Mini-mania?

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I've gotten a new avatar, which you can see to the left. It came from this page (in Japanese):

http://www.edogawa-jikan.com/request/me ... detail/211

It's a medical webpage put out by the Edogawa Ward of Tokyo and the article is entitled "manic-depressive illness." For the character in bed with her eyes wide open, you can see the onomatopoeia "gin gin" around her. Well, I didn't know what it meant, so I looked it up and it basically represents somebody getting really passionate about something and their mood getting elevated. I know. It has nothing to do with sound. Anyway, I guess that is an example of a manic episode.

Anyway, her manic state looked kinda familiar, as some of the other imagery of mania didn't, like the whole get really excited and go on a shopping spree thing. So I was like, yeah, I can get that way sometimes, though perhaps not for a whole week or even more than a day.

Anyway, on Monday I saw my therapist and got kinda aggravated and have been kinda, since. Basically, he was a little strict on some things and when I started thinking about it after I got home I started to feel very unnerved, like I was losing my center and the world no longer had a firm foundation. Nevertheless, I was able to focus on stuff and sleep normally until yesterday evening. Still, during those days I would be reminded or it would just pop up on my own the bad feelings again. I would ruminate over it and think of things and counterarguments and stuff. Then yesterday evening, I was surprisingly irritable while driving, though not by too much. I have a habit of criticizing other drivers, but this did seem a bit more marked. When I got home, though, things were OK and I chatted with my mum and stuff and I paced, the usual. I went to bed around 12, which is also normal.

Then I woke up at 1:30 in the morning with all the bad thoughts and feelings having returned and feeling unnerved again. Nevertheless, I still felt like I could go back to sleep as I still felt the sleepiness, but my mum was still working in the house, as she can sometimes stay up late, and every noise somebody made, whether it was my mum or the cat, seemed to jolt through me, making me feel even more awake*. Pretty soon my sleepiness was gone and I was just feeling miserable lying there. I braved my mum yelling at me for getting up and got up. She went to bed shortly after, and I got on my computer and did my usual browsing. I also self-stimulated by listening to the same song over and over again and pacing, which is something I do at least once every day and it soothed me. At 5 am, I started feeling sleepy again and went to bed, feeling much better. I got up at 8 am, feeling OK, though I did feel a little fuzzy in my head; nevertheless, I had an appointment and then needed to get to work.

I feel a strange sense of giddiness, but otherwise feel fuzzy in the head. I think it's largely passed, and I have been on 900 mg/day lithium for a while, so I doubt it's going to grow into a major manic episode.

Nevertheless, I thought it was interesting to share, and I do intend to bring it up with my therapist on Monday.

* I typically have poor sensory gating anyway, but here it seems the noises were louder and clearer.

Bipolar disorder NOS.

Well, I went by my therapist again. Well, last week, I saw my psychiatrist, and she put me on a low dose of Risperdal and Benadryl to help me sleep (and I see her again on Thursday). He helped me summarize the symptoms I've been having in the past couple weeks:

Paranoia (which has gotten better)
Stress-related symptoms
Sleep disturbances and lethargy
Loss of appetite, improved on medication
Worsened sensory issues
Difficulty focusing
Dissociation
Agitation
Vague issues with thinking (but not racing thoughts or flight of ideas)

One good thing, however: He said I don't look manic, as I don't seem to exhibit pressured speech at all and can be interrupted. He said to watch out for the following:

Continued/worsening paranoia
Extreme dissociation
Thoughts of harm to self or others
Hallucinations
Tangential thinking
Thanatophobia

I asked him about the tangential thinking and he said that can be a bipolar symptom. I told him that when I was a kid I was said by multiple sources to have tangential thinking/loose associations and I was said to have tangential thinking when I was in the hospital about 6 months ago, but I didn't realize that was occurring. He said that I would probably have to rely on someone else telling me.

(Honestly, now that I think about it, I always have tangential thinking; it's just most of the time I can prevent it from coming out in conversation. In fact, there was one time in the therapy session when he mentioned the word "cub" and all of a sudden I thought of the opening to Harry Potter and the Deathly Hallows when Voldemort said to Draco (of Nymphadora Tonks's children): "Won't you be there to babysit the cubs?" (paraphrasing). At this point, I stopped talking and I'm like, whoa, I need to pull this back out of there, but it took me a second as I had to search back to figure out what we had been talking about and for some reason I wanted to keep thinking it, almost like the thought was a tic. Nevertheless, I told him at this point, "I just went off on a tangent," as I worked to get my mind back to the subject we were talking about. Still, I have enough awareness to prevent it from being a problem.)

