• 💖 [Donate To Keep MyPTSD Online] 💖 Every contribution, no matter how small, fuels our mission and helps us continue to provide peer-to-peer services. Your generosity keeps us independent and available freely to the world. MyPTSD closes if we can't reach our annual goal.

Psychiatric assessment update

Status
Not open for further replies.

J'qel

MyPTSD Pro
Not sure how to type this out without it becoming a novel. I'll try and touch on salient points.

I went to get an assessment today because of rapid almost violent mood swings (violent in degree not in action) that hit me over christmas for no reason I, nor my husband can think of. It's been accompanied by nightmares (which I could probably count on my hands how many times I've had nightmares in my life-the last while has at least triple that number).

I'm not sleeping, or not sleeping well, when I sleep deeply, I have nightmares, other times I feel like I'm half awake the whole time I'm "sleeping" drifting in that state where you're not quite awake, drifting in darkness, but just able to hear enough to wake up if there's a strange noise or change in the environment.

The doctor, after much confessed puzzlement-we went over everything-life has been pretty decent to me this christmas other than the usual day to day that is dealing with PTSD on a low hum (I'm getting used to it and have been having some luck with some coping mechanisms to keep the worst at a low level). No sudden changes, no physical changes that we're aware of, in fact, if anything my diet is better than it was two months ago, when we were sleeping in our basement living room having renovations starting at 6am and not ending for almost twelce hours of banging and crashing and strangers tromping around.

So-sudden mood swing-talk to psychiatrist on call-he suggests seroquel and that's been okay. 50mg, it slows the moods, but *they're still there*. Just muffled and slower. Still getting the nightmares, still can't sleep for crap.

Took a sleep apnea test, first time I didn't sleep enough for any data. Second time will hopefully be the charm (husband urged me because he's heard me with laboured breathing and half choking in my sleep. I remember waking up feeling suffocated... but... he's more alert when it happens than I am, I suppose).

I had some blood work done in case it's thyroid, but my family has no history and I've been pretty decent the last few test came 'round. I don't know what else she had assigned. More than that, but what, I didn't ask. I was very tired that day.

I had my follow up with the psychiatrist and he did a full assessment-which I wasn't expecting at all. I know some of what he did triggered me with my prior abuse, though he didn't mean to, and he doesn't know me, so it can be forgiven. That doesn't help anything (he told me that two of my prior staff weren't available in the capacity they saw me in-but I *did* see them in that capacity-so it hits me back to my mother telling me I'm a liar and making things up. Normally wouldn't bother me, but the environment was setting me ill at ease and the surprise of an assessment put me on an uneven footing to begin with-so I was already primed.

He wants me to enter into a program at a center where I have gone-and left because they said self harm was acceptable as long as you didn't kill yourself. I was very not okay with that-for *so many* reasons. So I'm skeptical. He said it's evidence based, but I still have a bad feeling left over.

He wants me to try adding two *more* meds to my regime and I am not okay with that. My Doctor has earned my trust enough for her to persuade me. I'm not okay with some random person I just met, Doctor or know prescribing me pills that mess with my mind. It was a fight to get me on cipralex to start and I only accepted because I was suicidal and saw no other choice.

Then I come home, still high keyed, anxious, wanting to cry and wired for sound, and stick my head in a book to calm down. Eventually, it all pools out, and I'm exhausted. I lay down for a nap....

And am greeted with a nightmare where I am drugged up and start going more and more crazy while another person hurls insults and attempts to abuse me, while to add onto it, my face starts swelling and I start choking on my tongue. I wake up finally, and the nightmare was *SO* visceral it takes me a half hour to remind myself that this, the waking world is real, and that it was just a nightmare. Even now, reality feels less...sensory, almost faded, by example, but it's fading.

Now I'm terrified to go to sleep, still feeling like crap from the appointment and none of my regular coping mechanisms are helping enough. They're helping-I'm not curled into a ball in the bathroom on the floor, but I still want to. Even if I wasn't asleep, I'm so keyed that I can't.

Help?

*ugh even if I wasn't afraid to sleep-I'm so keyed I can't.

Also apologies, but this is sleep&nightmares, flashbacks, other symptoms and anxiety. I didn't know where else to put it.
 
