Cognitive Distortions and Being Vague on My Blog

On my last post, Brigitte left a comment re: the Cognitive Distortions I was having/feeling and how I was being vague about the details. Let’s see what I can do about this.

As far as being vague on my blog, I responded back that I have done this before, perhaps even purposely. If not purposely, I may have just been rambling (although I didn’t mention this in the comment to her.) As far as doing it in a purposeful manner, I mentioned getting into the five W’s and the H. Now, I don’t always have to do that but I have in the past a fair bit. To do that in some situations, it would lead to revealing far too much. Even though this blog is highly personal, there are some things that will never be revealed on it.

By extension, getting into the five W’s and the H would (or could?) threaten anonymity. This also was not mentioned in the comment but I think it makes sense.

I have found my list of Cognitive Distortions from hospital so we can go through what was going on, if you wish. Interestingly enough, I tend to have a pattern. I tend to feel the same ones. Also, I think we all are well aware of the stress I am under trying to work on getting it together to try and prepare for and gain employment. No doubt that is a huge stressor and stressors like anything else can be a trigger and colour our perception(s.)

I also think logically, it not only colours the perception of the stressor itself but of other things in our lives? Everything is connected in your thought processes. It is not like you can just box everything up in little parcels and stick them away and that is that–no matter how much we wish we could.

In reading some of these verbatim, they could certainly apply to my job situation, no doubt. Others? Well, they could apply to any situation in your life.

NOTE: these are all taken from D. Burns, ‘Feeling Good Handbook,’ 1999©

And, these are mine, typically; also applicable to last night in varying degrees. There also may have been some “spillover” to the job stress as well, as mentioned above.

1. All-or-Nothing Thinking: You see things in black and white categories. If your performance falls short of perfect, you see yourself as a total failure.
2. Overgeneralization: You see a single negative event as a never-ending pattern.
3. Mental Filter: You pick out a single negative detail and dwell on it exclusively, so that your vision of all reality becomes darkened, like the drop of ink that discolours the entire beaker of water.
4. Jumping to Conclusions: You make a negative interpretation even though there are no definite facts that convincingly support your conclusion. There are two subcategories to this: Mind Reading: You arbitrarily conclude that somebody is reacting negatively to you and you don’t bother to check this out. The Fortune Teller Error: You anticipate that things will turn out badly, and you feel convinced that your prediction is an already established fact.
5. Magnification/Minimization: You exaggerate the importance of things (such as your goof-up or someone else’s achievement), or you inappropriately shrink things until they appear tiny (your own desirable qualities or the other individuals imperfections.) This is also called the “binocular trick.” NOTE: I only apply this to myself, not others.
6. Catastrophizing: You attribute extreme and horrible consequences to the outcome of events. A turn down for a date means a life of utter isolation. Making a mistake at work means being fired for incompetence and never getting another job.
7. Emotional Reasoning: You assume that your negative emotions necessarily reflect the way things really are: “I feel it, therefore it must be true.”
8. “Should” Statements: You try to motivate yourself with “shoulds” and “shouldn’ts” as if you need to be whipped or punished before you could be expected to do anything. “Musts” and “oughts” are also offenders. The emotional consequence is guilt. When you direct “should” statements toward others, you feel anger, frustration, and resentment. NOTE: I do not direct these statements toward others.

Now, I managed to tick off eight out of 11 on the list. There was one more that I didn’t add but I do it all the time. I don’t know if it is so much of a Cognitive Distortion all the time or me just being “The Queen of Guilt” and also using a lot of self deprecation on my blog. Perhaps all three. It’s basically seeing a negative event as indicative of a characteristic of yourself or taking responsibility for things that were not your doing. I don’t really do the latter.

Oh, and there is also one about Labeling and Mislabeling where you don’t describe your error but degrade yourself. Or conversely, if someone behaves in a way that you don’t like–you do it to them. Again, I don’t do that. PA doesn’t call people nasty names. She will call herself nasty names when she screws up, though.

So maybe if you want go all the way, there are two more. Nine of 11? God, I sound like a Borg. A Cognitively Distorted Borg. *PA rolls eyes* Resistance is futile to your bloody brain.

In waiting for my sleep meds to hit, beloved Tallis playing and lying in my bed…trying to think… Just what the hell, you know? I did try to slow myself the fuck down–do a wee bit of CBT on myself–and this post is getting long enough so I won’t get into the therapy aspect of it.

So, while passing the time, come, sleep come… I started to cry a bit. I just thought, ‘What are you thinking?’ No, really. With a lot of that stuff up there, it’s based upon the “unknown.” Maybe that is why I chose to use the word “illusion” before, even if it wasn’t quite right? At this point in my life, there are SO many unknowns and I feel like I simply can’t deal with having more! I know that there will always be unknowns, of course! I’m not that daft!

Alright. So, maybe I can wrap this up with a tidy little bow in case anyone else is as confused as Brigitte was. A combination of trying to cope and deal with the anxiety that lies before me with my professional life and as far as the personal? I am looking for stability and support. It has been there in the past and I wish for it to come back. I sure do need it now. Perhaps it all got muddled when I wrote it and it didn’t come out properly?

Try As I May…?

I more or less crafted the post that I wanted to make earlier. Unfortunately, I don’t think I have it in me to write it. I am just so bloody exhausted.

Apologies to the (couple of) comments that are awaiting from my regular readers and an email that is outstanding from someone.

And definite, definite apologies to Tribalnoizes. I don’t know if you are familiar with my blog or not in terms of how I respond to commenters. I always type their names/monikers in bold font. And I usually respond in a timely fashion!

You left a great comment and again, I do want to get back to you–and I will!

Shit.

I want to write the post I had in mind but I feel like I am going to just pass out. Maybe I could post this and try and start writing the one that I really wanted to write? It might me…well, a little longish? And that always requires editing, proofing etc…

However, I need to stay up for a suitable time as my mobile is dead and I need it to wake me up. I need its alarm feature as my alarm clock is broken. I suppose I could just let it charge a little bit? How long for a full charge and how much more sleep will I lose waiting for it to go all the way?

True Confession/s?

I’m not really doing myself any favours when I come home. I’ve been getting a bit soused these days after dealing with “Fix Me Up.” Uh huh. A bit? Gimme a break. With such a high tolerance that has been built up over…hmmm…let’s say at least 15 years of self medication…well, you can imagine how a) it’s easy enough to stroll right through the door, all gilded with gold when stressed and…well, shit…b)? This is kind of funny…

No, it’s NOT. Perhaps funny in an ironic sense but for wee PA who is again, hovering somewhere between 90-100lbs./6.5 Stone let’s approximate for my UK/Irish folks? For a tiny girl, she can belt them back. That is not a good thing.

It’s not good for her bean (and all of her meds.) It’s not good for her being wee (and also her meds–specifically her Anticonvulsants) as it will make her prone to falls! Anticonvusants (generally–well, a lot of the time and especially for PA) can make you/her fucking clumsy! Add copious amounts of alcohol? Hello, face plant.

She’s actually blogged about it before. She has fallen and sustained head injuries (not serious ones.) However, one was bad enough that she had to monitor herself for a fucking concussion!

I’m sorry. What did you just write, PA? And yes, trying to monitor yourself when you live alone if you might have a concussion? No. That’s not good. The major issue is with sleeping. Basically, you might not wake up. Still, Dr. PA was “on call” and knew how to handle herself.

But if any of you out there are on your own and think you may have a concussion, GET YOUR ASS TO THE HOSPITAL!!!

I know. I sound like I’m a hypocrite. I am not, however. I know when to go to hospital.

But I digress. Back to me getting all numb from the booze.

And so…the self medication wagon just keeps marching on. Wait. Falling on and off the wagon. I just typed that sentence without even realising the euphemism. I do make unintentional puns all the time–both verbally and in writing.

Okay, it’s almost midnight which means I “deadlined,” again. It also means I should try and get some sleep as I have Merlin #1 tomorrow and should go back to “Fix Me Up.”

I gotta check the charge on my mobile, though. Being so exhausted…I’ll need an alarm to wake me for sure.

Who Has The Magic Wand? PA Or Merlin #1?

Bless. Bless, bless. I have the most amazing medical team in the world. Well, sans neuro but you can’t have it all, right? I was thinking of them all, my appt. with Merlin #1 on the way home and almost crying–but what doesn’t make me want to cry these days?

So did PA wave some magic wand she has over Merlin #1? She got everything she wanted. She stated her case, all of her med suggestions and they were discussed and agreed upon. I can not believe how lucky I am to have a team that respects me and cares for me so much. And I have a YouTube that I am dedicating to them at the end of this post that is also making me cry.

So, up the Seroquel/Quetiapine from 50mg to 100mg to get me to sleep? We all know how important sleep is for Bipoles who are cycling like crazy (no pun intended.)

The benzo conversation was interesting. I mentioned before that my ancient Serax/Oxazepam…well, I haven’t taken it in years and I actually had a brief memory flash: there were times when it didn’t work so well when my anxiety levels were really high. Maybe not a good choice right now. Also off the list: Klonopin/Clonazepam due to the side effect of Depression with extended use and Ativan/Lorazepam as it doesn’t work. Okay. Do we go with Valium/Diazepam or Xanax/Alprazolam? We decided to go the Valium route.

I also got my Topamax/Topiramate increase. Up from 200mg to 300mg. It’s hard to say which is the most important: managing the anxiety, sleep or trying to somehow get the Bipolar managed with the AC increase as they are all tied together. But playing with the AC is the one that’s a little more complicated. I again reiterated that that Lamictal/Lamotrigine was just too slow of a titration and it’s too “prissy” of an AC. It was added as an adjunct for me anyway. My Topamax and I have had a beautiful relationship for years and I can handle a faster titration.

Erm…titration? No titration. Spare no expense…we’re going straight up to that 100mg.

Now everyone! *PA claps hands* May I have your attention please!

I would never tell you how to manage your treatment with your physician/s but this isn’t really… *sigh* …”irresponsible?” It’s not…”unsafe.” Necessarily? It’s perhaps…”unorthodox?!” “A bit risky?!”

Slower titrations are always best. Especially if you have NEVER been on the med before. Especially if…wow, so many reasons why you really should not make a huge jump like this. I thought about not doing it but I know the med, I know what could happen? I am under a medical care. It’s not like I’m just doing this myself. We both agreed since I was deteriorating so quickly, unravelling to such a degree…go for it. I need help now.

This could be interesting? Also, I said to him I think I shall do it in a divided dose! Oh, yes we surely agreed on that one. Let’s not blast my brain with it all in one shot!

With any increase in an AC I could have some silly seizure activity reoccur. However, I’m already cranked on seizure prophylaxis whereas I wasn’t before and I don’t give a shit. I need to get stable. The loss of appetite and…loss of weight! I’m already fucking tiny enough! My appetite is still fine and my stim didn’t cause me problems there so we’ll see. Nonetheless…just like now anyway: Eat PA! Eat!

So, holy fucking Med Head PA! The Seroquel is no big deal as I just need a sledgehammer to knock me out as I am not getting enough sleep. The benzo? Let’s see if Valium can work well enough for me. The fucking “jump right up” Topamax? Again, that might be kind of interesting. I might be pretty much in La-La-Land until my brain gets used to that. God, taking benzos too during the day?

Well…thank goodness my doctors have faith in me and I have faith in them. I’ll be picking up all the scripts tomorrow but I think I might wait until the weekend to give them all a go. Except maybe the Seroquel as I have enough on hand at home to increase.

You know, I hope this will help. I really bloody well need it…help! I even feel maybe just a tiny bit better…just knowing that we’re going to try? That someone is willing to listen?

Okay, here’s the Tube dedicated to my medical team…they and it…oh, tears…

Calling In The Cavalry

Appointments with both Merlin#1 and my GP next week. My GP is excellent. She does the regular 10-15min. medical appts. but longer 30min. ones or so for counselling etc…

I contacted her office and asked to speak to a fantastic nurse that has called me directly before to let me know test information over the phone. This has amazed me as you usually don’t hear if anything is negative/all fine which was my Ferretin/CBC aka Complete Blood Count. I guess it was because of the outstanding gastro stuff and I needed to know? Still!

I wanted her to relay the information as it is confidential and I didn’t feel comfortable telling the receptionists! Also, I knew I could trust her to get the information to my GP in a timely and suitable fashion. She also said to call back on Monday if things got bad to see if my GP could get me in faster as my GP doesn’t work on Fridays.

Merlin #1 is a regular follow up since last time so no point in changing. Although if I start to go totally loony, I could call him as well.

I guess I need to do this.

So let’s get everyone in position. Armed and ready to move. Unfortunately on my orders? And yet, good bloody god, I feel like I’ve got the finger on my own “Red Button…”

Still Very Unwell

I suspect you will be receiving daily dispatches about how messed up I continue to be for quite some time? At least I am keeping up with Blog365! Can you believe? You are all of such support to me that I will not stop blogging. However, yes, I am not feeling well. Also, what is not helping me is another view from work.

PLEASE. I BEG OF YOU. WHOEVER YOU ARE…BE KIND TO ME AND SHOW SOME COMPASSION AND CARE.

PLEASE STOP READING MY BLOG.

AS ONE COMMENTER SAID, I HAVE HELPED MANY PEOPLE BY EDUCATING THEM AND SUPPORTING THEM REGARDING MENTAL HEALTH ISSUES.

I DO NOT WISH TO STOP DOING SO.

THIS IS ALSO A CREATIVE OUTLET AND THIS MAY ENCOURAGE YOU TO KEEP READING, NONETHELESS, PLEASE ALLOW ME MY PRIVACY.

I will no longer write about my former workplace anymore. It is starting to upset me too much, especially by seeing someone read me from there. This entire event has been and is too stressful already. I loved where I work and still do. It is breaking my heart to leave.

So, on with simply my life as it currently stands–or lies (lays?) for that is all I really want to do. I just want to lie/lay (even my grammar is shot right now) in bed all day and not move. Can you smell my depression emanating from your computer right now? Indeed.

However, I am moving for here I type. I got up, took my meds and had a bit of breakfast. I feel like I am running my own little hospital with room for only one, little patient. In my fitful state of sleep (oh…bad dreams, bad dreams…) I hear a nurse screaming in my ear: “Breakfast! Breakfast! Time to get up!”

Followed by me not wanting to move…”PA? PA? Are you alright?”

In PA’s head: Oh, silly nurse! Do you think I’m alright? I’m in a bloody psych ward!

Followed by a coaxing nurse: “Come on PA, time for your medication and some breakfast…”

By this time I can’t get back to sleep anyway so what the hell. I need my meds regardless of food so who cares? I can always go back to bed later. Oh, and by the way folks…I am wearing hospital bottoms as pyjamas today so this whole “hospital for one” thing just gets even better and better.

Cognitively? Who knows? BWAH-HA-HA!!! Good one, eh? Did you catch that? Cognitive impairment…“who knows?” Oh…PA…even when life is going down the tubes you can still find a sense of humour? Even for a nanosecond?

Sure. Now I’m depressed again.

I have to see gastro man tomorrow. I was tempted to call and cancel this morning but his card says they require 48 hours notice. I see. Does that mean I get a charge if I don’t call within that time frame? Some doctors here (at least in my area) do that and for some other things (script call-ins to pharmacies etc…) Well, I’d rather avoid that. So, maybe I should try really hard to go. It’s really far away from my home, though. It would take a long time. It would get me out of my flat, at least. If so, nicer weather? It is very dismal today. Good god, like I even care about the weather! I only care about my bed! And tea. I always care about my tea…

I’m also supposed to pick up new baby MacBook tomorrow. I was so looking forward to that, even though the whole ordeal cost me so much money. I am not happy about my new computer at all. In fact, I don’t even care. I love baby MacBook–both in old and new forms. Now? Don’t care.

I’m just so scared. One day at a time, right? So easy to say but not easy to do.

Wow, I do feel like going to hospital. Not because I’m at risk but just because it’s “safe.” I felt that way when I was there a year ago. Just like everything was alright…it was like this little haven where I didn’t have to worry–about anything at all.

*PA crying*

“Wake Up!” Let’s Start Treating Insomnia Properly!

I apologize as I need to cut and past this entire interview/discussion as only some of you may have access to it? It’s from Medscape on this little microsite, almost. Here’s the link anyway.

It might be a little long but skip over the parts that bore you. Or feel free to skip over this entire post if it bores you. I shall interject with a few comments as always. This article may not be that thrilling, but it interested me somewhat.

The Impact of Insomnia on Sleep: An Expert Interview with Daniel Buysee, MD
By Suma Jacob, MD, PhD

Dr. Jacob is the 2006 American Association for Technology in Psychiatry Fellow, sponsored by GlaxoSmithkline.

Introduction: Daniel Buysse, MD, is Professor of Psychiatry, at Western Psychiatric Institute and Clinic University of Pittsburgh, Pittsburgh, PA. Dr. Buysse is an internationally renowned psychiatrist and sleep expert, who discussed the interaction of depression and insomnia with Suma Jacob, MD, PhD in the Fall of 2006.

Dr. Jacob: Dr. Buysse, in addition to insomnia being a medical disorder, it has often been a prominent symptom or comorbid with other disorders, especially depression and anxiety. How common are these co-occurrences?

Alright, insomnia is a “medical disorder.” Yes. This is true. Can it occur as well with psych stuff?

Dr. Buysse: They are very common. If you looked at people who have chronic insomnia, approximately 50% of those will have comorbid depression. So depending on how you diagnose people, one can easily come to the conclusion that comorbid insomnia, particularly insomnia that is comorbid with depression is the most common type.

Why sure! The first words out of his mouth are “chronic insomnia!” If that doesn’t speak to “medical disorder…?”

50% too. That’s a fair figure as well. I know I sure fall into that number! If I don’t have my meds I can’t sleep at all! I think if you took me off them I might never sleep again! Well I might sleep at some point for brief intervals, but I would still have insomnia.

Dr. Jacob: 2005 National Institute of Health (NIH) Consensus Conference made a point about the concept of comorbidity in insomnia. What are the consequences of considering insomnia to be a symptom as opposed to a disorder?

I’m sorry. I can’t find the NIH Consensus Conference information, but it’s important. They didn’t link to it or anything.

Dr. Buysse: Considering insomnia to be a symptom only could lead to under treatment and it could influence general treatment outcomes. If we consider the specific case of insomnia comorbid with depression, it is a fairly common occurrence that insomnia persists after depression is treated. We know that when insomnia persists it leads to a reduced rate of remission in the depression itself and increased risk for relapse and recurrence of depression. So there are consequences for not treating insomnia.

Oooh. This is getting exciting now. Insomnia as a symptom only. We’re heading back to the issue of perhaps a (chronic) medical condition too? If not (or even if so) the point about “under treatment” is very important here.

Think about it. How many of us with any of our illnesses have “comorbid” insomnia? How much has it messed us up? It is absolutely possible that we might experience a shift in mood, we might feel better, but our sleep is still completely disastrous. Then our moods get completely out of whack again. This guy is making some sense, don’t you think?

Dr. Jacob: Do you believe that there is a common mechanism or pathway in the brain that can explain such a common co-occurrence with depression?

Dr. Buysse: We don’t really know the answer to that. There are data to suggest that the biology of insomnia and the biology of depression are related to one another. One potential key is that both disorders, depression and insomnia, involve dysregulation of the HPA axis and in particular, elevated corticotropin-releasing hormone.

Okay, the “HPA axis” is the “Hypothalamic-pituitary-adrenal axis.” It’s a major hormonal “hub,” if you will, between your brain (the first two parts in the name) and the the adrenals that sit atop your kidneys. Obviously because of that there’s a whole whack of stuff going on.

However, for the sleep business the CRH mentioned above comes from the Hypothalamus. What gets me more excited, even though it’s not mentioned here, is that Cortisol is also involved! I am always fighting for my Cortisol to get more “press,” and research done with it as far as all of our head crap!

I did find this under the Psychopharmacy section in Wiki that doesn’t get me so excited. Changes in CRH in cerebrospinal fluid have been noted in suicide victims. Better get that insomnia treated! I’m kidding. That’s not funny.

Another way of getting at the similar pathways involved in insomnia and depression is through functional neuroimaging studies during sleep and wake. Similar patterns have been observed in depression and insomnia using positron emission tomography. Both depression and insomnia show a relative persistence of brain activation in the frontal brain regions during non-REM sleep.

Huh. That’s kind of cool too. There’s a bit more on that later.

Dr. Jacob: When both insomnia and depression are present, are there any data that describe which came first?

Dr. Buysse: In the last 5 years or so, a variety of data have suggested that the usual expectation that insomnia is due to depression may actually be the incorrect sequence. There are now several epidemiologic studies that show that having insomnia independent of depression, there is a risk for later developing depression. Insomnia is one of the stronger risk factors identified for development of depression.

In recurrent depression, there are additional data suggesting that insomnia typically appears first and depression appears later. A study by Ohayon and Roth suggests that the particular sequence of insomnia preceding depression is a more common one than insomnia appearing at the same time as depression or depression coming first and insomnia showing up later. Therefore, the data suggests that insomnia commonly precedes depression.

Oh, yes indeedy over here! I know my insomnia hit like a freight train before I became depressed. Shall we take a poll? Who else out there experienced sleepy problems prior to moody problems? Again, let’s “wake up” to this people!

Dr. Jacob: If assessment for sleeping difficulties is a part of a usual mental status exam, why is insomnia often missed?

Dr. Buysse: I am not sure that it is necessarily missed, but rather underplayed. We know that sleep difficulties are part of the diagnostic criteria of depression, anxiety disorders, and bipolar disorder. I think that clinicians are assessing for sleep difficulties. However, when sleep difficulties are present, they are seen as another symptom of a depressive or anxiety disorder and the assumption is that treating the depression or anxiety disorder is sufficient for dealing with insomnia. As we previously discussed, this can lead to under treatment.

Yes, yes…please can we keep hammering it home?

Dr. Jacob: Would sleep patterns present differently with comorbid insomnia and depression (i.e. falling asleep, staying asleep, early morning awakening, and overall length of sleep)?

I can answer this one before Buysse! Completely not! I’m still leaning to my “chronic insomnia”/medical condition presenting along with psych illnesses opinion. See above with his 50% statistic?

Dr. Buysse: In general, people who have comorbid insomnia and depression have more severe difficulties than people who have insomnia alone. The specific type of difficulty is not very different than in people with primary insomnia. Patients with primary and comorbid insomnia have about equal degrees of difficulty falling asleep, difficulty staying asleep or early morning awakening. The usual assumption is that early morning awakening is more of a sign of depression, but there is not really great data supporting that.

Dr. Jacob: Does age play a factor in these two disorders presenting comorbidly?

Dr. Buysse: Younger patients with depression more often have hypersomnia, whereas older adults with depression more often have insomnia. There is evidence from sleep laboratory studies that depression and age interact. That is, older adults have disproportionately worse sleep when they are depressed than younger adults.

This may be true. Although I will say as a caveat that adolescents’ sleep is completely screwed up because of their hormones anyway. It has been proven that they need more sleep–depressed or not. The depression may just exacerbate this, however.

Dr. Jacob: How does anxiety fit into this?

Dr. Buysse: In general, older adults with depression will have more anxiety symptoms than younger adults. Older adults can have a more activated or anxious depression and have greater insomnia symptoms as part of the picture.

Hmmm. Well we all are different. When I was depressed as a kid…well, I was anxious since birth. However, I do know that my anxiety increased with depressive episodes as an adult.

Dr. Jacob: Which disorder would you treat first in comorbid insomnia and depression?

Dr. Buysse: We shouldn’t necessarily think of treating either one first or second, but of treating both conditions adequately. If a patient has significant insomnia as well as depression, he/she should be treated promptly, for both problems. If you look at overall morbidity, there is more danger in not treating for depression than missing the treatment of insomnia. Depression, if untreated, can result in greater negative outcomes. The key is to diagnose and treat both conditions appropriately.

Hallelujah! This is what we need! Treat them both! Don’t just focus on the psych illnesses! Those are important as well, especially if the patient is in imminent danger, but TREAT THE SLEEP PROBLEMS! *laughing*

Dr. Jacob: What impact does insomnia have on quality of life? What impact on quality of life does comorbidity with depression have?

Dr. Buysse: Insomnia, both as a primary disorder and as a comorbid condition, has a negative impact on quality of life. Insomnia has its own independent negative impact on quality of life, even when it occurs with disorders such as arthritis, cardiovascular disorders or cancer.

Perhaps I should have deleted this. It’s a very dumb question.

Dr. Jacob: Are there functional MRI changes seen with patients who have insomnia compared with those who don’t?

Dr. Buysse: I’m not aware of fMRI data. However, using positive emission tomography during sleep and wakefulness, we found that in people with insomnia actually appear different in both sleep and wake time compared with good sleepers. Patients with insomnia have relative brain activation. That is, when they appear to be asleep by polysomnographic criteria, their brains show excessive metabolic rate in the frontal cortex and in the brain arousal structures. During wakefulness, their brain is more metabolically active than good sleepers but insomnia patients have a relative decrease in areas such as the frontal lobe which are important for executive function and higher order cognitive function.

I find this a bit more interesting than the brief mention above about the PET scans, and non-REM sleep. However it doesn’t distinguish between those with primary insomnia, and those who have psych illnesses either with, or without primary insomnia. Maybe it doesn’t matter *PA raises eyebrows*

As far as the latter, there have been many studies done with PET scans, and fMRIs (not mentioned as being done above for insomnia) for those with psych illnesses, and measuring frontal lobe activity. I am not sure, but many seem to have been done regarding Schizophrenia–at least from what I have read. There may be more regarding other illnesses.

So is it illness related that your cognitive, and higher order functions are compromised, or is it because of lack of sleep? At the very worst (or “best” for the scan results) could it be that after building up a massive sleep deficit, your cognitive functions are completely screwed up?

However, I think what is more interesting, is that being measured while the insomniacs are asleep: the fact that they have a higher metabolic activity than the “good sleepers.” So what are we doing when we’re sleeping? Rather, what are our brains doing?

If we go back to the HPA axis, and try look at what Buysse is trying to say about the change in the CRH…well? Release of CRH is moderated in part by my good old friend Cortisol! Also by “stress,” but Cortisol is also known as “the stress hormone.” So it’s all a bit tricky. Circadian cycles get linked in there too…well, gee! That’s just going to screw things up, and not really help right? If you’re already thrown off because of your Circadian Rhythms, you’re probably not sleeping!

Like everything else in the big, wide, wonderful world of (brain) science, we require some more research here.

Dr. Jacob: What are potential consequences of not treating a patient who suffers from insomnia?

Dr. Buysse: Not treating insomnia results in poor quality of life and poor functional outcomes. Evidence suggests an increased risk for subsequent depression and anxiety disorders and there is some evidence for cardiovascular and other health outcomes as well.

Again, apologies. Dumb question. Of course there are other consequences as well. We can all think of some.

Dr. Jacob: How can we create better awareness about insomnia among physicians and patients? Do you believe that the new NIH Consensus Statement will help change clinical practice? If so, how?

Dr. Buysse: The NIH State of the Science Conference may help change medical practice. It really comes down to education and awareness. The practicing physician had very little sleep education during medical school or in post-graduate education. There is a great need to educate physicians about insomnia.

Hallelujah Part II!!! Are you listening doctors???

Dr. Jacob: How extensive is the economic burden of insomnia? Direct and Indirect?

