#still in the prodrome phase

[battywitch]

Cool cool cool cool this is great and definitely totally fine 🙃

[scalpelsister]

.

[slipper007]

🧠

[excalculus]

I saw some mentions of rabies going around again and have no clue what's set it off this time, but given recent scientific developments I want to revisit the idea of curing symptomatic rabies.

First things first: there is still no practical way to do this. The famous Milwaukee Protocol fails far more frequently than it succeeds, and even the successes are not making it out in anything like a normal state. It's been argued that it should no longer be considered a valid treatment [1] due to these issues; any continued use is because there's literally nothing else on the table.

However. There are now two separate studies showing it's possible to cure rabies in mice after the onset of symptoms. The lengths you have to go to in order to pull this off are drastic, to put it mildly, and couldn't really be adapted to humans even if you wanted to. But proof of concept is now on the board.

long post under the cut, warnings for animal experimentation and animal death. full bibliography at the end and first mention of each source links to paper.

Quick recap - rabies is a viral disease of mammals usually transmitted through the saliva of an infected animal. From a contaminated bite wound, it propagates slowly for anywhere from days to months until it reaches the central nervous system (CNS). Post-exposure vaccination can head it off during this phase, but once it reaches the CNS and neurological symptoms appear it's game over. There will typically be a prodromal phase where the animal doesn't act right - out at the wrong time of day, disoriented, abnormally friendly, etc. This will then progress to the furious (stereotypical "mad dog" disease) and/or paralytic phases, with death eventually caused by either seizures or paralysis of the muscles needed for breathing.

That's the course we're familiar with in larger animals. Mice, though, are fragile little creatures with fast metabolisms.

In the first study's rabies infection model, lab mice show rabies virus in the spinal cord by day 4 after infection and in the brain by day 5. Weight loss and slower movement start by day 7, paralysis starting from the hind limbs from day 8 on, and if not euthanized first they're dead by day 10-13. [2]

This study (fittingly conducted at the Institut Pasteur) had two human monoclonal antibodies, and wanted to see if there was any possibility they could be used to cure rabies after what we think of as the point of no return.

Injecting the antibodies into muscle saved some mice if done at days 2 or 4, and none if done later, even at high doses of 20 milligrams per kilogram of body weight of each. Conclusion: targeting the virus out in the rest of the body is no use if it's already replicating in the CNS.

Getting a drug past the blood-brain barrier is, to use a highly technical term, really fucking hard. It's the sort of problem that even the best-funded labs and biggest companies in the world routinely fail at. And that's for small molecule drugs, which are puny compared to antibodies.

But this isn't drug development for a clinical trial. This is a very, very early proof-of-concept attempt, which means you're willing to ignore practicality to see if this idea is even remotely workable. So you can do things like brute force the issue by cutting through the skull to implant a microinfusion pump, which lets you deliver the antibodies directly into the normally-protected space around the brain. Combine this with the normal injections, and you can treat both the CNS and the rest of the body at the same time. Here's a survival graph of treated mice. X axis is days, Y axis is percentage of mice in that group still alive.

Figure 2A from reference 2, accessed February 2024

The fact that the blue, green, and purple lines did anything other than sink horribly to zero is unheard of. When the combination treatment was started at day 6, 100% of the mice survived. Started at day 7 (prodromal phase), 5 out of 9 mice recovered and survived. Started at day 8 (solidly symptomatic, paralysis already starting to set in), 5 of 15 mice recovered and survived. And when they say "survived", they kept these mice all the way to day 100 to make sure. Some of them had permanent minor paralysis but largely they were back to being normal mice doing normal mouse things. So, success, but by pretty extreme means.

Enter the second paper [3]. This was a different approach using a single human monoclonal antibody against Australian bat lyssavirus (ABLV - closely related to rabies, similar symptoms in humans) to try for a cure without needing to deliver treatments directly into the CNS. They also made a luminescent version of ABLV that let them directly image viral activity, so they could see both where the virus was replicating and how much there was in a live mouse.

