Sunday, November 26, 2006
Surfacing
Finally, a reprieve.
The Other Half has been asking me to write for the longest time. Well, here I am at last.
It's not that I haven't wanted to; I'm sure many of us know the feeling - you encounter a particularly inspiring or frustrating person, object, or situation and think - this would be so perfect to write about, when I get home I'm going to write... "..." and the words begin to fall into place in your mind.
Only you never really do get home till it's too late and the moment has passed, and then the words are either forgotten, or exhausted into nonexistence.
Work's been a killer, and when I haven't been working there's been so much more out there to do other than to write - perhaps it's habit-forming, not-blogging. Playing on the computer, visiting the gym (or not), seizing the few moments I can to catch dinner with or talk to a friend... blog? Where got time.
And now, a reprieve.
Not from the mundaneness of ordinary life - I've come to accept, and enjoy that.
These last four days have been hell. I shan't go into too much detail; it's... a lose-lose situation all around. But for the last twenty four hours my mobile phone hasn't been ringing every ten minutes, and I haven't had to live in fear for my family's sanity -- or even their well-being. And it feels good.
This blog may not have much time left to exist.
If the colleague I spoke to was being candid, I have about two weeks left before I should pack this place up and shut down for good.
It's sad, really. These are my memories, written by me, for me - not for an audience, not for art, not for poetry. It will be sad to lose them all.
Anyway.
I just watched "a beautiful mind tonight." Now there's irony for you; it was completely unplanned.
Here's a little something for the few of you who know why I'm writing this.
********
Bipolar Affective Disorder ("manic depression")
Clinical Features
The cardinal clinical feature of a manic episode is alteration in mood which is often elated and expansive but may also be characterized by intense irritability. Associated features include increased psychomotor activity (rapid thinking and speech, distractibility, decreased need for sleep); decreased social inhibition and disregard for potentially painful consequences (sexual overactivity, overspending, indulgence in poorly considered or inappropriate business, religious or political initiatives); and exaggerated optimism and inflated slef-esteem, which may be reflected in grandiose delusions or hallucinations. Mood incongruent psychotic features may also be foundl indeed one or more Schneiderian first-rank symptoms (symptoms used to define schizophrenia) are occasionally present but may indicate a schizo-affective disorder. Heightened sensory awareness is common. More specific speech abnormalities include uninterruptibility and sound rather than sense-triggered speech content (punning, clanging)
Insight is often variable or absent.
Schneider's First Rank Symptoms include -
specific types of auditory hallucinations, specifically third person discussing the patient, making a running commentary on the patient);
thought echo (hearing one's own thoughts out loud)
thought withdrawal (thoughts "taken out of head")
thought insertion (thoughts put into one's mind)
thought broadcast (thoughts available to other people, the patient thinking everyone is thinking in unison with him/her)
passivity (made acts, feelings, impulses, ie being controlled by outside forces)
somatic passivity (bodily senasations controlled from without, eg "blood boils after being struck by lightning")
delusional perception to a normally perceived object, often preceded by edlusional m ood (eg "I heard a police siren and knew I was one of God's prophets)
Epidemiology
The lifetime prevalence of bipolar disorder is about 1%, with a female to male ratio about 1.5 to 1. Peak age of onset is in the early 20s.
Aetiology
There is clear evidence of a strong familial component. Rates are commoner than expected in first-degree relatives of bipolar subjects.
Management
Acute mania almost invariably requires hospitalization. Since patients lose insight early, this may require detention without consent, using appropriate mental health legislation.
Antipsychotics (in similar doses to those used in schizophrenia) form the mainstay of acute management of both mania and hypomania. Antipsychotics are effective in controlling overactivity and agitation, and (somewhat more slowly) in reducing elation and disinhibition. Lorazepam may be useful for rapid tranquillization. Lithium is also effective as an acute antimanic agent, although it lacks the potential for very rapid behavioural control. Electroconvulsive therapy may be effective in patients unresponsive to antipsychotics, particularly where extreme overactivity is a threat to physical health.
A number of anticonvulsants, (carbamazepine, sodium valproate and possibly lamotrigine) appear to be effective in preventing manic relapse, particularly where psychotic feelings have been prominent. Psychotherapeutic support is important in helping patients come to terms with their illness, and their remorse at their past manic behaviour.
Prognosis
The lifetime prognosis following a single manic episode is poor, with 90% of patients having manic and/or depressive recurrences (averaging 4 episodes in 10 years)
Long-term functional prognosis is almost as poor as in schizophrenia. A minority develop "rapid-cycling", with four or more episodes a year; they have a particularly poor prognosis. There is an overall increase in premature mortality, only partially explained by a suicide rate of 10%.
