We also hope that Tempest's story will help friends and family members understand what a person experiencing psychosis goes through, and thus see how the bipolar people in their lives can be helped -- and that more than a few mental health professionals will read this as well.
Since my Mom died in 2005, I have been suffering from increasingly terrifying paranoia and persecutory delusions. My Spanish guy who wears a red t-shirt and tries to kill me with a knife while I am showering has lived with me for about seven years, so I won't count him.
I had been on 300 mgs of clozapine (brand name: Clozaril), which for the most part took away most of my hallucinations, but I still suffered from severe paranoia and persecutory delusions, which just kept worsening. My treatment team did not, it appears, look to see whether this 300-mg dose was in a therapeutic range of clozapine in my bloodstream. Or else, since most of the hallucinations went away, they decided to settle on that and not increase it, even though I still had psychotic symptoms that were not alleviated at this dose.
Was someone monitoring my clozapine level when I was reporting a swordsman living with me, trying to cut my head off? And the man who would stand behind me with a knife at my throat for three hours while I worked at my computer? And the man who came up the stairs and stood in the doorway waiting to rape and kill me -- such a pleasant thought as I went to sleep each night.
I thought you had to live your life this way, suffering horrendously, facing death at any moment, until someone on this site's forum said that her psychiatrist had pushed the limit with her antipsychotic medication, and all these problems went away. I myself had to tell that to my treatment team to even give them the idea that they should try to help me by raising my clozapine dose.
In response to this information, I learned from the web site, my treatment team increased my clozapine dose from 300 to 500 mgs. This greatly improved my paranoia, but did nothing for my persecutory delusions. Then, unfortunately, there was an increase in the severity of my illness, which resulted in more persecutory delusions, voices, and delusions of reference, all of which I reported to my treatment team. My treatment team did not increase my clozapine in response to this. At one point I was given Risperdal PRN* that did nothing and was eventually dropped. The only antipsychotic (AP) that showed any impact on my psychosis is clozapine. I have been on all the new and old APs, and the only one that did anything was clozapine, taking away most of my hallucinations, except during times of stress.
In October 2007, after seeing the expert medication specialist pdoc in the area for a second opinion to treat my Schizoaffective Disorder, Bipolar type, my clozapine dose was increased by 100 mg to 600 mgs. Apparently they did a blood check at that time and found I scored 201, when the therapeutic dose starts at 200.
I just learned this, seven months later. I cannot believe they did not have me on a therapeutic dose of clozapine since 2004 until that blood test in October 2007, which showed my level was barely in the therapeutic range at that moment. It is quite likely that since my level was only one point over the 200 threshold, I probably fell below it at times, and still remained on a non-therapeutic dose even after the October 2007 increase.
Who was responsible for monitoring my clozapine level to make sure I was at least on a therapeutic dose to begin with, forget trying to push the limits? Was I at one point therapeutic and then fell under the therapeutic level?
The consulting psychiatrist's advice was to increase the clozapine dose and monitor the level, so that I would have at least some ammunition to fight my demons.
I only find now, in May 2008, when my team finally decided to raise my clozapine by 50 mgs to a total of 650 mgs to deal with continuing breakthrough psychosis, which has been quality of life hindering and also traumatic and fearful (to put it mildly) my clozapine level went from 201 to 222. As stated before, the therapeutic range starts at 200. So at least now I should be somewhere in the therapeutic range most of the time. It was Lily, my service dog, who got rid of the shower guy, the knife guy, and the rapist. It was she alone who fought for my sanity. The clozapine dose was not even in the range to be therapeutic.
Next: I Dropped My Pepper Spray - Instant Paranoia
*PRN stands for "Patient Report Need" - in other words, to be taken when needed at the patient's discretion.