Figure 1 from reference 3, accessed February 2024

Mice infected with ABLV start showing symptoms around day 8. You can see in the figure that at day 3 there's viral replication in the foot at the site of infection, which has shifted into the spine and brain by day 10. So what happens if you give one of these doomed mice one single injection of the antibody into the body?

Done at day 3, the virus doesn't make it to the brain until day 14, and while disease does set in after that around 30% of the mice survive. Days 5 and 7 are much more interesting. Those mice still develop symptoms at day 8, but the imaging shows the amount of virus in their spines and brains never gets anywhere near the levels seen in untreated controls, and within days it starts to decrease. Around 80% of day 5 and 100% of day 7 mice survive.

Okay, sure, you can stop another lyssavirus, but technically you did start treatment before symptoms appeared. What about symptomatic rabies?

The rodent-adapted rabies strain CVS-11 starts causing symptoms as early as day 3 after infection, and untreated mice die between days 8 and 11. The same single dose of antibody saved 67% of mice treated on day 5 and 50% of mice treated on day 7. Without making the luminescent version of the virus there's no real-time imaging of the infection, but you can still track symptoms.

Figure 2 from reference 3, accessed February 2024. CVS-11 is the name of the rodent rabies strain and F11 is the name of the antibody.

Disease score is a combination of several metrics including things like whether the mice are behaving normally and whether they show signs of paralysis. In untreated mice it goes up and up, and then they die. If one of those lines starts coming back down and continues past day 10 or so, that's a mouse that recovered. The success rate isn't as good as against ABLV, but again, this is a rabies strain specifically adapted to rodents and treatment wasn't started until it was well-established in the CNS.

So how on earth is this happening? The antibody neutralizes both ABLV and rabies really well in a test tube, but we've already established that there's no way a huge lumbering antibody is making it past the blood-brain barrier without serious help. Something about the immune response is clearly making it in there though. And it turns out that if you start trying this cure in mice missing various parts of their immune systems, mice without CD4+ T cells don't survive even with the treatment. By contrast mice without CD8+ T cells take longer to work through the infection, but they eventually manage it and are immune to reinfection afterwards.

To grossly oversimplify the immune system here, CD4+ are mature helper T cells, which work mostly by activating other immune cells like macrophages (white blood cells) and CD8+ T cells (killer T cells) against a threat.

Normally, T cells are also kept out by the blood-brain barrier, but we know that in certain specific cases including viral infection they can pass it to migrate into the brain. In the brains of the infected mice for which antibody treatment either wasn't given or didn't work, you can find a roughly even mix of CD8+ and CD4+ T cells along with a whole lot of viral RNA. But in the brains of those successfully fighting off the infection, there's less viral RNA and the cells are almost exclusively CD4+. So the antibody doesn't work by neutralizing the virus directly - something about it is activating the animal's own immune system in a way that gives it a fighting chance.

Again, neither of these proof of concept treatments is really workable yet as a real world cure. The first one is almost hilariously overkill and still has a pretty good chance of failure. The second is less invasive but careful sequencing still shows both low-level viral replication and signs of immune response in the brains of the survivors even at day 139, so it may not be truly clearing the virus so much as trading a death sentence for life with a low-level chronic infection. But now we know that 1. curing rabies after symptoms begin is at least theoretically possible, and 2. we have some clues as to mechanisms to investigate further.

Not today. Not tomorrow. But maybe not never, either.

References:

Zeiler, F. A., & Jackson, A. C. (2016). Critical appraisal of the Milwaukee protocol for rabies: this failed approach should be abandoned. Canadian Journal of Neurological Sciences, 43(1), 44-51.

de Melo, G. D., Sonthonnax, F., Lepousez, G., Jouvion, G., Minola, A., Zatta, F., ... & