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Bipolar psychosis and new pdoc


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So I saw my new pdoc today. The good news was she gave me a diagnosis of 'bipolar affective disorder'. Least I know my assumptions weren't entirely wrong.

Anyway, I've been having quite a hard time with mania recently. My mother has nearly had to take me to hospital several times (bear in mind hospitalisation is very rare in the UK). I've been getting more and more psychotic- worsening visual hallucinations, voices holding conversations with me/commenting on what I'm doing, hearing music playing (the weirdest part of this is it's songs I've never heard), women chattering/arguing in the distance. Sometimes when manic I just lose it and have no idea what I'm doing. My memory goes, my speech is entirely incoherant. It frightens me. A few months ago I was considered 'just' depressed. I'm dealing with being bipolar, it doesn't frighten me, but the psychosis does- I feel like I'm going completely mad.

So to get back to what I was on about. The pdoc had my notes made by my lovely old pdoc, who I met through the crisis team. She hadn't read the notes at all, and insisted on reading out some of my most embarrassing, intimate thoughts/actions in a cold clinical manner. Lovely. She asked what my highs were like, and I explained. I lose the ability to function. I am incoherant. My memory goes. My thoughts speed up until it gets to the point where it's terrifying and nothing I can do slows it down, I just want to leap of a cliff to end it. I spend, spend, spend. I see and hear things. Pdoc nods. So on goes the meeting, and she continues to piss me off. 'Was not having Mum there when you came home when you were younger hard?' I was like What. The. Fuck. Firstly I'm an adult- your mother does fine. Secondly, who the fuck is bothered by not always having a parent there when getting in? Anyway, we just totally clashed. I went into sarky bitch mode.

In comes the mother. Pdocs asks her to rate my highs out of 10, 10 being the highest. She gives me a 10. Pdoc's like mmmkay. Again I try to explain about my psychosis. Again she changes the subject.

Finally, I demand a diagnosis, and get BP. I ask her if I'm a I or a II. She says probably a II, because I 'haven't ever been admitted to hospital. Therefore I can only go hypomanic.' Sorry, when was hospital admission a criterea for mania? I nearly HAVE been taken to hospital, fucktard, it's only that my mother's a nurse and concequently has dealt with people off their trollies that she's able to cope. That and I'm a rapid cycler, so if I take lots of Seroquel I can sometimes tame it for a few hours at a time until it's passed. I told her I go psychotic. She changes the subject. I leave.

I'm just so pissed off. If I really am BP II, I'd be happy, because it's not quite as terrifying as being BP I. But I didn't think hypomania and psychosis went together? Can you be hypomanic and get psychotic? And I mean, what about classic manic things like not sleeping for the duration of the mania (several days), loosing complete control and functionality, total incoherance of speech, loss of memory? I suppose it doesnt matter really. But I really wanted her to rationalise the psychosis for me. I'm terrified of it. This weekend, a skeletal face came flying at me through the dark. The voices got worse. I started hearing music. Sometimes I walk round the house and all the walls wobble. And she didn't even want to talk about it. She refused to even acknowledge it.

What's happening to me? Am I just an over imaginative drama queen? Should I just get the fuck over it? I don't like this woman at all, but if she listens to me, accepts my symtoms, explains them and medicates me appropriately then that's cool- I don't want to be her best friend.

Am feeling weepy and like shit  ;)

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I'm sorry you are having a hard time with a new pdoc. I'm guessing that in the UK with national health care you can't easily switch to some other provider. If that is the case, perhaps you can try telling the pdoc that you want relief from the psychotic episodes--that they are of great concern to you and you need her help.

My feeling on psych. diagnoses is that many are grand generalizations. There are probably few MI people who fit all the criteria for single condition and only that condition. So, I find the diagnosis only mildly helpful. The best pdoc I have had really only focused on managing symptoms...which is helpful if your symptoms are distressing.

I recently read the notes for a continuing ed class for mental heath providers on Bipolar Spectrum Disorders (http://www.continuingedcourses.net/active/courses/course001.php) and found it shows the state of lack of knowledge and confusion on the BP diagnostic category. The researchers are trying to better understand the disorder, but it seems they are a long way off.

Best,

--Weasel

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Cheers Weaseltine. Yep, the NHS sucks, I can't change pdoc. Though the way she's made me feel, if it's no better next time then I'm not interested in psychiatric care. I know the dx isn't that important, but I feel in a way that she's undermining my suffering- her attitude was very much that the BPIs were the people with a real problem and that with BPII, I wasn't 'sick' in the manic sense- my depressions were the problem, with the hypomania some sort of bonus add on. Granted, in my last major depression I nearly took my own life, but that was an extremely bad depression lasting several months. I find my highs MUCH more problematic then the lows, as do those around me- I simply cease to function in every aspect of my life when I'm high, and have been fortunate that they've never occured (as this has been happening for only a few months) when I've been with people who don't know me well enough to have been told about the BP.

