Boisterous stimulation

28/10/13 08:06 [Monday]
I am in a bit of a condition of excitement, or perhaps a better word is urgency, which without a doubt has developed (or the propensity for it has) over the months I have been on the lower dosage of Risperdal instead of the higher dosage (in fact the dosage I was on was the middle one of three available dosages, and I am now on the lowest). One major point I wish to make is that this condition - an elevated turnover of dopamine, doubtless - has taken many months to work itself up and does not correspond hour by hour (or even day by day) with the reduction in Risperdal in the metabolism. I presume the condition has come about through some sort of slowly effective positive feedback by which the dopamine turnover has ratcheted up. One alternative hypothesis is that it has come about so slowly because it depends on changes in the synapses, that is synapses altering in the sort of way they do when memory traces are laid down, to gradually allow more transmission of dopamine. I believe there is evidence that people on dopamine-blocking drugs over an extended period develop some slight tolerance, as the synapses adapt and allow more dopamine through despite the dopamine blockade. So one would guess the number of receptor sites in the target plate increases as some of the existing ones are rendered ineffective by being blocked constantly. (Of course the trouble with that theory is it might lead one to expect the opposite on withdrawal or reduction of a dopamine-blocker, that is for the number of receptor sites to decline as a greater proportion of them become effective.)
I did not get a lot of sleep last night. I slept from about 8 pm to about midnight, and this is a feature I have in my nature, to get sleepy early but also to wake up early and what one would have to call disproportionately early many mornings. I have been logged into Twitter most of the hours since midnight, and I was finding that slight stimulation (which you can understand mostly disconnected fragments such as get through from Twitter provide) was capturing my interest and keeping me 'on the hook'. However, the interest I find in explaining myself here was enough - the foreseen interest, that is - to persuade me to turn Twitter off and start writing down my experience and my interpretation of it.
I have to say some nights I do catch up on my sleep and the following day feel refreshed and able to cope easily with any stimulation I need to process for. I suppose it strengthens what I think of as the positive feedback if I am tired (not having had enough dreaming sleep to post-process during the night) so that in the daytime I rush at things without adequately preparing. Deliberately removing stimulation (turning Twitter off) and taking time over what needs to be done surely is a method which despite the electrochemistry of the brain (versus the pharmacology) will improve matters. To be honest, that's one thing which hospitalisation has always provided - even before effective drug treatments - that is removal of factors needing processing in a version of a holiday, hopefully to interrupt the positive feedback loop. That was the ideal of hospitalisation, although on first arriving at the hospital finding a weird and unlearned milieu (and quite possibly unanticipated, if the patient was Sectioned) would worsen symptoms by giving more to process on.
As regards my situation today - I mean today Monday - while I was on Twitter I was not planning what I need to do, to make sure I cope efficiently and effectively; and I am not even planning adequately now, as I am writing this. If I had had more sleep (to show up with more exemplary detail how it would work) I would be doing the planning at the same time as doing other 'processing', on Twitter or composing what I am writing. Without adequate planning I will rush from place to place, from activity to activity, and tire myself out more than need be, and worsen the 'positive feedback' cycle of having to cope with more and more but having fewer and fewer resources (especially if I keep missing sleep).
What I actually need to do today is fairly simple, when thought through explicitly, and certainly is less taxing than if I were in a position where I needed to go to work and also cater for my home life. I need to go shopping, and the only slight complication is I need to go to two different towns, and what I call planning for efficiency and effectiveness comes down (to a large degree) to going to the towns in the right order, and (I suppose) at the right times. I am better off, in some ways, with spending my time writing this, as it is not actually costing me much physically - in terms of energy or money - and at least it is related at one remove to the genuine planning I would be well to engage in.
When I was awake in the night - possibly this was caused by the numerousness of the distinct stimulations on Twitter (separate Tweets, put simply), or more likely by less time having passed since the physical stimulations of yesterday at home (even if the additional passing time has not seen me sleep a lot of the hours) - I was feeling active and as though I might go out very early (say as soon as buses started running) which would have been a cost in money (because my Concessionary Bus Pass is not valid before 9.30 am) and a cost in worsening positive feedback from exposing myself necessarily to more stimulation out and about. (Incidentally, readers will see that getting into that sort of cycle is the very antithesis of leading the empty worthless life I lead on too high a dosage of medication.)
I think all I have to add now - before thinking more thoroughly about what time to go out and where to go first - is that mentioning 'physical stimulations at home' I had in mind the fullness of the house this week, my grandchildren (step-grandchildren, anyway) having come to visit their mother who with her dog is herself a semi-permanent fixture in our home now. What I mean is, my elevated level of mental activity, which risks turning into an elevated level of physical activity and elevated in the sense of variety requiring processing (not going for a brisk walk every day on a regular route at a regular time, which might be a beneficial increase in activity), could well have come about substantially because there are more people now in my day-to-day life, and they are more boisterous people.