Last edited by a moderator:
When I started to improve in how I handled my flashbacks and traumas, my nightmares increased as I had relaxed enough to handle the next batch of memories. My sleep worsened and my moods fluctuated more. Moods actually fluctuated more because my sleep wasn't sound enough or long enough. I am writing this at 3:40 am ironically as I have been having nightmares tonight and I fell asleep after remembering some happy memories from my past, which I thought were lost. My sleep and mood up and downs increase when I start dealing with issues too. While it is uncomfortable, I know this too shall pass eventually. Nightmares are brains way of trying to make sense of the day or other thoughts. Just worrying about meds and what is causing them can increase them.

Find a night time relaxation routine which works for you. Stay away from news and hot topics before bed. Remember deep breathing exercises to calm. I also have a fan on for white noise and the moving air helps me breath easier when sleeping.
 
i struggle with assessments too, people who have no idea of anything about me, and they dont really try, they just sit there and select meds which they want to try me on. so like you - i tend to not be happy at that. to the point where i say, i am not here for meds, i want therapy - or other help. I always say "if you can assure me 100% these meds wont make me worse, then ill take them" - they never can of course so that tends to shut them up. but it doesnt always result in therapy either, often its a case of "ok then, off you go, dont bother me any more". Perhaps thats just how the NHS is in the UK, but im whole heartedly sick of the whole system
 
It's not just uncomfortable, I live in a house with my husband and two others. My mood swings became so sudden and so very overwhelming that I was going from laughing to crying to enraged. Not just sad and happy, but it got to extremes that switched around like you'd given a tv remote to a toddler with too much sugar. I'm concerned about the people I live with. It's why I eventually went to see the doctor when it became obvious they were getting worse, not better.

As for the nightmares, I'd agree, except this last one is the only one that makes any sense. One of them I was going through a building with people talking about...something, and then my nose started to bleed. The harder I tried to stem it, the worse it got. As you would in real life, I grew more and more concerned until I was terrified. I woke up in a cold sweat gasping for air.

They've been similar things, in one my husband told me to get out and that he despised me, while he went on to have an affair with someone in front of me (we have a very solid relationship, to the point we wonder why most people even bother getting married). It's not something I'm worried about or that could possibly happen.

All of them are fully sensory, very visceral and leave me waking up in terror and fear and just the blackest of feelings while I struggle to reconnect with a reality that feels less real than the nightmare.

I can think, touch, taste, read, all of it. It's a full sensory experience, like life only in high contrast with everything cranked up (no, I have never done drugs, so I wouldn't know if there's a parallel-but I have always had full sensory dreams, just rarely ever any nightmares-maybe ten total my entire life until this started? Probably less).

Each time it's harder to come back from the hazy feeling of unreality and the unease and fear takes longer to go away. Each time it feels like it lasts longer and it's harder to wake up from them. And of course, I'm just getting more tired, with each one I feel like I lost sleep after having them.

I'll take the meds, but I won't like it, because my doctor made the appointment for me to go in, and I trust her. Truthfully, I detest the idea, I hate it more than I fear it. I'm a stubborn one and if it makes me feel miserable I won't take it. I won't be stoned out of my mind.

I'm just at an impasse. Things seem to be progressing, and I need something more than my usual coping mechanisms. Usually I scrub my brain with a book if something is bothering me and on the rare occasion I have a nightmare. I've been through five now, and past my twenty four hours.

I can't keep doing this, staying up until I'm so exhausted and then collapsing, only to wake up gasping for breath and terrified and exhausted and worn.
 
As for the assessment I know why it bothers me, I just can't seem to grab hold of my triggers and turn them down right now. It's like there's a block my usual methods just keep smacking right into, as if I was throwing a water balloon high speed at a brick wall.

I guess I'm hoping there are folks who may have had similarly intense periods who have a "last ditch" option that jolts them out when nothing else works.

Otherwise it's going to be a rough two weeks, and I have no idea how I'm going to get through them. I know my husband is there for me, but I really don't want to subject him to what I'm going through right now, but I'm not sure how much longer I can keep him distanced from it.
 
Have you considered that the nightmares may be caused by the medications you're on? Psych meds are funny things - you can be on them for a long time and suddenly they'll stop working or suddenly you'll experience a side effect you hadn't experienced in the past.

You mentioned Seroquel - vivid dreams and nightmares have been reported with Seroquel, but they're not listed a common adverse event in the prescribing information (most likely because they didn't occur at a high enough percent in the clinical studies and haven't been reported at a high enough rate in post-marketing reports).

Many years ago, I took Ambien to help with sleep - I experienced "sleep eating" and also a choking sensation that felt like my tongue had swollen up. At the time, these events were not listed in the prescribing information and my doctor was a bit dubious. The PI has now been updated to include "'sleep driving' and other complex behavior"
 
Not sure how to type this out without it becoming a novel. I'll try and touch on salient points.

I went...
It sounds like you are scared of getting more meds and that is certainly understandable. Just like you mentioned, the symptoms are still there but we react slower when we are drugged up. I am a stalking victim and can not afford to be drugged up, because I have to be alert for those suckers who seem to think they have a place in my life.
 
I started having the nightmares before Iwent backl on seroquel. When I was on it previously, if anything it made my (regular for me) vivid dreams occur slightly *less* often. If I'd had nightmares on seroquel before and they'd just started after I went on it, I'd already be off it and trying to work out something else with my doc.

I really don't like meds. My sibling is junkie. You name it, they've probably tried it, and I've gotten to watch what it has done to them over the years, I will *never* go that way. I trust my doctor, because she's earned it by working with me, being respectful, responsive and understanding. I absolutely adore her.

The psych though? I don't know him. I went to have my assessment in what I hope was a temporary room-and it was very aggressive and unpleasnt environment. The wall paint against the desk actually bothered my eyes (a weird mint greenish shade against the orange yellow of the wood) enough that I had to stop looking up (almost felt like my eyes were buzzing painfully-as if I was severely overstimulated-never happened with my vision before). There were two restraint beds in the room, pieces of equipment were in pieces or missing from empty brackets, and the floor was stained and cracked. If the bulbs had been flickering it would have looked like something out of a horror game. Not the best place to be doing an assessment in, but I think it was a temporary room he was using in the interim. Still, as much as I understand, it still put my nerves very much on edge.

An update:

Feeling tired and sore today, a little swinging but not as much. Yesterday and the day before were great. I was puzzled but very happy about it. Didn't sleep the night before last, was up all night. Got a nap in the afternoon, but woke up again feeling juuust fine. No swings, mind clear, everything hunky-dory. Then today I had my third period in six weeks. Not evenly spaced either. Seems I was having a version of PMS. Now I'm tired and a bit off (not as bad as when I had to go in, but not as stable as I'm used to yet), worn and crampy. Good news? Maybe it's a hormonal imbalance. Bad news? Could be a lot of things causing that.

I think I missed my doctor update on the bloodwork, but I could have sworn the appointment was next week. I'm not sure, I have to call on monday. Apparently confusion was one of my symptoms as well. Still feeling clearer than I have but have had to have my husband pull me back from the thousand yard stare a few times today. At least I didn't try and put my meds in my dice box today, (apparently I did a couple nights ago-because that's where I found my pill bottles a couple of days ago) nor pour ginger ale in my coffee (brain kicked in before I ruined a perfectly good dose of morning caffeine but ugh).

Once I do get in for my appointment, I'll update here if I have results, I'm hoping it's a simple thing like a thyroid issue (as simple as that is) that decided to start off with a bang. Early menopause isn't a thing in my family (either side) so I don't think it's likely and the other opstions are messier, more complicated and I just want an answer and a fix for it.

My biggest problem; wanting solutions *now*. Especially when it has my mind all over the place. I hate being this erratic with no way to control it other than gritting my teeth when the worst hits. Keep your fingers crossed for me. :)
 
A hormonal imbalance can cause a multitude symptoms. It might be prudent to request a thorough evaluation of your endocrine, nervous and adrenal chemistry. These systems all work together, so an imbalance in one can impact how the others are functioning. With cycle disruption and an uptick in mental health symptoms, I'd definitely be asking questions. It might be an issue like PMDD that could be readily treated or a thyroid issue. Perhaps you can write out all of your symptoms as they stand now, and how they were before and when the change occurred. Keeping a log of all factors involved, i.e. meds/supplements, meals, physical symptoms, mental health symptoms, exercise, any triggers, etc... helps to narrow the field when it comes to diagnosis and treatments. Just a couple of thoughts for you to consider. It puts the power back in your hands as well which is a good thing. It would be a shame to have you on serious psych meds when this could be a matter of PMDD or an off balance thyroid.
 
