Reflection: "I'm in psychosis right now'

so I came across this video from the channel living well with schizophrenia um which is a substantial Channel it I haven't watched too many videos but it's by a person with schizophrenia and she makes a lot of content from a lived experience point of view she does a lot of interviews um I'm going to get into it I'm going to watch a lot of the things but she just released a video that I thought was quite striking and vulnerable and Powerful uh talking about that she's not doing so well at the moment she's finding herself falling into a psychotic episode and I just watched part of the video and looks like she's in the early stages of psychosis and she's talking about the symptoms she's experiencing so I thought it could be interesting um and maybe helpful to other people to kind of watch the video make a commentary around the symptoms um or the pathophysiology or whatever comes to my mind just talk about kind of uh what what a Psychiatry doctor is seeing and I'm a Psychiatry doctor in training I'm not a psychiatrist yet I'm on the training program but I can still kind of give helpful tips around the stuff that I've been studying and and looking at as a quick 30 second summary schizophrenia is chronic psychosis psychosis is really defined as having a problem understanding reality having a different different experience of reality to what we consider normal the pathophysiology is very complex it's thought to be related to hyperactivity and a mesolympic dopaminergic circuit which is a circuit in the brain related to the kind of positive symptoms we see with hallucinations and delusions but there's no doubt that it's far more complicated than there's important relationships with serotonin and the serotonergic circuits with nmda receptor hypofunction and the Gaba inhibitory into neurons in the cortex and there's also a lot of problems in the strength of synapses and synaptopathies associated with psychosis so very complicated thing anyway the way that affects people is through delusions hallucinations paranoia and things like that so let's have a look at what this person's going through I don't know her name I'm new to her Channel um but I'm sure yeah Lauren so um all right Lauren I hope you're okay with this if you're not just send me a message and I'll take the video down but I just thought it'd be helpful to kind of make a comment a commentary or a reflection on on your on your video that you're sharing so so let's get into the video before I play it um I like to just make a quick comment on the start psychiatrists and psychiatry doctors are always trying to do mental state examinations okay looking and analyzing and trying to report what someone's current mental state is so looking at this scene without even a person in it there's a couple of very important observations you can make first of all you've got very bright uh room right with no holes in the wall uh the windows wide open so that already tells me that there's a sense of trust and and you know not much paranoia at Baseline um to because people with schizophrenia and paranoia and a paranoid subtype they often close windows shut the curtains keep it very dark this is very bright um the plants are doing very well so there's obviously a level of function in being able to manage and care for things there's beautiful art and the hats look very nice and there's no holes in the wall and things like that so this is what we can say you know you know this is all just speculation but you can speculate that this person has well managed that Lauren has a well-managed schizophrenia at Baseline and if you look closely it looks like she has a partner there's a photo on the on the window on this cabinet that suggests that they're in a partnership all right let's go through the video foreign I don't I don't really know what to say right now because my mind keeps just going blank I think the reason why I decided to pick up my camera and record today is because I think a criticism that I get sometimes is that I come across as being well all the time and I don't show the more difficult um aspects periods or whatnot of living with an illness sex gets affected disorder and so I kind of wanted to try to be a bit more transparent about um being in a difficult period and experiencing some of the more difficult aspects of the illness so um it's been about not quite a week but a few days of um of you know red flags popping up um it's difficult to hold the train of thought right now I'm sorry um red flags popping up sorry to pause early into the video um we're two minutes in uh there's a couple of important observations uh it's clear that Lauren is suffering right now and um that something has destabilized what is obviously uh not like a baseline or well-managed psychotic illness um I guess a couple things that I wanted to comment on uh is that she reports a diagnosis of schizoaffective disorder as opposed to schizophrenia which is the name of the channel but um really the the difference is essentially schizoaffective disorder just means there's a mood component that can occur when you're psychotic so the psychosis can either make you manic like um having a flight of ideas pressured speech very intense like really quick No Sleep doing too many projects being dysfunctional getting angry at people because they can't keep up with you and then taking