I'm just pissed that she wouldn't listen and that she wouldn't acknowledge my psychotic symptoms. It was like the outcome of the meeting was decided before I even went in.

Thanks for the link, I'll have a read through.

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;) ((((Hugs))))))

I am sorry that things are so rough for you, and there was this miscommunication which has no doubt stressed you out. You are not a drama queen and do not need to get over it. I am a manic/psychotic person with a nurse mother in the UK, so I feel your pain!

My main diagnoses (I have had 8 so far) have centred around psychosis because I have had all your symptoms for months with pretty much constant occurence. I do have mania to a much less degree (which is why I was dx'd bipolar and offered Lithium once) and I notice that when I am very down or very up, I am way more psychotic. My recovery seem to be mananging the highs and lows with a mood stabiliser and small dose of anti depressant (too much and I go high and psychotic) and with a small anti psychotic to knock off the psychotic symptoms. I still have them most days though. I have lived with them for a year and so am sort of used to it, but often it can be very scary. Today I have had invisible people following me around the house, but I know that is a stress reaction cos I am worried about something. Hearing voices and stuff is really scary and annoying. It makes you feel vulnerable and you doubt yourself.

Has your hospitalisation been on a voluntary short term basis? Is this new pdoc one in the community mental health team or in the hospital?

Pdocs tend to have crap manners, and read out symptoms in a very clinical way, and that can be rubbish when you want reassurance. It might help to be able to say 'Obviously that (the list she just read) scares me and I feel as if I am the only one who experiences it, could you reassure me?' and hopefully she will get a clue and talk to you. Sometimes you have to make things obvious because pdocs can be too clinical. Remind them that a real, flesh and blood person is sitting opposite. Demand a counsellor. Press the point.

Did you feel that she didn't understand the highs? Sometimes pdocs have a mental list of things to check or tick off, so they don't comment on something that we feel is important, so *again* say if you feel a symptom or thing is particularly important and you want feedback on it. Or she will work through her list without noticing your fears.

It may be that she suspected Borderline personality disorder or another personality disorder, or was trying to get a pyschological perspective, hence the odd question about your mother being around when you were younger. I know this is probably annoying but you just gotta answer truthfully, which you did. Again this may have meaning to her, and not to you, but you have to say so and make sure she knows that you think that it is an odd question.

It sucks that hospital admission is classified as criteria for mania, because it shouldn't matter, like you say, coping skills are what determines hospital admission. I'd have said that out loud, but I can be a bi-atch  :)

It is totally possible to get manic and pyschotic, as far as I know, I am after all! I get the impression that she was more interested in your mania and BP potential than your psychosis. Psychosis is tricky because to be taken seriously you generally have to be either a drooling, out-of-it nutter or threatening to hurt someone, thus getting admitted to be diagnosed. I would start by either making a diary of your symptoms, or having your mum keep a note of when you get bad, so that next time you see her you have some concrete, organised symptoms. Sometimes it is more compelling to pdocs if we can point to a night where we heard threatening voices for 12 hours or saw visions three times an hour. Or you can start calling your out of hours GP when it gets bad, or seeing your regular GP. You could reschedule an appointment with the pdoc to reiterate what you're going through. My advice is to be persistent and honest about what you experience.

What you see/hear/smell/feel is REAL to you and you DO suffer as a result, and no one, medical professional or not, can disregard or play down what you're going through. Delusion or no delusion, it fucks your life up and needs to be sorted, don't you ever feel the need to apologise or be quiet cos a pdoc gets funny weith you. You are not over dramatic or spoilt or difficult or a bad patient or anything you fear that you are. You're just not being supported by the health services. Having a nurse mother can be tough cos they are touch cookies who know and can stand a lot and tend to stand in for health services. But you should be calling doctors, pdocs, the Samaritans, shouting about what is happening until you get meds therapy, whatever can be offered.

MIND are fab for supporting you in this. PM me anytime you feel crappy and I will pep talk and support you. I'll be a good fairy whenever you need one! This is a shitty situation but it won't be forever, promise. Keep that head up girl.

:P

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Heya whatsgoingon,

That *sucks* altogether that you can't get referred to a new psych.

And, it's ridiculous that so many therapists and psychiatrists think BP I and II are so easily distinguished.