Dopamine-blocking drugs

01-02 April 2013 [Bank Holiday Monday - Tuesday]
When my thoughts and feelings were less restrained by dopamine-blocking medication - that is in the years preceding 2011 - I was very concerned that I might be made to have dopamine-blocking medication as I had been over decades up to my parents’ deaths and that it would affect me very badly as it had then. This fear (to say genuinely what it was) was combined with anger that I had been made to have such medication in those decades and that it had resulted in a terrible and empty experience for me of life then.
I am now being given the minimum dosage of Risperdal Consta injection, which is 25mg every two weeks, and I can see that it is improving life for me. This contrasts with the conclusion I had reached, that any dosage of a dopamine-blocker would do the opposite of help me.
My concern now is that - especially as I am moving home soon - a new psychiatrist may increase the dosage and thereby again consign me to hurt. Up to about a year ago I was on a higher dosage of Risperdal Consta - in fact it was 37.5mg every two weeks - and it made for an unpleasant experience of life for me, doing me hurt not good. I wish to set down the effects of the higher dosage in a version I can make available to any doctor who might think to put me on a higher dosage than 25mg. (This is especially so when at the time I am on the higher dosage I cannot formulate words and sentences adequately to convey what I mean.) It strikes me such a description might be of help to others if published on the internet - not that everybody responds the same to the same dosage but still it would be a warning of the possible adverse effects of too high a dosage for the individual - and a description of the helpful effects of a successful dosage (25mg for me) might be an encouragement too, for example to patients who have encountered nothing but hurt from the dosages (too high I mean) prescribed by psychiatrists who may be insufficiently caring and attentive. For now though I defer a description of the helpful effects.
The main results in me of the higher dosage of Risperdal were those I read reported as side-effects of reserpine, that is depression and anxiety (but anxiety not accompanied by the usual physiological symptoms such as increased heart rate and increased breathing rate). Also I was markedly underactive - going to bed early in the evening because I could find nothing of interest to do and not pursuing my usual interests such as those connected with computing - and indecisive. I found it difficult to engage in conversation because thoughts did not come to mind: my mind in fact was a blank. If I was in a context of requiring to talk to people - as I was because matters arose relating to the bungalow I owned and occupied, in 2011 specifically - I lost track of what I had to say and could not draw together the facts of the case in my mind as the conversation (what passed for a conversation) progressed.
It seems plain to me that the way the brain works one thought leads to another - or ideas presented from other people through language or other symbols set off chains of thought - through a mechanism where neural structures are physically linked by dopaminergic connections. Blocking some dopaminergic synapses weakens the connections so that the excitement of neural structures downstream from some stimulation is reduced, and blocking too many synapses results in thoughts petering out before they really get going. This effect was very apparent to me through introspection in the years when I was given very high dosages of dopamine-blocking drugs.
As regards anxiety, my experience of it since being on dopamine-blocking medication (but not at the current low dosage) is that it arose because the little degree of mental ‘processing’ I did resulted in no decisions being come to - I did not (and could not) think things through enough to reach conclusions - so I was in a constant state of uncertainty. On top of that because of underactivity I did not do things I should have done in preparation for any known up-coming need, so that I was unprepared for things which might arise even when I knew beforehand that they were going to arise. Examples of that would include getting together (that is I did not get them together, because I was underactive) ready for some application I was going to make (say a form I had to fill in, or to be more specific phoning a workman for help with my central heating).
Regarding depression: I am sure nature (or rather evolution) has made it a pleasure to mentally ‘process’ (up to a certain degree). What I think happens in the absence of dopamine-blocking is that as one becomes aware of problems or decisions to be taken the dopamine turnover in the brain increases. This corresponds to ‘processing’ to try to resolve what is perceived as needing resolution (an example which could be tested being the presentation of and the attempt to solve some mathematical puzzle). When the problem is perceived as solved - when some final decision is come to - the level of dopamine drops, sometimes quite suddenly. This gives a surge of serotonin, which is experienced as pleasure. But it is the ebb and flow of dopamine which gives rise to surges of serotonin, and a constant low level of dopamine does nothing for serotonin (and for completeness I remark that a constant high level of dopamine - corresponding to having puzzling problems which never get resolved - equally means there are no surges of serotonin).
Returning to the phenomenon of anxiety, I remark that the more usual origin of anxiety is, not insufficient ‘processing’ to come to any conclusion or decision, but rather, constant ‘processing’ on and on without ever coming to a conclusion or decision because there are too many factors in the ‘processing’, that is too much going on in the mind, in a mutually contradictory and self-defeating range.
In summary, too high a dosage of dopamine-blocking medication causes my mind to be empty. I do not do things I need to do and I do not reach any conclusions, this manifesting as anxiety; I cannot find anything to contribute to a conversation; and life is nothing but depression - death-in-life with very high dosages - because it is so unstimulating.