doing high risk behaviors or it can make you depressed The psychosis schizoaffective kind of depressive subtype would look like someone who thinks they're rotting and staying in bed all day and not going to the shower not not even going to the toilet just staying in bed and and getting on well that way so schizoaffective just means that there's a mood component as well that's one thing the second thing um there was two minutes of uh kind of you know empty time at the start so uh obviously she's trying to formulate her thoughts I'm going to make a comment as to whether that's abnormal or normal but for her I think because she made the point uh it's probably abnormal compared to her bass line and so and as she was reporting there's problems in the stream of thought so when we think about thought and Psychiatry there's different modalities of thought there's the form is it and that's basically the stream of thought so is it um linear like is every idea following the previous idea logically like hopefully what I'm speaking to you right now it's that each sentence makes sense that it's following the previous sentence but some people can get tangentiality where they go off on tangents and then you can never get back to the original Point some people can get circumferentiality where they go off on a tangent but eventually after a minute or two to find the original Point some people have complete derailment where you just cannot follow what they're saying and it can get so bad that it can become a word salad where they're just saying words that don't even follow the previous word because the thought is so disorganized but there's other parts of the thought that you have to assess as well you have to assess the content is it delusional content or non-delusional content you have to assess the quantity of thought is a Poverty of thought so gaps of thought where there's just nothing happening or is there a lot of thought too much thought you know pressured thought that people can't even keep up with and perception is another part so you're looking at people are they responding to perceptual events that you're not seeing so delusion responding to hallucinations are they talking to someone you know these are perceptual abnormalities because they're talking to someone but there's no one there and and so we call that an abnormality what we've seen with Lauren so far though is that she seems distracted she seems like there's either well I can't tell yet I would have to ask her but it's either that there's multiple things happening in her mind at once that are competing for her attention that are affecting her ability to kind of stay on on point all that there's just gaps and blocks and empty events happening and that's called thought blocking um but from watching her kind of looks like she's getting distracted with her thoughts kind of running away from her not having control of the streams of thought happening in her mind let's continue around um indications that I am slipping into a psychotic episode and I think that this has been more difficult to identify and understand because usually when this happens I it's because I stopped taking my meds or whatever and I haven't done that this time I'm still taking my medications regularly I feel like I've been trying to do a really good job of taking care of myself and so I think it was difficult to identify when things were slipping but Rob kind of brought it to my attention yesterday and it kind of clicked that I don't feel I have a good grip on on my reality right now and so other important information so I I'm assuming and this is all speculation this whole video is speculation that Rob is her partner or at least her main support and probably the person in the photo in the background um and that's often one of the first signs that people have that they're getting unwell again is the people around them pick up on abnormalities and their behavior from from their you know normal behavior the other thing the other thing is she's spoken about Med compliance being a trigger previously for relapse I do a lot of videos on the medications and the side effects and the issues with compliance antipsychotic medications are notoriously prone to side effects and therefore people often stop them sometimes without telling their doctors and then things can get really bad so if you're on antipsychotics tell your doctor before stopping them work with your doctor around the side effects because there are a lot of treatment options to the side effects that happen and a final point to make so far is this happens commonly in mental health that that chronic mental illness that's a relapse remitting nature like a you know like psychosis but it's true with other mental illnesses like depression and bipolar disorder these are relapse remitting conditions so you can go into remission where there's no symptoms but then you can have relapses where the symptoms come back and these relapses are often triggered by something as you're saying either non-compliance sometimes it's just stress simply just being stressed about stuff can can trigger um a relapse and sometimes we don't find out what it is what is triggering the relapse and that's particularly heartbreaking for people because you know we're humans we want to explain what's happening and we want to have something to to blame when things are going wrong um