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Archive for October, 2012

That Friday Feeling….

26 Oct

It’s 3 o’clock on a Friday afternoon and most of my social media pages are filled with comments about it nearly being the weekend and how great it is (especially as the clocks go back and we gain another hour). And I’m really pleased for my friends who are looking forward to 2 days off, but then there is the reality…

Friday for me means getting through days knowing there is very little support around. Especially the way I am feeling at the moment, where suicidal thoughts are on my mind a lot, knowing that there is very little help is a hard thing to deal with.

I am told to go to a&e if I get bad. Again, a reality check. A&E at weekends is probably their busiest time – full of drunks and people going out for a good time (that has gone wrong in some way). Is this a place I would take myself if I was feeling like I would act on my suicidal thoughts? No, it really isn’t. I’m sure there are exceptions to the rule but whenever I’ve been in a&e after an od, I have been patronised and made to feel like I’m wasting their time.

So with a&e really not being an option, it is down to me to make it through every hour (which trust me at the minute, is no easy task). It just brings up that age old question, why is mental health seen as a Monday to Friday, 9-5 illness?

 
 

Rant about getting help!

17 Oct

This is no more than me having a rant about trying to get help when I feel I need it.

I’m not one to call my care co-ordinator outside of our weekly appointments, I generally try to hang on until I see her face to face. This is mainly because I really struggle to use the phone and ask for help, so when I do it, it’s actually quite a big deal. My cc knows and appreciates this.

Today, I’d had enough. On Monday in my appointment with my cc, it was suggested that my anti-depressants might be increased because I’m having such a hard time at the moment. She also asked if I thought a sleeping tablet for a few days would be a good idea. I said I’m happy for increase but I’d rather not take another medication on top of this.

However, after 6 nights of hardly any sleep (think I’ve managed around 10 hours in that time), I decided I’d ask for those sleeping tablets. In the past they haven’t really been effective, but really grasping at straws here. For those that don’t know, until fairly recently I used to use over the counter sleeping meds to ‘knock me out’ when my emotions got too much for me to deal with (usually taking quite a few of them!) and to be quite honest it’s been in the back of my mind that I should do it again just to relieve some sleep tension.

But instead, I called my cc just now and asked if she could get me some prescription ones and she told me she’d already asked my psychiatrist at the same time as asking about a dose increase. In terms of that increase, my psych had said no, she feels that it’s because I’m going through a rough time in therapy and not something an anti-depressant can help with. Fair enough, I trust she knows her job and the best for me in terms of that. But she also refused me sleeping tablets because she said I’m an increased risk with the way I’m feeling.

So here’s me, trying to work with them, asking for only 2-3 days worth and being told no. Exactly what incentive have I got not to go back to my old way? I’ve tried really hard to see their point of view, but I can’t! How much harm can I do with 2 or 3 tablets as opposed to the pack that’s now looking likely of the over the counter stuff?

It seems I’m always told to ring in for help, but when I do there is nothing they are willing to do. Not even give me a daily prescription, just a resounding no!

**UPDATE**
This afternoon (the next day), my cc called and said her & my psych had a chat and because I’m working so hard in therapy at the min, and trying to avoid old coping strategies, they want to support me. And so I’ve been prescribed 4 days worth of zopiclone to get me over the weekend and will reassess on Monday. Feel happy that I’m being taken seriously and listened to!

 
 

Therapy update

15 Oct

Last month I mentioned that my therapist was going on maternity leave and that I’d been told I would be put back on the waiting list (6-9months) in order to carry on.

Today I had an appointment with my care coordinator (cc) and she’d spoken very briefly with both my psychiatrist and therapist this morning so they could all arrange a meeting to discuss properly. It seems now, that my cc has been fighting my corner, and it looks like I won’t be taking a long break – which is great!!

The options that are flying around at the min seem to be three fold:

1) They are replacing my therapist on a part time basis and so would be for her to take over. However my current therapist doesn’t want the remaining time to be a handover period because we are going through a really rough patch, but one we are pushing through. This is essentially the nightmare exposure work I’ve mentioned. It is extremely difficult for me to deal with it all and the other memories that are coming through are making me sleep deprived and emotional to say the least!! She thinks we are at a crucial stage and introducing someone new into my remaining sessions would be counter-productive. The alternative for this is for the new psychologist to be introduced to me via my cc appointments.

2) I see an existing therapist who they think is easy to get on with and therefore I could build trust and rapport relatively quickly so we can start off from where I left off. There would be a break until she gets a slot available for me.

3) To add an extra session with my cc and do some self help stuff (like dbt) with her having supervision from a psychologist. At the same time, I would be put on one of those original waiting lists for 6-9 months.