However, I guess if I'm kinda in a bad state, my tendency toward tangential thinking will start emerging in my speech in a way that I don't even realize it's happening, so I definitely want to rely on others to spot it.

Anyway, so that's an update. I go back to my psychiatrist on Thursday, and my therapist has kindly passed the notes of today's session onto her.

Someone diagnosed me with Schizoaffective bipolar disorder and I've am taking the same medications you are (Lithium and risperdal). What you wrote about with tangential is something I have noticed in my own thoughts as well. It is very rare to be able to identify tangential thinking. I've done it once or twice but for the most part it requires someone telling you something like "that was random".

I went by my psychiatrist today and she thinks I'm doing better. She's going to keep me on my current meds. I asked her how long this was going to last and she said that it may continue indefinitely, but that it's good that I have insight, good judgment, and control of my emotions, and that if I can exercise, interact with people, and keep a good structure/routine, then I should be OK.

I think the Risperidone is working, as I've felt better the past couple of days than I have been. I've still noticed some ideas of reference, but they don't seem as anxiety-producing as they were a week or so ago. Nevertheless, sleep is still somewhat disturbed.

OK. Here have been my symptoms over the past couple weeks:

obsessive ruminations (long term issue)
sensory issues (long term issue)
social withdrawal (long term issue)
restricted interests (long term issue)
sleep disturbances
confusion
anxiety
lightheadedness
paranoia
psychomotor agitation (long term issue but has gotten worse)
poor memory recall (long term issue)
emotional reactivity
dissociation
thought pressure
illusions/pseudohallucinations
lethargy

My psychiatrist ordered lithium levels and put down for billing purposes ICD-9 CM code 296.51, "bipolar I disorder, most recent or current episode depression (mild)." She put me on Abilify 5 mg/day for the first week and 10 mg/day afterward. Hopefully, this helps.

Anyway, my symptoms look like they've been all over the place.

A lot of the mania descriptions don't fully describe me much either. I don't spend thousands on getting a collection of sunglasses or anything. I'm just more careless with money. Usually, I end up downloading a whole load of music, buying songs just by liking the name of them, buying several at a time, become obsessed with Britney Spears and download her whole collection...and then remember why I don't like her music when I'm depressed.

As it is, I don't think I'm ever "manic" long enough for spending to become a serious problem. I become completely obsessed with something when I'm hypomanic (never been manic, it's just hypomania for me). For example, I'll suddenly be obsessed with MMORPG's and download a load of them onto my computer. I don't even play half of them, I just downloaded them, all at once. Or I'll be obsessed with breakfast cereal and get excited when I realize that there was once a limited edition version of Cheerios at one point.

Well, I was tense when the blood was drawn today and hadn't been drinking a lot of water, and the blood stopped coming out, so I started getting panicky. I'll go back Friday for another draw.

It doesn't go back quite a month, but here is a perfunctory list (with the latest update being from 5/22 on):

5/15-5/20:
Lightheadedness
Attention deficits
Loss of appetite
Sleep disturbances
Intense anxiety
Lethargy
Psychosomatic symptoms
Paranoia
Illusions/pseudohallucinations
Delusional ideation
Thought blocking
Dissociation
Sensory issues

5/20-5/22 (remove loss of appetite from previous group):
Ideas of reference
Psychomotor agitation

A lot of these symptoms just kinda seem to come and go over the past few weeks, but they don't look very specific to me to any type of mood episode. That is why I wondered it could be a mixed episode, or at least mixed features, and maybe it is the latter. I was surprised by depression, because I can still take pleasure in things and my mood has been good and stable--I still feel productive at work, I still perform necessary tasks, I'm not *too* productive, I'm not particularly irritable, etc.

Now, this group of symptoms does look like the kinda symptoms you get leading up to a psychotic episode. I had a psychotic episode at 14--which wasn't properly diagnosed because they didn't know that's what it was at the time,--so I think I am vulnerable to psychosis. I've been sharing my concerns with my psychiatrist and I'm glad that she seems to take it seriously.

I'm wondering how this could develop. I'm actually kinda interested in finding this out, in this sort of detached, bookish way.

I feel a lot better today at work. I was nervous when the Japanese Duskin crew came in, but I did well with the paltry Japanese I can speak--I can listen to far more than I can speak. I want to follow up and try to get into better contact with Duskin, so I'll be talking to the translator guy. Maybe I can get somewhere with this.