and if you have a trigger then you know what to change to make things better but sometimes we don't find the trigger and we have to do medication adjustments and stuff to get back to a new Baseline there's uh there's also non-medication you know treatment options for schizophrenia and psychosis things like ECT but let's stay on topic and continue the video struggling a bit with coming to terms with in terms of I feel like I've been doing everything right I missed a dose of my medications I think it was two Sundays ago and I'm kind of becoming fixated on well that's why this is happening right now but that doesn't actually make a lot of sense I I have a a PRN as needed medication from my doctor for when I'm experiencing more symptoms and so I decided to take that yesterday to kind of deal with um just slipping away from reality Sensation that I was experiencing and it really really sedates me and so I it's been it's been probably almost 24 hours since I took that not quite but I I feel like the sedating effect is kind of finally starting to wear off but the last 18 hours or whatever have been very much just kind of being stuck laying in bed having a difficult time communicating with Rob who's the main person who's supporting me and yeah it's just been it's been a difficult period And I don't think I'm doing a great job of communicating about it maybe I'll talk more about this specifically the symptoms and whatnot that I was experiencing at a later time when I feel I have a better grip on things but the gist is that I don't feel that I have a good grip on my reality right now and it feels distressing and scary and hard to wrap my head around because how do you wrap your head around the fact that you that you can't wrap your head around things that your brain isn't working properly and that you can't really trust your brain it's difficult to sorry just that's a really powerful Point how can you wrap your head around the fact that you can't wrap your head around things and um it's just making me reflect on my own practice often when I work with suicidal depressed people out you know I say the last person you should trust is yourself whilst these medications are taking into effect uh you know um and uh and that's probably a useless thing to say really because when you are deeply depressed to you know some people get depression with psychotic features and uh or when you're whenever you're psychosis it's like I'm not even that real to them understand and come to terms with that and figure out what to do about it so I I reached out to my psychiatrist who I can't talk to and I can't see until next week next Friday um this is coming isn't it you know things are going really bad and you need like acute help and so um you gotta you know you've got to talk to your psychiatrist but they're fully booked till months away one week's actually pretty good to be honest um but I feel like when I'm a psychiatrist uh I I think I'll try and just keep like a half day a week free uh to just deal with like my you know consumers who are having uh you know breakdowns like the emergency situations that way you can just see them like within a couple of days anyway this is you can you can send this video to me in the future if uh if I don't hold true to it the plan anyway right now is to take the PRN as needed and try to get through the next 24 48 hours or so and see how I'm feeling after that and see I actually also increase um the main antipsychotic that I take um my doctor has kind of let me titrate that dose as needed and so I'm going to try to go up on that again and see if that helps at all in the next couple days um if it's it's still not going great and I'm having a difficult time and not feeling like things are improving at all then a plan is to call it's called access 24 7 in my city it's a it's a basically an emergency mental health clinic and so give them a call and see if they have any further insight into how to manage this I'm worried that I'm going to end up needing to be hospitalized to try to figure out medications and whatnot I haven't had great experiences with hospitals in the past and so that's a worry though I don't know there's like a an ounce of Hope or optimism that I I feel like I'm in a different headspace with this psychotic episode that I have been in the past where I've been a lot more um I guess less aware or more fearful or combative with the people around me and I sorry to pause again just talking about the treatment options she's described sounds like Lauren's really across her and mental health and and how to manage it um so yeah there's uh increasing the standard dose of antipsychotics is something that even if it's just temporary it's something that that can be done augmenting it with a second antipsychotics in this case it looks like she's had a PRN which is basically an as needed medication which is zonked her out for 24 hours so the PRN is kind of quite taxing often you can desensitize to the sedative effects of medications so they don't continue to dunk you out as much but still it's very unpleasant we also have a government-funded kind of 24 7 Mental Health Service in Australia it's state run it sounds like she's got one called access 24 7 so you can call them but in an emergency you've got to go to hospital and and I know she's had a horrible like Lawrence had a bad time in hospitals before often when