Dr. Buysse: Insomnia is associated with decreased productivity and increased costs for individuals, employers and society. The financial impact is difficult to estimate but one study suggests that in the United States, the costs of insomnia are $77 billion to $92 billion annually, including lost productivity and accidents. The direct and indirect costs of depression are equally costly and estimated to be at least $44 billion annually for the US economy.

Stats, stats…bottom line you don’t perform when you can’t sleep, indeed work productivity plummets, people screw up, and it’s bad, bad, bad!

Dr. Jacob: Dr. Buysse, thank you for your time, I’ve enjoyed our discussion today!

Hopefully you’ll thank PA for her post and her time–and you won’t think this sucks *laughing*

Can You “Therapize” Yourself?

Now before I get all the Professionals jumping on me, and saying, “Hang on PA, where are you going with this?” I do have a point.

When you are in therapy, or even if you speak to any medical professional, psychologist, social worker etc… everything gets documented. Although we like to think that our records are confidential, they may not be or become so.

For example, although this wasn’t really a case of non-confidentiality as it was discussed with me, the entire “record shuffling” process eventually led me to find out that non-bio dad was…well, not my biological father. As painful as that was to learn, it was a good thing to find out. I am very glad to know who is, in fact, my biological father. Had that not been “disclosed” to me, I never would have known. Possibly ever.

There is a downside to disclosure of your records and what you share with your practitioners. I will only say this once (and I can’t believe I am but I am tired, vulnerable, and it is applicable to this post.)

I was a victim of “inadvertent disclosure” by one of my doctors. It forced me to take legal action. Not against this doctor but against a third party. Thankfully, I “won” but it could have been a huge nightmare beyond what it already was, and honestly, I am surprised that it didn’t drive me completely over the edge and put me in hospital for yet another bloody time! I am still frightened to death of it all and it happening again.

A few people know of this.  It will not be written about on this blog beyond this point–again because of the legal ramifications.

We all have secrets. I even made a post asking if I should send something to PostSecret. Is that “enough” to help you deal with the issue? Or do you need to do more work on it to…”deal” with it?

What if there is something that you really want to talk about that you do not under any circumstances want written down or documented for others to see? Something that will forever be there for “the system” to have access to for the rest of your life? Even if it’s such a tough issue, can you get over it yourself? Can you get past it?

Even if you “write a letter” to the practitioner stating you do not want it documented, it doesn’t matter.  Whatever you say gets written down as the practitioner feels “it is your best interest.”

I am not saying that professionals are not “human” and are incapable of making mistakes, but I paid dearly.  I am also not saying that in these settings you should hold important things back.  No, you should be honest when you need care.  Without it, you will not be able to get well.  I’m just tossing the question out there.

Good lord, this is a record for Blog365 posts.  Three in one day.  I just don’t know what to do with myself so I keep writing.

Out And About Last Night

I saw P. from our spring hospital stay last night. We met last weekend and he really wanted to keep the contact up and I am certainly fine with that. We had dinner and went to see a movie. The dinner was great but the movie was absolutely awful!

We went to go see “Lions for Lambs.” Now I positively forbid all of you to see it! It’s about the U.S. war in Afghanistan and the plot is easy enough to follow etc… but as you are watching and waiting for something to actually happen, it just ends! P. and I were…huh?

Good grief.

P. has found an OCD support group to attend. Support groups really aren’t my thing but I was definitely pleased for him as he sounded really enthusiastic about it. I asked him if he wanted me to go with him. After all, it is a “support” group, right? He said to me that he was thinking about asking me but he wasn’t sure what I would say or if I would be interested.

Oh, I just about died on the spot. Of course I would go! He’s such a sweet guy and I would do anything to help him.

It meets once weekly in the evenings and I’m not sure if he’s going to start this week or not but I’ve cleared my calendar (like it’s that busy haha) so I can attend.

I think it might be interesting, though. I’m not sure. Like I said, support groups are not my thing… Well, I guess I’ll find out.

Acoustic Amazement And Nutbar Radar

I’ve been staring at my screen for a long time now. Health Psych made a comment that she thought, even though I was thinking of, or needing a blogging break, her suspicions were that I would soon come back to be among “friends.”

That made me think. A lot. A lot about blogging. A lot about my state of mind. A lot about what has happened and indeed, the support that everyone has given me.

I do still want to get away from “life posts.”  But whatever.

I accomplished a lot this weekend–more than I had hoped.  I skipped down to a pub–not cesspool! And don’t worry…not a lot to drink.  Just a bit.  I thought I needed a break.

A man was playing music.  Accoustic guitar, some pedals and an amp. but not overwhelming.  He was good.  But what really blew me away was he played Queen’s “Bohemian Rhopasody” on his own! Now, correct me if I am wrong but are not all of the members of Queen classically trained? And is that song so incredibly complicated and arranged? For one man to do it perfectly (as he did) solo on just an accoustic guitar…

I had to approach him and say something.

Now, I know virtually nothing about music but I know at least that what he did was pretty amazing.  I bought his CD.

Prior to that.  I met, yes…a fellow nutbar.  How does this always happen? I swear, my nutbar radar is now better than my gaydar.

He was this huge man! I mean, what…270lbs? He utterly dwarfed PA.  Talk, talk, talk…no point in really how we got around to it all…it’s the same story, how PA always tells and advocates.  He said, “We have a lot in common.”

Bingo.

He had mentioned something briefly about a hospitalization but he didn’t say why.  We went outside for a cigarette.  I asked him about it, what he meant–about what he had in common.  He slowly lifted his sleeve and showed me his cutting scar.

It is very hard for men to admit they cut.

He said to me, “I am so ashamed.”  His eyes began to well up with tears.  I told him that no, no…I understand! There is no need to be ashamed! I raised my sleeve and showed him my scars.  He told me not to show them in public, his eyes starting to fill more.  I gave him a big hug.

