Friday, July 18, 2008

Updates

Thank you to everyone who has asked how Mr Man is doing. I’m sorry to have kept everyone waiting so long for an update; since the weekend I seem to have swung from being mentally very alert and hardly sleeping, to feeling like a zombie and sleeping at every available opportunity. I expect this is a normal reaction to stress, and my sleep patterns seem to be governed by the perceived level of need from Mr Man – now that he is sleeping more soundly, I am too.

Dr Hillary was able to go back into work on Monday afternoon, and she obviously felt that seeing Mr Man was more of an emergency than whoever had spoken to the receptionist that morning, as she called to say that she would come for a home visit after 5pm that day.

It was important for her to establish why Mr Man had stopped taking his medication, as this would have a bearing on which direction her care would take. She was happy to find that it wasn’t due to any loss of insight, or command hallucinations, but because Mr Man had simply had enough of the side effects (I will write more about this soon). She was also concerned that Mr Man could be suffering from rebound psychosis after stopping his Clozaril so abruptly, but again, was happy to note that this didn’t seem to be the case.

Actually, I have been very surprised that Mr Man’s symptoms have not deteriorated as much as they have in the past. I suspect that the Abilify he takes has helped him far more than anyone realised. About four years ago Mr Man skipped some Clozaril, hoping to control some of his side effects, and at that time he became very ill, very quickly. He was careful not to skip more than one dose at a time so that he wouldn’t have to be reintroduced to the drug (which is when the side effects are at their worst), but within days he was sitting right up close to the TV, with a note pad and pen in hand, insisting he had to write down “codes” from the commercials for “the company”.

At that time he was also taking Risperidone, but the worsening of his symptoms without the Clozaril was dramatic. This could lead some to conclude that maybe the Risperidone wasn’t really up to the task, but it’s interesting to note that when the Risperidone was reduced before the introduction of Abilify, there was a marked deterioration in his symptoms then as well, even though he was still taking Clozaril. This is why I say that the Abilify has obviously helped Mr Man more than anyone realised, as it really seems to have kept him afloat this time. I can’t help wondering if some of Mr Mans current psychosis is in fact rebound from stopping the Clozaril abruptly, and I wonder if he would have managed on Abilify alone if the Clozaril was reduced gradually and the Abilify increased slightly. Perhaps we’ll never know.

Of course, from Mr Man's point of view he's not doing very well at all - the voices have worsened, his anxiety is worse, and he is struggling to "hold it together" as he put it. I've no doubt of the internal struggle he is having to remind himself of what is real and what is not, and I know that when the voices worsen it becomes very distressing for him, but he hasn't lost his insight and become completely delusional so from my point of view he is doing very well. He even spent some time in his studio this evening. I still keep running up the stairs every time I think I can hear him in the bathroom though, so deep down I know the potential for further deterioration in his symptoms is there.

Dr Hillary praised my good sense (her words) to increase Mr Mans Abilify over the weekend and has decided to keep the dose at the increased level of 15mg instead of 10mg. She didn’t want Mr Man to continue relying on Diazepam for sleep though, because of its addictive nature, so after also noting Mr Mans heightened anxiety (he was shaking from head to toe), she prescribed him Quetiapine, also known as Seroquel. Quetiapine has a sedative effect and is sometimes used for the treatment of sleep and anxiety disorders, although it is primarily an anti-psychotic medication. So hopefully it will cure everything! So far it seems to have had the desired effect – we’re both sleeping better and I’m not even the one taking it!


On a Lighter Note

After researching Quetiapine on the internet I discovered that it is highly sought after by inmates in US prisons, referred to as “Suzie Q”. I told Mr Man that if he decides to cut out his medication again to give these ones to me instead of throwing them away – I might be able to sell 'em!

And Hannah, from Coloured Mind and Scattered Thoughts, raised an interesting point in the comments section about crisis teams and early intervention. Dr Hillary mentioned this during her visit. She said if we wanted to be referred to the crisis team we should let her know before Thursday. It seems one actually has to be referred to a crisis intervention team before they can intervene, which really isn’t any use if you’re suddenly having a crisis out of the blue, is it?

14 comments:

Seratonin said...

You have a very supportive hands on Psychiatrist.Good to hear that you managed to get her to visit & check things out.As far as I know our Psychiatrists don't do home visits.
I agree that needing a referral to the Crisis Team seems a bit odd.Then again I suppose they have to draw the line somewhere, otherwise they'd be snowed under.
I did have brief contact with our Crisis Team earlier in the year.My 'referral' was via the out of hours GP service.Granted I had to wait for hours before I even got a call from a GP to find out my problem & then the stupid woman was reluctant to even contact the Cris Team.According to her 'they never answer their phones & there's no Psychiatrists working weekends'. Which of course was an absolute lie.In the end I didn't need a visit by the team, they offered but I managed on an increased dose of Diazepam.
Hope things settle down & glad to hear you're both getting sleep.
Take care
Sis xxx

Anonymous said...

You give such insight into care- giving. Mr. Man is lucky to have you. Plus, you understand his genius! Your writing is beautiful and therapy for me.(To know that I am not alone.) Thank you. Sincerest wishes to you both. DianeG.

