive person" you could recruit to essentially babysit you for a bit?  That was one of the things that reassured PHP pdoc I think.  It sounds like your partner has been a great support for a while, but may not have the capacity to continue.  Is there anyone else you can think of who could step in?  Friends in the area or even friends of your partner if both of you are comfortable with them knowing what's going on?  One other IP alternative (if they start heading down that path) is agreeing to a PHP/IOP thing...which may not be appropriate given the symptoms you experience, but could at least help with the mood disorder piece perhaps.

Sometimes insurance companies can be required to pay for a 24/7 behavioral health specialist in the home (or wherever you go).  Think like a CNA, but with mental health instead of physical health training.  I think they're fairly hard to get, but it might be worth an application if the answer to the question above is no. 

Given what you're saying, the bipolar diagnosis seems at least like a possibility (distinct mood episodes? or alternating between mood states?).  I can see how treating it would be first priority.  And the good news is that if the psychosis is secondary to the mood piece, stopping the mood issues should stop the psychosis component.

Best wishes on all of this--I wish they listened to you when you asked for help (understatement of the century). 

 

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