I reassured him as best I could that there is nothing wrong with what he did or what I did.  I also started making the crazy joke I always do about becoming the terrible “amateur surgeon” where I severed only my median nerve and no major arteries or veins.  No one in hospital could figure out how I did it.

He wanted my number.  Sure…happy to talk if you need.  But be forewarned.  I am a nutcase who may not always pick up the phone.  I may be tired.  I may be busy.  I may be just preoccupied.  But I do pick up my messages.

How do I find these people?

PA just has psychiatric ESP?

God…when he left I was almost in tears for him.  I don’t know if I’ll hear from him but at least we got a chance to talk and perhaps he will know that he’s not the only one? Not that I’m giving myself that much credit for such a brief exchange…no, not at all.  I just know how hard it was for him to open up.

I’ll never forget those tears welling up in his eyes.

So For All You Heavy Drinkers That May Be Addicted And Want To Quit…? Get Yourself Some Topamax!

Oh.My.God. I just about had a Simple Partial Seizure when I read this, for which I do take this med (among other things…)

I don’t even know where to start. It must be my week (or a few days?) to get hit with a Big Pharma blast as yes (of course?) they were involved in this. Not to mention some rather overzealous researchers? Or ill informed ones? Granted, I am not a scientist, nor a M.D., nor a statistician…nor…nor…nor…

However.

Take a look at this article: Pill Helps Alcoholics Taper Off Drinking. Now, I usually link to msn.com as I think their links stay live but I’m not sure. I haven’t gone back and checked them from older posts and no one has told me that they ended up in error or you need to pay for subscriber services, archives or anything. Nonetheless, forgive me AP for drawing attention to some highlights. That maybe a naughty in the reproduction department but I did link to the original which is fine. And no one is making money from me so sue me for the “parts” I reproduce. I’m just a wee mental case blogger with an opinion. Not many people read me anyway?

But I really need to talk about this.

First off in this very tiny blurb about Topamax/Topiramate and it being used as a treatment for alcoholism, they refer to it as a “migraine med.” Okay, perhaps I am being picky but Topamax is primarily used to treat seizures. It is an Anticonvulsant.  For migraines, it is used in prophylaxis. It is not the same as an abortive. So skipping ahead, when people read this, will they say in the same vein with preventing alcoholism, “Gee, doc’…my migraines are killing me. Can I pop some Topamax when they get bad?” Then the doctors, neuros etc… have a bloody flip out as they can’t deal with uneducated patients asking for crap they know nothing about. Think of all the adverts you see on television now for this drug and that drug…

“Talk to your doctor if this is the right drug for you!” Again…thank you Big Pharma. I have read posts on doctors’ blogs who absolutely hate these ads!

Alright, time for some excerpts for those of you who have not clicked on the above link. And I will apologize here. This is going to be a long post.

Now, before I get into the AP stuff, there is a link there that will take you to the study published in JAMA (The Journal of the American Medical Association.) At the moment, the study is free to read but it will probably disappear in a week. Yes. If you are not a subscriber, you will have to wait six months to read it! And again, that is if the link on msn.com survives! So you’ll just have to take my amateurish word re: the JAMA stuff.

Okay, let’s have some fun! From the AP blurb on msn.com:

Experts said the drug is likely to appeal to heavy drinkers who would rather seek help from their own doctors, rather than enter a rehab clinic to dry out.

No fucking kidding! Rehab’s a drag! Let’s just pop a pill–even if it doesn’t work!

Addiction specialists not involved in the study said the findings are promising, although side effects such as trouble concentrating, tingling and itching caused about one in five people to drop out of the study.

I’ll tackle this when I get to JAMA. But I had the first two with Topamax and they went away with time. I still have trouble concentrating but that’s more to do with the ADD.

The study, published in Wednesday’s Journal of the American Medical Association, was funded by the maker of the drug, Johnson & Johnson Inc.’s Ortho-McNeil Neurologics. The researchers also reported financial ties to the company. Ortho-McNeil reviewed the manuscript, but did not change the results or interpretation, the researchers reported.

Well, good bloody god, I hope not!

“You can come in drinking a bottle of scotch a day and get treatment without detox,” said Dr. Bankole Johnson of the University of Virginia, who led the study, which was conducted at 17 U.S. sites from 2004-2006.

Bankole’s so positive you know. Despite that fact, I think he might have been just about the only one not mentioned on the Financial Disclosure of the JAMA study? However he was involved in The Lancet’s prior dalliance with this where the JAMA study got their “magic number” (as I call it) dosage of Topamax for this engagement. Again, why the hell people dropped out?

The study didn’t follow the drinkers long-term, so it’s unclear how many relapsed after they stopped taking the pill.

This is actually accurate reporting. The JAMA study states this. So, erm…who the hell knows? Addiction is addiction. Or, having problems with drinking, is simply that. People fall off the wagon all the time! How do you know if your study works of you don’t track your outcomes over time? Especially with something as tenuous as this?

But there were lasting effects for Tom Wolfe, 44, a carpenter from Earlysville, Va., who said he has been sober for two years thanks to Topamax. After years of heavy drinking, he took part in an earlier Topamax study. He felt “a little lightheaded” at first until he got used to the drug. Alcohol lost its enjoyment, strengthening his resolve to quit.

“It’s been a miracle to me,” Wolfe said. “It got the monkey off my back.”

Ah, nothing like a good testimonial to drive it home, right kids?

The drug works by inhibiting dopamine, the brain’s “feel-good” neurotransmitters that are involved in all addictions, said Stephen Dewey, a neuroscientist the Brookhaven National Laboratory, who was not involved in the study but does similar research.