you're psychotic in a hospital it's it's horrible um and it's really just the lesser of two evils and you know I want to make a video about this but sometimes as doctors we have to traumatize traumatized individuals so someone's psychotic and attacking people we've got to pin them down and give them an anti you know you've got to give them really strong medications and that's traumatizing it sucks I wish there was a better way to kind of control the risk but if someone's a high risk of harmful stuff and others it's not but anyway I guess my point is the earlier you go to hospital the less likely that is to happen because you can get on top of the symptoms earlier so the more pleasant it is at delusional line of thinking or paranoia or whatever it may be that causes me to not trust the people around me and so I I don't know how this video is turning out I think it was probably not a great articulation of what I'm experiencing but I just wanted to provide a bit more of an honest glimpse into the difficult periods and so feels embarrassing and quite vulnerable to um be sharing about this state because it feels um laughs sorry um it feels like a bit of a personal failure or um feels like weakness or I I don't know you know I would never say these things to anyone who was you know communicating that they're experiencing this with me and so I'm trying to not say these things about myself or I think this thing's about myself but it it feels it feels vulnerable sharing that I'm experiencing this and also because I don't really know what to do to get myself out of it and I just gotta kind of respond to that that's um first of all it's very admirable to make such vulnerable videos uh Because the Internet is a you know challenging place um and uh that it's just so obvious that Lauren has done so much work with psychologists or just you know maybe genuinely just like by herself has these very good insights like to say I wouldn't speak to other people this way so I shouldn't speak to myself this way is a common theme in a lot of like psychology work and um and I think this video is really helpful to help show people who don't have psychosis what the kind of early warning signs can be but also show people with psychosis that it's okay to be open about your symptoms you know I just want to tell Lauren I wish I could speak to that it isn't her fault and uh I'll often need to relapses uh just be on the realm of human understanding but there is just so much hope because there's so many treatments available that um that I mean I don't know what uh Lauren's history in you know psychiatric history is but um there's just there's plenty of medications plenty of non-medical options that are available and so there is hope to get recovery so that's kind of where I'm at um I don't know yeah I don't know what's going to happen in the next few days but I will try to be transparent about it because I do think that it's important that people understand again the more difficult sides of having an analyst like schizophrctor disorder or schizophrenia and if you were if you yourself have it to feel less alone and hopefully hopefully to help you not feel the things that I just communicated that I'm feeling or I feel ashamed or weak or embarrassed or really really vulnerable sharing about these things I hope that this video helps to kind of make it a little bit more okay to talk about um when these periods are happening because I think I think I I I I get blocked a little bit by those feelings in terms of being able to lean on the people around me who want to support me through more difficult periods um and I I don't want to admit to them or to myself that I am struggling with my mind yeah there's a lot to unpack there maybe perhaps that's for another video but I'm having a tough time I wanted to come on here and share with you all that that is kind of what I'm going through um yeah I guess that's all I really have for today thank you for listening if you are going through a tough time as well know that you're not alone um yeah I guess that's it see you in the next video bye okay so I mean that's um oh that was a very powerful video I I think it really actually uh makes me grateful for the platform of YouTube and and the power the positive impact that YouTube can have uh you know this what Lauren is doing is creating parasocial relationships with people so like it's not a face-to-face relationship but it's a it's a relationship where people who for example suffering from schizophrenia can see her videos can understand that they're not alone and it's creating empathy and a connection between them it's very very positive it's something I wish my channel you know it's one of the goals of my channel as well one day to kind of create a kind of parasocial uh network of people and and uh so people can help one another and learn and and hopefully you know improve everyone's mental health I mean I wish I knew myself the way she knows herself you know she's clearly done so much work and um and I and I wish her the best for this relapse

Channel: Dr Syl

Views: 85,904

Keywords: Dr Syl, medical doctor, medical student, intern, australian doctor, aussie doctor, Dr_window_syl, reactions, reviews, mental health, psychiatry, psychology, demystified, explained, medicine, medical education

Id: meW-iQSmYgQ

Length: 25min 18sec (1518 seconds)

Published: Mon Jun 05 2023