Mr Mans Wife said...

Thank you Sis.

Yes, we're very lucky - the psychiatrist we have is very caring and very knowledgeable.

I understand why crisis teams need referrals, it's just that it seems to defeat the object of being able to call them and have them respond immediately! I'm glad you were able to manage in the end without a visit.

...

Diane, thank you so much for your lovely comments. Sincerest wishes to you too.

Barbara K. said...

You are so very present for Mr. Man. And there is so much to juggle and hold in one's mind. I'd be interested in learning about how you leave space for yourself?

Mr Mans Wife said...

That's easy Barbara, I make time for myself by neglecting everything else! :)

Seriously though, I think "me" time is something that everyone struggles with. It can be a bit hit and miss, and sometimes I get less than at other times, but Mr Man is usually very aware of my needs. He feels incredibly guilty when I need to cancel or postpone something because of his illness. I suppose knowing that he would never make unnecessary demands of me makes it easier to cancel plans and stay at home with him when he needs me to. I used to find it so difficult, feeling that I was "missing out" all the time, but in time I have adapted and as Mr Man's condition has improved it has become easier to leave him at home.

Until this recent situation, I was able to leave Mr Man at home alone for a few hours, but obviously things have now reverted back to how they were previously. I have adjusted by finding hobbies that I am happy to occupy myself with at home. When Mr Man is very poorly I need to be available for him and ready to stop what I am doing, but again, this is something I have just got used to over time. When he is well enough to engage in hobbies of his own I use this time to do what I want to do. During the table tennis season he likes me to accompany him to matches, so I try to take something with me to do - either a book to read, music to listen to, or pen and paper to write blog posts.

I think sometimes "me" time is a state of mind. I could go out with friends for a coffee and a chat, but if it's not what I really want to do at that time it feels like a chore.

I hope that answers your question? Thanks for your comment Barbara.

Seaneen said...

Fingers crossed for Seroquel- it has so far kept away my psychosis. I have only relapsed into psychosis when I've quit taking it. x

Mr Mans Wife said...

Thanks Seaneen, here's hoping eh?

There and Back said...

"It seems one actually has to be referred to a crisis intervention team before they can intervene, which really isn’t any use if you’re suddenly having a crisis out of the blue, is it?"

No! It isn't! Our crisis team doesn't come out in a 'crisis' at all. I could go about this all night, but I won't!

Glad you've got such a supportive psychiatrist and that you are both sleeping better. That's good to hear.

Catherine said...

Sometimes I think it is worse knowing that you are heading downhill, even if medically it is supposed to be better. Everything is moving in motion and you can feel it happening, but you cannot seem to stop it. Like watching a car accident in progress except you are the car.

Mr Mans Wife said...

Thank you There and Back.

We've never actually had any experience with the crisis team - I think they are a fairly new concept in this area, and thankfully we have had no real "crises" for quite a while. They don't sound very useful if they don't even come out though! Mr Man's psychiatrist said they would come out 3 times a day to offer support if we needed them to. This is obviously not your experience then?

...

You explain it brilliantly Catherine. The sheer panic when you are in expectation of something bad, but there is nothing you can do to avoid the "impact" except brace yourself.

I hope you are keeping well. Thanks for dropping by.

colouredmind said...

I am glad that you have such a supportive psychiatrist who can tell the proper difference between a crisis and a non crisis. Heres to hoping that the Suzie Q works. Hannah X

Mr Mans Wife said...

Hehehe :) Thanks Hannah.

Carol said...

DH had a "crisis team" when he first got out of the hospital (he was hospitalized for depression, and you know what that does to someone when they're really bipolar)...anyhow, they were more stablizing than I thought they would be--they came to the house every day and spent time with DH, talking about his mental health and trying to keep him out of the hospital. His team was good, but when he went into more mania some time afterwards, his psychologist wouldn't let him contact the crisis team because DH "wasn't in crisis anymore". I guess he (the psychologist) knew better than we did.

DH has been on Seroquel for quite some time and although it knocks him out, it did seem to help the worst problems that were happening until he got on the Lithium. He's talked sometimes about seeing if he could stop the Seroquel, but I think he's doing so well right now that I hate to "tamper" with anything.

You are so perceptive and considerate of your husband and his illness. I wish I had your insight--I'm sure our house would be much more stable than it's been.

Mr Mans Wife said...

Thank you Carol, that's very kind of you to say that, but I often think it must be so much more difficult to cope with the ever changing environment that living with someone with a mood disorder must create.

I'm glad that your experience with the Crisis Team was a positive one. I'm guessing their usefulness varies from area to area, like so many other services.

I completely understand your reluctance to change medications when your husband is doing so well. But I have to say that it's because Mr Man knew I wouldn't want him to come off his medication that he did it without telling anyone! So if that's what he really wants, maybe it's better to be prepared!

Mr Man hasn't found the Seroquel/Quetiapine to be too sedating thankfully, but when he was taking Lithium back in 2001 it completely knocked him out for about 18 hours a day!

Thanks for commenting Carol.