I’m really pleased that we have a lot of options now available, as opposed to the original plan I was told! Apparently everyone is really pleased with how hard I’m working at the min in terms of therapy and lack of self abuse and all three of them see me being able to get better (be it a long path I’m on)

In terms of the above options, I’m not too sure which I’d chose. I don’t think I like the thought of 3 as I see my relationship with cc completely separate from any kind of psychology work. But they have arranged a meeting in November and whilst they want to sit and chat about it for half an hour, they then want me in for the second half. All three say I know my mind (aka stubborn!) and have not only a valuable contribution but also the ultimate say in the next step. It feels like I’m in control of the situation and for someone who has been through what I have, it feels right.

 
 

Borderline Personality Disorder Vs Complex PTSD

02 Oct

I know I have covered this in a previous post where I discussed the DSM IV and how I felt the diagnosis of borderline personality disorder didn’t fit my symptoms. This diagnosis is only a recent one (within the past few months) as my psychiatrist thought I was displaying behaviours that weren’t part of either PTSD or depression.

I had a good chat with her at my last appointment before my last hospitalisation and she agreed to re-look over my notes and see about the diagnosis. However, I then saw her un-expectantly the week after when I had taken a turn for the worse and was told I was going in to hospital. Due to this, our conversation has been forgotten about and so here I am again, trying to get the diagnosis changed.

Since my last conversation with my psychiatrist I have done a lot of reading and watching of seminars to truly understand the different diagnoses so I can still keep our conversations at an educational level and not just about me saying I don’t agree. And so I have put together this diagram that uses the DSM IV criteria for BPD (I know in the UK, we use the ICD-10 but for this, the list of criteria is easier to work with). I have then listed the symptoms of complex-ptsd as written by the Royal College of Psychiatrists and then married the two together. There are a lot of similarities, but they also have their differences and it came as no surprise to me that the behaviours my psychiatrist said didn’t fit anywhere were in fact the ones that were in both bpd and c-ptsd (the ones in the middle in the below diagram (you might need to click on the actual picture to see it fully).

I am fully aware that complex-ptsd isn’t in either the DSM IV (or upcoming V) or the ICD-10, however it does have its own section on the Royal College of Psychiatrists leaflet for PTSD. My main point of doing this is to show that just because 4 of the 9 behaviours are shown as BPD, there are actually other explanations for them (I am not even touching on the fact you need 5 or more of the behaviours to be diagnosed!)

OK, so that’s ok if I was in America, but I’m not and the DSM IV doesn’t apply and so I have taken the diagnostic guidelines of the ICD-10 for Emotionally Unstable Personality Disorder, also known as Borderline Personality Disorder, and made 5 citations (not sure if you can see on the picture so will write below as well) of how I don’t fit this:

1) ‘Conditions not directly attributable to another psychiatric disorder’ – I have answered this above.

2) ‘abnormal behaviour pattern is enduring, of long standing, and not limited to episodes of mental illness’ – This is not long standing, the behaviours my psychiatrist mentions are purely since my trauma and to be honest, even more recent than that.

3) ‘abnormal behaviour pattern is pervasive and clearly maladaptive to a broad range of personal and social situations’ – They are basing this diagnosis purely on seeing one hour per week where we discuss my trauma. Absolutely none of the behaviours are outside of this (ie in social situations).

4) ‘the manifestations ALWAYS appear during childhood or adolescence and continue in to adulthood’ – I have capitalised always as this is extremely important. Until the age of 30 I had never come in to contact with secondary mental health services. I had never cut myself, wanted to take my own life or struggled with inter-personal relationships. Until I pushed people away after my trauma, I had a large set of friends in different social circles and never struggled in this area. I had been to university and got a decent degree and grown a successful business, which involved a lot of rejection, as does every business, and never once did I see or feel worried about rejection in any area of my life. Since my trauma, this has all changed; I cut myself (the reasons of which are outside this remit), always fighting suicidal thoughts and have pushed everyone away so I don’t have to deal with people. My business is also very close to failing. This is all SINCE my trauma, not ALWAYS!

5) ‘the disorder is usually associated with significant problems in occupational and social performance’ – I think I’ve answered this one above. I’ve never had problems with my occupation and stayed in employment long term until I started my own business, which I have run for 7 years. Socially, before the trauma I was out most weekends with friends, I was the secretary of my football team and had a lot of goals that I was working successfully towards.

So, all in all, as you can probably see from this post, I strongly disagree with the diagnosis. I have only had these behaviours since the trauma and so I struggle to see how a developmental illness can be diagnosed. Some people will argue that this trauma triggered this illness but all I can say is I am the expert in me and I know how I used to be – my mental health team can only see me now and therefore might assume this is how I have always been. I think it is up to me to show them this isn’t the case hence all of the above.

I am seeing my care co-ordinator tomorrow and want to show this to her and ask that she relays it to my psychiatrist so I can discuss it at my next appointment in November.