As for the assessment I know why it bothers me, I just can't seem to grab hold of my triggers and turn them down right now. It's like there's a block my usual methods just keep smacking right into, as if I was throwing a water balloon high speed at a brick wall.
Assessments get to me badly too. Hard to figure out all the reasons why.
I guess I'm hoping there are folks who may have had similarly intense periods who have a "last ditch" option that jolts them out when nothing else works.
Strong safe sensations help me. Walking around on different surfaces barefoot. Bouncing a ball, shooting hoops, smelling string scents, sour or minty candies or gum, spicey food, holding ice and then something warm and soothing... It oddly helps pull me out of triggered panic, and helps settle out my body and anxiety and spinning mind somehow.

That program that tried to make self injury ok sounds terrible! I think you had good instincts about it. Maybe there are other programs. I turned down a few before I found one that fit me.
 
Thanks tons guys. I'm worn and exhausted-3 periods in about 5 weeks will do that, but it's nice to have more input.

I have actually written the date it started the third time, the second was the next day from my last doctor appointment, so that will be on record. I usually am rather analytical, and use it to help me stay on an even keel emotionally as part of my coping mechanisms. I'm still on the 50mg of seroquel though so that's seemingly keeping the mood swings low and slow, as opposed to the randomness I was experiencing before.

I know I can't expect much from an assessment that take a half hour or so and consists largely of checklist with no time for discussion about the answers. The psych suggested I may have BPD as well as PTSD-but I don't think he's right. I have no fear of abandonment and it isn't that I was having mood swings from responding to emotional surrounds, but having wild swings for *no apparent reason*.. I could be looking at a video of cute kitten and be suddenly deeply depressed followed by enraged and provoked to hilarity. It wasn't stimulus generated and I don't think he understood that. I think he got stuck on wild mood swings and assumed there was a stimulus for them when there wasn't.

I understand why he'd assume there was, to not have a mood tied to stimulus is weird. To have an utterly random series of random time, random intensity mood swings rapidly with no provocation is not something I expect many go through without being pregnant (I'm obviously not).

I will likely talk to my doctor about my misgivings when I speak to her, I don't know what she'll suggest. Since it seems rather more easily controlled and slowed down now, I expect she'll merely increase my seroquel dosage and ask me to keep an eye on it and let her know if it happens again. She's wonderful. I wish everyone had a GP like her.

My appetite has been all over the place, and for the next day or so I will be sleeping a lot. Between the amount of ibuprofen I need to set aside the pain of my (rather severe) cramping, and the blood loss, I usually sleep for a couple days with breaks for bathroom and meals. I am carrying extra weight I can't get rid of, but I always thought it was because of the medication I'm on. Some general pains and aches that could be related to flu or colds, or stress, things have tasted strangely-either bland or off -again cold or flu would explain it.

That's the issue. A lot of the symptoms I'm having are fairly low key and I've been ignoring them as just general mild illnesses-as two of the folks who live with us work in jobs where they deal with a lot of the public so they bring stuff home. The wild swings with no provocation are my only stand out symptom-well until the *third* incidence in the last five weeks. Ugh. I generally am satisfied with my biological sex, but there are times when I seriously envy the other half. *sigh*

I'm actually banking on it likely being PCOS-the symptoms didn't seem tied to my cycle. While that's no fun, it's something that's understandable and treatable without extra psychiatric meds and programs that I don't feel are .... appropriate.

For some they do work, the one he wants me in focuses on making art and talking it out. I talk it out with my husband and I already draw, paint, write, sew costuming and have a history with metalwork and sculpting. I'm already using art to constructively express, so I don't see how making a collage or painting a beach scene in a classroom environment would help me more than writing about it, or sketching it out on my computer. Maybe I'm missing something.

I'll hold out hope and express my concerns about additional medications with my doctor. She's been great so far, so she may continue to do so. *fingers crossed*

Thanks for helping me reason it out, guys it's a huge help. :)
 
Status
Not open for further replies.
Back
Top