My psych is giving up.

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My psychiatrist seems to be giving up on me in terms of autism. I know that she is really meant to only deal with mental health, but she prescribes me my meds.

I am having daily meltdowns and she seems to think I'm not trying hard enough and that I am being pathetic.

She didn't like the fact that I was taking a taxi home from my last appointment because I couldn't face public transport and my support worker couldn't accompany me back home.

My psych said no increase in meds, try harder instead.

I can understand that looking for triggers to meltdowns can help prevent them, but it hasn't really worked so far. I nearly fractured my wrist yesterday and today it is all lumpy (am typing with one hand).

I am really scared that I'll end up in the secure unit agian. I am truly scared of this. I am avoiding going out because I worry that if I go out alone and someone in public does something like put their hand on me, or I get subjected to too much loud noises etc, I will end up attacking the person or smashing something. Last time the police got involved I attacked one of the officers and ended up restrained and handcuffed. I narrowly missed being charged.

I just want to live a life but I am housebound when I am not in uni or with my friend or support workers.

What are you looking for? It seems like you're maybe looking for suggestions but I'm not sure what you want us to focus on?

Last edited by Waterfalls on 12 Nov 2014, 11:53 am, edited 1 time in total.

I'm sorry Steel Maiden. It sounds like you have a very difficult time and your psych is not really understanding this.

Thanks.

I am asking for suggestions, any suggestions. Reducing meltdowns. Managing sensory overload.

I am looking into getting prescription sunglasses (I have complex sight problems) but I need to go to a more local specialist optometrist so it's finding one first. My current glasses are Irlen lenses but they're not dark enough.

Are these medications even helping as far as you can tell? She does not sound like a very professional psychiatrist, might be a good idea to look into other ones. Taking a taxi instead of public transport because you feel there is a good chance you could get triggered and freak out on public transport seems like a responsible thing to do....very unprofessional for the psychiatrist to refer to it as pathetic.

Also maybe find a therapist, they might be able to help you with some of this. Also if you have a support worker perhaps this is something you could discuss with them....but not sure exactly what they do. Sounds like you simply need more support than you are getting.

I take two antipsychotics, primarily for psychosis and OCD, but also an attempt to control my challenging behaviour. The psychosis is manageable. The OCD isn't really manageable. As for challenging behaviour they do f*** all. I cannot take antidepressants as I've tried four different ones in the past, one by one, and they all made me go manic.

My psych has been great in the past, but she seems like she can't be bothered with me anymore. However I keep getting told by my mental health team "we aren't an autism team, we deal with mental health", so I'm going to email my support worker. She mentioned something about getting me to see their behaviour coordinator in the past.

My psych seems to think I can use my high intelligence to override the meltdowns. Not that easy.

She might be concerned about the amount and variety of meds you are taking and have taken.
You might be running out of med options.
I think that you should talk to your support worker and perhaps a psychologist about how to proceed with the emotional dysregulation problem, which I see as your biggest problem based your threads.

I think you tried CBT previously, didn't you? It might help to revisit that.

I would suggest starting out with small steps. Make a short list (two or three) of your behaviors that you believe can be improved easily. When you accomplish them (in a week or a month, whatever), make another list of two or three behaviors that you believe can be improved with a little more intensive work. Then, another list after that for behaviors that might take even more intensive work. It is like exercising muscles. Aim to accomplish the small victories first, then move on to the more difficult victories. If you get stuck with one or more behaviors, ask on WP for more advice or ideas that others found worked for them.

I believe that your best motivation is your fear of getting put back in a secure facility again. Look at that fear as your enemy. Do whatever it takes to defeat that enemy. Your success in changing behaviors over time is your weapon. Take your current anger and aim it at your enemy. With your behavior changes, aiming your anger correctly is a big help.

Good luck!

Perhaps the behavior coordinator could help....also though maybe you need an anxiety medication. I mean I have had anti-psycotics prescibed for anxiety but they didn't really help that, seems like some of your challenging behavior could be anxiety related and while OCD is not anxiety I think it is technically considered a type of anxiety disorder main anxiety meds are benzos and can be addictive, but there are other anxiety meds but I am certainly no expert on meds. Either way it could be the psychiatrist is getting burnt out or something, either way even if they have been good in the past sounds like they might not be the right one for you anymore.

But yeah its a good idea to talk to the support worker, perhaps if she could set you up to see someone to address some of the autism difficulties then they could help determine if you need to chance psychiatrists and maybe even help set you up with someone else.

Based on your own description, I can imagine a list with two columns -- of people, places, and things, which agree or disagree with you.

I can't write that for you or tell you how to use it.

Thanks those suggestions make a lot of sense. I will talk to my support worker so that she can help me implement these strategies.

I have had CBT before but the first two lots were for psychosis and the last one for OCD. I will email the psychologist at the mental health team and ask him if they would give me any more sessions, although I doubt they will (NHS = lack of money due to budget cuts = reduce services offered).

I probably am running out of medication options but I'm on 300mg/day of amisulpride (and 20mg olanzapine which can't be increased) - the amisulpride could be increased to 400mg/day (it's been done before while taking olanzapine at the same time); I just think she wanted to challenge me to beat this without extra meds. So I will try then. I will try the methods you've suggested. And I will ask about CBT or the behaviour coordinator.

I will ask my psych about a new clonazepam prescription. I am very judicious with clonazepam though.

I'm seeing one of the head support workers of my local branch on Friday so I will ask him.

I'm going to uni tomorrow and I'm not looking forward to it.

As far as the possibility of ending up in a secure unit . . . okay, think about the cross-hand grip. And you can say, 'they were getting too close, I grabbed their shoulder.' And in other ways, try to adopt or modify martial arts so that you can defend yourself without hurting another.

Maybe take the approach, 'I'd like to get a second opinion.' It does sound like your current person is burned out or frustrated or no longer particularly helpful. And I think 'second opinion' is potentially a good way to look for someone else as you continue to get some benefit from your current person.

With OCD, I think it's worth considering PANDAS. Some doctors are skeptical about the whole thing or will say 25 is too old, but not for subsequent cases. Anyway, I'd say prophylactic antibiotics are such a free roll that it's well worth trying to see if you can get a doctor on board. You study stuff related to medicine. Maybe look up rheumatic fever and the relatively older ages, like in their twenties and occasionally thirties, people can get first cases and especially subsequent cases. And also look up Sydenham chorea. The idea with PANDAS is that your body's own antibodies to strep inappropriately attack the brain's basal ganglia, which is amazingly similar to Sydenham's. Okay, one study found that approximately 50% of suspected cases were in fact PANDAS and 50% were something else, and this was the highly likely cases to boot. So, I'm not saying you have it. I'm saying it might be worth checking. A beginning might be to get a doctor to do a blood test to check for the titer level of strep antibodies.

PS I think 'trying harder' is poor advice! Now, maybe trying diagonally in a new way, that might be more like it.

So sorry to hear that SteelMaiden

I had a Chinese psychiatrist when I was 19. He was really big into meditation, finding one's zen place, and being able to "go there" when you need to.

They were hard techniques to learn but I did get them eventually - and they helped me a lot in the decades since.

Don't know if it's something that would work for you but you want to try - there are lots of eastern practitioners out there. Your support worker might be able to help you find one.

Take care and good luck

Thanks both.

I will ask my GP for a health check. I can't really request blood tests without going through her though.

Meditation sounds good. I will research online although I doubt I would be able to afford 1:1 sessions as I'm on benefits. And group sessions are not an option as I can never relax in a group.

That's only reasonable to a point. You can't expect them to be experts in autism, but you should be able to expect them to at least learn enough (or consult with experts as needed) to factor in your autism when it's relevent to your mental health concerns and treatment needs. Or at least to refer to you to people who actually do know about autism to fill in the gaps in the care that the mental health team provides.

Have you tried to learn action-based harm-reduction strategies for meltdowns (specifically, you try to train yourself to replace/redirect behaviors that are causing a lot of harm to you or others with behaviors that cause less harm or no harm)?

If your meltdowns are like mine, you might need someone to help you if you try the harm-reduction thing.... at least at first (someone to cue you to use a harm-reduction behavior until it, hopefully, becomes automatic enough that you don't need to be thinking clearly nor have intact self-control to do it....assuming, of course, that at some point you're able to actually respond to the cue).

Harm-reduction examples (some would be alot harder to do than others, depending on how out-of-whack/impaired your senses and cognition are during meltdowns -- and some would require planning and/or only apply to specific environments):
>Putting a pillow or something between you and your own fists/hands when hitting yourself and trying to only hit the pillow protected area of your body.
>Directing hitting at an inanimate object that is unlikely to cause injury to you (if you could find something compact enough you could carry it around, maybe even clipped to the outside of a bag or something for easy access);
>Always having a supply of items around to destroy (e.g. old newspaper, cardboard boxes);
>Always carrying something that you can literally beat against walls and floors/ground without instantly causing damage to the object or anything else, and without hurting yourself or anybody else (e.g. foam bat);
>Carrying lengths of surgical-type rubber tubing that you can try to pull apart lengthwise;
>Getting those small spongy stress balls to throw at the floor/ground or a spot on a wall again and again until you've exhausted yourself;
>Having a designated room or even a corner of a room in your house where go to have meltdowns that you set up to prevent injury and to prevent destruction of anything you don't want to destroy;

For preventing meltdowns it seems like managing stress levels and anxiety generally, and learning self-calming strategies that work for you is important .... kind of like preventing meltdowns even before you get to the trigger point, by increasing your mental resources and regulating your physiological state.

Self-calming strategies can be anything at all -- breathing exercises; a specific formula of questions to answer or things to think about to facilitate cognitive re-framing or problems-solving; physical activities like running, push-ups, jumping up and down, tai chi, yoga poses; soothing sensory input; self-distraction....really anything. It's good to try to develop a sort of "toolbox" of self-calming strategies, because one strategy may not work for all levels or types of stress, and you may need different calming strategies for different situations. Some people keep a list of self-calming activities and refer to it when they stressed out. For myself, having generic list of self-calming strategies doesn't work because I would continually lose the list and would never remember to look at it....and I can't just think of all the self-calming strategies I know and pick one -- I basically have had to train myself to do specific things in specific problem situations, working with a counsellor on one specific situation and behavioral response at a time.

For general stress management maybe see if you can make a list of activities that normally calm and relax you or make you happy, and make a schedule of specific times to do those things every day, and also make time to do them before and after times/activities where your stress is highest. You could maybe also try sensory integration activities in the same spirit as generic calming activities if you think they might be helpful (e.g. if you benefit from deep pressure, maybe make time one or more times a day to hang out for a bit under weighted blankets or a pile of books or the mattress from your bed -- and do so before and after really stressful and/or sensory-nightmare type activities)...I cant remember for sure but I think that the book "Too Loud, Too Bright, Too Fast, Too Tight" has ideas in it for all the different senses.

^^^I verry merry berry recommend the approaches above too.
Learning strategies to deal with meltdowns is key.
I have found that if you focus on the meltdown or the upcoming meltdown or the bad emotions leading to the meltdown, these thoughts make the meltdown inevitable during the times when you are stressed.
So it is important to learn strategies to defocus from the meltdown or bad emotions preceding and calm yourself and take yourself away from that state.
The sensory overload itself is only secondary to the emotional dysregulation, because if you focus on the meltdown, whatever sensory triggers are causing it tend to get amplified, and the whole things goes out of control from there.
Reducing sensory overload is less useful than learning strategies to deal with emotional dysregulation.
You might have found over time that even if you reduce sensory overload by avoiding more and more stimuli that you still have meltdowns, probably due to focusing so much on meltdowns that smaller and smaller stimuli are able to trigger problems.
So I suggest that you work as much as possible on regulating your emotions through any and all non-med options, and you may find over time that once you have some strategies, that you can use them and sensory stimuli that used to be severe triggers can be handled for moderate periods of time.
Also, as another poster further above said, it would be helpful to take a small step and work on one small thing at a time and see if you can improve that one thing.
It will be good to reduce your med usage, and also the truth is that if you want to accomplish your goals, then you do need to learn more internal, self-regulated strategies.