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At what point would I need hospitalization?


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I'm tilting toward mania I think. I've never been manic, but I have a BP1 diagnosis because of the psychotic features. I don't know if I could go manic, but I think I'm going that way. I'm worried that I am going to end up in the hospital, but how would I even know I needed it if I was manic. Wouldn't I be out of control? Right now I think I'm just hypo, but I don't know. I know that if I didn't have kids and a husband I'd be at the bar partying it up right now or maybe getting a new tattoo or a piercing. All those things sound nice. But I had the opportunity to purchase something I really want, and I technically have the money, but I resisted because I think it's ridiculously over-priced. So maybe it is just hypo? Or maybe it's nothing, and I'm just in a good mood. But I'm not really in a good mood. I'm angry at times too, and I'm nervous about how I'm going to care for two young boys when I'm so angry I'm hitting myself. What if I lose control? Maybe I should call my pdoc tomorrow. It's too late tonight. They'd just send me to the emergency room, and I don't think I need that, and anyway I can't afford another $1000+ bill. What's the tipping point when you need hospitalization? What should I tell my husband to watch out for? I need to be safe for my kids and, more importantly, I need them to be safe.

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I've been in hospital twice for mania. Basically I went into hospital both times because I couldn't be trusted to keep myself (or my job) safe anymore, but here are some specifics:

The first time the tipping point was that I was driving recklessly (and by recklessly, I mean thinking every other person was cutting me off, so I would actually chase them even through red lights to get back at them) and was so agitated by sensory overload and hallucinations and derealization that I literally couldn't do anything in my life anymore. When I went in I totally snapped during the admissions interview and my hospital paperwork describes me as "hostile" on entry.

The second time the tipping point was that my psychosis was getting to a point where I was absolutely terrified half the time and absurdly euphoric the rest of the time. I couldn't handle being in public without saying strange things and generally drawing attention to myself. I was also refusing to do basic things like sleeping and eating, and this was just making the mania worse. I got hospitalized to put me in an environment where I would be forced to rest while new meds took effect.

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For me, both times the psychosis and the mania collided into a nasty combo.  I wish I could say more than that, but my memory from right before both is a little foggy (correction, memory from second comes back to me in flashbacks, but isn't crystal clear other times to the degree that I'd feel I was at risk of misleading you).  I'm noted as having been non-compliant with meds on both sets of paperwork, so I think part of it was that I got so disorganized that I couldn't keep track of meds anymore.  That's only part of the picture, though.

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2 hours ago, Chantho said:

I'm tilting toward mania I think. I've never been manic, but I have a BP1 diagnosis because of the psychotic features. I don't know if I could go manic, but I think I'm going that way. I'm worried that I am going to end up in the hospital, but how would I even know I needed it if I was manic. Wouldn't I be out of control? Right now I think I'm just hypo, but I don't know. I know that if I didn't have kids and a husband I'd be at the bar partying it up right now or maybe getting a new tattoo or a piercing. All those things sound nice. But I had the opportunity to purchase something I really want, and I technically have the money, but I resisted because I think it's ridiculously over-priced. So maybe it is just hypo? Or maybe it's nothing, and I'm just in a good mood. But I'm not really in a good mood. I'm angry at times too, and I'm nervous about how I'm going to care for two young boys when I'm so angry I'm hitting myself. What if I lose control? Maybe I should call my pdoc tomorrow. It's too late tonight. They'd just send me to the emergency room, and I don't think I need that, and anyway I can't afford another $1000+ bill. What's the tipping point when you need hospitalization? What should I tell my husband to watch out for? I need to be safe for my kids and, more importantly, I need them to be safe.

Hypo and mania are matters of degree, but mania sends you off into la-la land. If you're hypo, you might install a new sprinkler system in your yard. If you're manic, you might move thousands of miles away and start a new life as a prosititute. My behavior becomes very, very reckless when I'm manic. I'll fuck anything that moves and consume massive quantities of drugs and alcohol. When I'm hypo, I'll make a bunch of spreadsheets to solve world hunger. I'll cook a five course meal every night, and scrub every corner of my home clean. When I'm manic or mixed, I don't give a shit about mundane tasks like cleaning, and wine bottles and beer cans will take up every inch of space I have, along with lines of cocaine and whatnot on every countertop. There is a considerable difference between the two. I fly so high when I'm manic, that I'm just off in never never land. When I'm hypo, I can focus. I can do stuff. And I definitely do stuff. When I'm manic, the euphoria is so intense that I have no connection to reality. Well, at least not the reality that most people subscribe to. 

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Well, good. I'm not approaching mania yet. I'm glad I'm not because I'm already at my wits end dealing with this restlessness, the urge to go out and stay out until all hours of the night (I would if dh let me), the racing thoughts, the anger. I feel out of control. I must be really weak. 

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10 hours ago, Chantho said:

But I had the opportunity to purchase something I really want, and I technically have the money, but I resisted because I think it's ridiculously over-priced.