The Other Half has been asking me to write for the longest time. Well, here I am at last.
It's not that I haven't wanted to; I'm sure many of us know the feeling - you encounter a particularly inspiring or frustrating person, object, or situation and think - this would be so perfect to write about, when I get home I'm going to write... "..." and the words begin to fall into place in your mind.
Only you never really do get home till it's too late and the moment has passed, and then the words are either forgotten, or exhausted into nonexistence.
Work's been a killer, and when I haven't been working there's been so much more out there to do other than to write - perhaps it's habit-forming, not-blogging. Playing on the computer, visiting the gym (or not), seizing the few moments I can to catch dinner with or talk to a friend... blog? Where got time.
And now, a reprieve.
Not from the mundaneness of ordinary life - I've come to accept, and enjoy that.
These last four days have been hell. I shan't go into too much detail; it's... a lose-lose situation all around. But for the last twenty four hours my mobile phone hasn't been ringing every ten minutes, and I haven't had to live in fear for my family's sanity -- or even their well-being. And it feels good.
This blog may not have much time left to exist.
If the colleague I spoke to was being candid, I have about two weeks left before I should pack this place up and shut down for good.
It's sad, really. These are my memories, written by me, for me - not for an audience, not for art, not for poetry. It will be sad to lose them all.
Anyway.
I just watched "a beautiful mind tonight." Now there's irony for you; it was completely unplanned.
Here's a little something for the few of you who know why I'm writing this.
********
Bipolar Affective Disorder ("manic depression")
Clinical Features
The cardinal clinical feature of a manic episode is alteration in mood which is often elated and expansive but may also be characterized by intense irritability. Associated features include increased psychomotor activity (rapid thinking and speech, distractibility, decreased need for sleep); decreased social inhibition and disregard for potentially painful consequences (sexual overactivity, overspending, indulgence in poorly considered or inappropriate business, religious or political initiatives); and exaggerated optimism and inflated slef-esteem, which may be reflected in grandiose delusions or hallucinations. Mood incongruent psychotic features may also be foundl indeed one or more Schneiderian first-rank symptoms (symptoms used to define schizophrenia) are occasionally present but may indicate a schizo-affective disorder. Heightened sensory awareness is common. More specific speech abnormalities include uninterruptibility and sound rather than sense-triggered speech content (punning, clanging)
Insight is often variable or absent.
Schneider's First Rank Symptoms include -
specific types of auditory hallucinations, specifically third person discussing the patient, making a running commentary on the patient);
thought echo (hearing one's own thoughts out loud)
thought withdrawal (thoughts "taken out of head")
thought insertion (thoughts put into one's mind)
thought broadcast (thoughts available to other people, the patient thinking everyone is thinking in unison with him/her)
passivity (made acts, feelings, impulses, ie being controlled by outside forces)
somatic passivity (bodily senasations controlled from without, eg "blood boils after being struck by lightning")
delusional perception to a normally perceived object, often preceded by edlusional m ood (eg "I heard a police siren and knew I was one of God's prophets)
Epidemiology
The lifetime prevalence of bipolar disorder is about 1%, with a female to male ratio about 1.5 to 1. Peak age of onset is in the early 20s.
Aetiology
There is clear evidence of a strong familial component. Rates are commoner than expected in first-degree relatives of bipolar subjects.
Management
Acute mania almost invariably requires hospitalization. Since patients lose insight early, this may require detention without consent, using appropriate mental health legislation.
Antipsychotics (in similar doses to those used in schizophrenia) form the mainstay of acute management of both mania and hypomania. Antipsychotics are effective in controlling overactivity and agitation, and (somewhat more slowly) in reducing elation and disinhibition. Lorazepam may be useful for rapid tranquillization. Lithium is also effective as an acute antimanic agent, although it lacks the potential for very rapid behavioural control. Electroconvulsive therapy may be effective in patients unresponsive to antipsychotics, particularly where extreme overactivity is a threat to physical health.
A number of anticonvulsants, (carbamazepine, sodium valproate and possibly lamotrigine) appear to be effective in preventing manic relapse, particularly where psychotic feelings have been prominent. Psychotherapeutic support is important in helping patients come to terms with their illness, and their remorse at their past manic behaviour.
Prognosis
The lifetime prognosis following a single manic episode is poor, with 90% of patients having manic and/or depressive recurrences (averaging 4 episodes in 10 years)
Long-term functional prognosis is almost as poor as in schizophrenia. A minority develop "rapid-cycling", with four or more episodes a year; they have a particularly poor prognosis. There is an overall increase in premature mortality, only partially explained by a suicide rate of 10%.