It’s a new approach, he said, that “clearly did work on a very small subset in the population.”

Okay, Dewey. Were you misquoted here? Fair enough it does theoretically inhibit dopamine but lets not forget about GABA and glutamate? They are also possible neurotransmitters that are involved? It’s not just about knocking out pleasure seeking. Remember, this is primarily an Anticonvulsant and dopamine is not necessarily thought to be involved in causing seizures? Otherwise, we could throw people with epilepsy and seizure disorders on a bunch of Antipsychotics? Granted they generally hit the D2 receptors? Regardless…there is more to Topamax than dopamine.

As a matter of fact, if I may go on my typical little speech about Topamax, it is a Temporal Lobe drug. It hits your Temporal Lobe hard. That is why it is considered “hit or miss” for people with Bipolar. For seizures, it’s a little more interesting as they seem to know a bit more about them–possibly. Dependent upon what type of seizures you may be having, a better Anticonvulsant might work for you (i.e. there are usually preferred ones for absence seizures etc… or at least ones to try first.) And, you may even get lucky with a physiological issue during an MRI scan (well, usually that may not be so “lucky…”) or something might be caught on an EEG to help you along. For migraine prophylaxis, who the hell knows as even less is understood about them!

As for Dewey’s latter statement, broad and sweeping and of no relevance, thank you.

Willenbring, who wrote an accompanying editorial, predicts that a future pill, although probably not Topamax, will do for alcohol dependence what Prozac did for depression: Remove the stigma.

Prozac changed the nature of depression treatment 20 years ago by allowing patients to see their family doctors for help, Willenbring said. An effective drug with few side effects could do the same for alcoholism treatment, he said.

Oh.My.God (Part II) Who the hell is this guy?! Just exactly what did Prozac do to remove the stigma of Depression or mental illness? When has any drug done that? A lot of times, when uninformed people hear you’re on meds they get totally freaked out? And when Prozac came out, it was one of the most over prescribed drugs on the market? And an “effective drug with few side effects.” Ohhhh…I’d like to see just one pharmaceutical company produce one of those–for anything!

And yes, here’s his finest moment:

“This is a huge market,” Willenbring said. “We’re approaching a Prozac moment.”

Ironically, on msn.com this was somehow posted under the url of http://news.moneycentral.msn.com.(etc…) That’s just too hilarious. Or not.

Okay, this is kind of weird:

But Topamax has big obstacles. With the drug maker’s patent expiring next year, there won’t be any big push to advertise it for alcoholism, Willenbring said.

Maybe I’m not up on my FDA patents but the Canadian patent expired a while ago and I have to take the generic due to my drug plan’s stipulations. Ah well…at this point, I’m to tired to bother looking it up and you still have to deal with me going through the JAMA article!

On Tuesday, Dr. Sidney Wolfe, director of Public Citizen’s health research group, sent a protest letter to the U.S. Food and Drug Administration questioning the promotion of Topamax for alcoholics by researchers funded by Ortho-McNeil.

“This is a very bad message to send out,” Wolfe said.

Well, Halleujah! At least someone’s paying attention besides wee PA!

Are you all still with me or falling asleep yet? Alright, I’ll try to keep the JAMA stuff brief.

Alright, so JAMA at least touched upon a bit of the glutamate stuff so that’s decent. And again, they proposed the study as a hypothesis (hello?) so it wasn’t so ridiculously posed as the media spun it.

Okay, they ran the dosage up to 300mg of Topamax (my “magic number,” right?) According to the JAMA study (from what I can gather from a notation) this was derived from a 2003 study that was published in The Lancet. Recall, happy Bankole Johnson? He was in on that one.

Now if you can jump on the JAMA study before it disappears and look at the titration schedule, well ‘geez, it’s no wonder some of the people went a little loopy and started bolting before it was completed! I mean, wow, they were titrating everyone 25mg every week! What happened to the rule of a slow and steady titration! When I looked a the chart I was just…

*PA shakes head*

I’m trying to recall my titration and if it was that fast and I don’t think it was. I’m pretty sure I went up 25mg every two weeks? Or maybe I didn’t. Maybe I did initially do 25mg a week with Dr. Asshole my ex-GP and then slowed it down? Either way…woo! I was pretty out there. And I’m on 200mg now. Good enough for me doing triple duty: Bipolar, Seizures and Migraines (although I ended up needing an adjunct for seizures–well, for Bipolar too.) Regardless, everyone is different but that is my point. Slap, bang! Let’s just ramp everyone up to 300mg!

Understood, I get that you need to have some sort of gauge in your study but also, when I looked at the table as well to show the adverse effects of Topamax participants vs. placebo…interesting variance in some cases? Certainly more than what you might see on something more generic like rxlist.com? Wasn’t anyone paying attention to prior research? At least they admitted in their limitations that their titration rates were too high. Well, duh.

Other limitations that they excluded were a significantly(?) large population of people that might have addiction problems? Yes, indeed…they called their population “…relatively healthier and more homogenous…” Okay, so how do the rest of the sickos and those with comorbidities work out? Not so well?

And yes…no follow up, period. But they were quite happy with their study results nonetheless and concluded as such:

Our finding in this study that topiramate is a safe and consistently efficacious medication for treating alcohol dependence is scientifically and clinically important. Alcoholism ranks third and fifth on the US and global burdens of disease, respectively. Discovering pharmacological agents such as topiramate that improve drinking outcomes can make a major contribution to global health. Because topiramate pharmacotherapy can be paired with a brief intervention deliverable by nonspecialist health practitioners, a next step would be to examine its efficacy in community practice settings.

Please…please…no.