If I was able to hold back on something like this I would definitely not be hypo.  If I was hypo/manic I would have bought it anyway.

 

10 hours ago, Chantho said:

What's the tipping point when you need hospitalization?

The tipping points are if I am a danger to myself or others (OD on something, ie), I will have to go in.  Or if I want to go in (I don't ever want myself to think like this again like I did 20 years ago, long story).  Another reason is if my current pdoc threatens me being IP, if I don't go on a med dose that he wants it to be, regardless of how I feel.  Last that I can think of is if I become psychotic and out of control foing things, and meds don't help.

7 hours ago, Chantho said:

Well, good. I'm not approaching mania yet. I'm glad I'm not because I'm already at my wits end dealing with this restlessness, the urge to go out and stay out until all hours of the night (I would if dh let me), the racing thoughts, the anger. I feel out of control. I must be really weak. 

No, you're not weak.  It is great you are being proactive about things.

 

10 hours ago, Chantho said:

Or maybe it's nothing, and I'm just in a good mood. But I'm not really in a good mood. I'm angry at times too, and I'm nervous about how I'm going to care for two young boys when I'm so angry I'm hitting myself. What if I lose control? Maybe I should call my pdoc tomorrow.

I think it is a good idea to talk to your pdoc tomorrow.

I think you sound agitated/irritable from what you wrote.

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1 hour ago, Chantho said:

So you think I may not be hypomanic after all, since I have some measure of impulse control? That would be nice to know. Although, I think I'm losing the impulse control.

I'm not BP but from all the posts I've read on various sites, "insight" into your condition seems to come with experience? A lot of people who are psychotic actually know they are psychotic. They know the voices aren't real, although that doesn't necessarily make them any less uncomfortable. So, some people can be aware that they are manic in certain situations and not aware in others. I think it all depends on the person and the circumstances, but again, I'm not BP so I probably have no idea what the hell I'm talking about. 

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5 hours ago, Chantho said:

So you think I may not be hypomanic after all, since I have some measure of impulse control? That would be nice to know. Although, I think I'm losing the impulse control.

I'm same with @Closure ... I also have some impulse control when hypomanic.  Not complete control, but there is some there.

 

4 hours ago, DopamineSick said:

I'm not BP but from all the posts I've read on various sites, "insight" into your condition seems to come with experience? A lot of people who are psychotic actually know they are psychotic. They know the voices aren't real, although that doesn't necessarily make them any less uncomfortable. So, some people can be aware that they are manic in certain situations and not aware in others. I think it all depends on the person and the circumstances, but again, I'm not BP so I probably have no idea what the hell I'm talking about. 

(bold) For me, this isn't true.  When I heard voices (auditory and not) and was delusional, I didn't think I was psychotic.  I thought everyone else was.  I thought everything was real.  When I finally realized I was psychotic was when I started on the right med cocktail and real life started happening.  Then I realized what was true or not.  I didn't know that though for a very long time.

I don't realize I am hypo/manic until it is already happening.  It is gradual ... at least for me you just don't wake up one day and you're hypo. 

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I generally am aware of when I am psychotic, even though I have not always been so; I used to have no insight into my thoughts of being watched or followed by unmarked police cars, or being hunted down by the police for crimes unknown to myself, but now when I am paranoid I generally do have insight (even though thoughts like that my AP was making me paranoid may imply that this should be doubted). Likewise, I used to have no insight into my hallucinations, but now I do, and I used to have no insight into my negative symptoms, but now I do. Of course, then, my tdoc says I very frequently had inappropriate affect when talking with her, even though I had absolutely no insight into this whatsoever.

About hypomania and mania, I can easily tell when I am in a high mood of some sort practically immediately, but I simply cannot tell hypomania apart from mania as it is happening; I have no awareness of a line between one and the other.

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this is kind of a difficult question for me too, i mostly get states nearly identical to what you describe in your first post. for that i wouldn't go to the hospital, though i would call my psychiatrist for an emergency appointment. i've been inpatient for (hypo)mania only once... i couldn't sleep for days, heard voices, was convinced i was a reincarnation of Virginia Woolf sent to this world to instill happiness through writing. the 'problem' was that i was very insightful. like even with the V. Woolf stuff I kept thinking that this could not be true even though other times i was absolutely convinced. i knew voices weren't real, either. psychiatrists that treated me were of the opinion that insight means i'm not 'really' psychotic, therefore not bipolar I. i don't know what to believe and don't really care. i've never had anything like that since. but to try and answer your question, hospital is either for when you lose insight and can't control, or in so much pain you can't stand it anymore.

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2 minutes ago, domovoi said:

hospital is either for when you lose insight and can't control, or in so much pain you can't stand it anymore.

Also for being a threat to yourself or others.  Also, some pdocs have different ideas as to what constitutes an emergency, and when to send them (a patient) to the ER.

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