Levels of dopamine, high or low

25/03/13 01:35 [Monday]
I’ve just woken from a dream about dopamine, and specifically the different behaviours associated with different levels of dopamine in the brain, from high down to low. The basic idea is that higher levels of dopamine create more of a distinction (when translated into behaviour) between objects or concepts the nervous system differentiates. The subject feels more certain that things which appear different from each other - perhaps only slightly different - genuinely are from different categories. On the other hand things between which differences are not noticed are more readily believed to be identical, or from identical categories. Things are seen more in an all-or-nothing manner. At lower (more normal) levels of dopamine the subject feels less certain that things are either different or (on the other hand) the same. At lower levels (I suppose) there is greater acceptance that things in the real world might be being perceived mistakenly: the response to things and events is more ‘gradualist’ with less investment in the initially formed way of regarding the thing or event and an easier quicker ability to change tack. (Also with lower levels of dopamine other people’s, or ‘Society’s’, ways of interpreting objects and events play a larger role in determining the individual’s response.)
Something I have been thinking about when awake recently is that some behaviours can be associated (the same) with both high and low levels of dopamine. For one thing this makes it difficult for doctors to be sure whether symptoms of schizophrenia are being seen, or on the other hand the effects of too powerful a dosage of dopamine-blocking drugs. For example, if the subject’s mind is empty of thoughts (from low levels of dopamine) he will be silent and appear withdrawn; but also if his mind is full of thoughts he may well appear the same since he cannot put the many and probably mutually contradictory (or ‘counteracting’) ideas into words until he has processed them, and he may never have time to process them to make them definite especially if he is being bombarded with new experiences either questions and an insistence on engagement from the doctor or (worse) the fearful experience of being hospitalised especially the first time and especially if it is by compulsion.
I adhere to the view I have come to, that schizophrenia (and related conditions: for nowadays I get the impression schizophrenia is less readily given as a diagnosis but conditions like Asperger’s or Autism more readily and earlier) results from dopamine responsivity which is too high. Given only slight stimulation very high-amplitude and possibly fluctuating waves of excitement of dopaminergic systems result. The degree and duration of the continuing fluctuation will depend on the precision of the neural networks available to do the processing ‘downstream’, that is on their resolution. The effect of such unpleasant results from any stimulation is that the subject evades stimulation, that is he becomes ‘avoidant’ or withdrawn. In turn that results in an absence of fluctuations in dopaminergic systems and this also is experienced as unpleasure, in the form of loneliness and perhaps boredom. There are ways available to a person having an over-responsive dopaminergic system of obtaining stimulation which is (if things go well) not at an overwheliming level, some more traditional (like reading, or listening to the radio or watching TV) and some new-fangled (like communicating with others - and best it is with others similar - via the internet). I will mention that Emily Brontë obtained pleasurable stimulation from her sister Charlotte when the latter described to her her ventures ‘into society’: there is something more directly appealing in real-life stimulation even at one remove (more nearly real-time, I suppose) than is available from fictive stimulation as from reading a novel.