I love that criterion, "never been hospitalized."  LOL.  Come on, never mind your personal circumstances -- a *very small* minority in my experience are actually hospitalized -- and here in Ontario, at least, it's *easy* to get a three-day hold (called Form 1) on anyone we're concerned about.

You sound like you have persistent psychotic features.  I would hope that your psychiatrist would ask you more questions to flesh these out.  Because no matter *what* your moods are doing, manic, "hypo"manic, depressed (what would "hypo"depressed be??), whatever, psychotic features are important.

Regarding what Weaseltine Cracker said, I agree.  The specific diagnosis is not so important.  What matters is what treats the symptoms that trouble you.

Make sure, next time you see your psychiatrist, that you are *very clear* (us docs can be pretty thick) about how distressing these psychotic features are to you.

If she doesn't specifically address this concern, ask why.

I don't know the NHS in detail.  What would happen if you asked her to refer you to a colleague who has a slightly different approach?

Hang in there.  We're here for you.

--ncc--

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Cheers guys. I've had a full on bitch rant to my Dad, kicked a few walls, taken the dog for a marathon march and had a shower so I'm a little calmer now.

ncc- The whole hospitalisation thing really is just dumb. I mean, if she wants to play by DSM criteria, perhaps I should underline the phrase 'may need to be hospitalised'? May. Exactly. I probably did, it's just we coped. My Mum said next time I'm manic she's just going to take me to A + E, so that I can get psychiatric assessment when I'm at my worst. I feel like I'm playing a game. And, lol, the psychiatric unit has about 15 beds. Literally. Hospitalisation is a rare beast.

I don't think she'd be terribly impressed if I asked for referral to another pdoc. She started going on and on about how in demand the service was, therefore I can no longer see her at the hospital and have to travel. My best bet is probably going to be to return to my GP, who I haven't seen for months but was fantastic when I was depressed- if I told her I was psychotic and no one wanted to know I think she'd have issues. The other alternative would be to contact my old pdoc (saw her through the crisis team and she continued to treat me after my discharge)- she took me seriously when I was experiencing very mild psychosis and put me on a low dose of Seroquel, I think she'd also be pretty pissed no one wants to hear about stuff now.

Karuna-  ;) Thanks. I'll take you up on your offer of pm-ing if things get bad again. The cowbag did up my valproate so I'll be interested to see if it stabilises me more, and what happens regarding the psychosis. It does seem to be mainly when manic, and sometimes it'll occure in a depression, but it's generally of a different form then.

I think it's possible she personally suspected a personality disorder (my diagnosis from my old pdoc was rapid cycling mood disorder)- I do have self harming tendencies so wouldn't have been suprised if she'd chucked BPD at me simply on that basis. I suppose at least she did officially diagnose bipolar. That's something.

I did feel that she didn't really grasp the magnitude of the highs. In my notes, it was documented I had suffered from hypomania- unfortunately my biggest highs have occured more recently, when not seeing someone regularly. I listed my symptoms but it was as though the minute I opened my mouth she went 'yeah hypomania- switch off time'. She is a community psychiatrist- I assume she therefore never sees people in the opening stages of illness.

Next time I see her, I shall really force the point about the psychosis. It's such a hard thing to open up about to anyone, let alone some bitch pdoc who appears to not give a crap. Ah well, we shall see what happens. 

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Just a quick update:

- Mother dearest went across to the psych unit in the middle of her shift yesterday. I needed a note so I could get extra time in my exams (which start next week), which pdoc 2 was very unobliging about. She ended up speaking to the ward manager, who turned out to be the woman she went to toddlers' group with (I don't mean she went- I mean she took me when I was a toddler!). She explained what I needed, and the WM agreed to speak to pdoc 1, so I should have a letter today. Hurrah!

- She also explained how crap pdoc 2 was. WM agreed, said I wasn't the first, invited us to make an official complaint and said she'd be 'doing something about her'. AND she's referring me onto another pdoc, who's meant to be fantastic- really patient and a good listener. Apparently they referred a woman to him who was totally med non-compliant, and he got her to take them. So am much more cheerful about the situation now- for starters I never have to see pdoc 2 again!

So yeah. I love my mum being a nurse!  ;)

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whatsgoingon,

yay mom!  that's so awesome that you're getting a new pdoc, and a good one it sounds like at that.

i hope you do write up an official complaint for the sake of other patients who don't have kick ass moms on their sides fighting for them.  it's cruel for a doctor to minimize or dismiss a patient's pain and fear at their symptoms.  gragh.

let us know how your first appointment with the new doc goes, ok?

penny

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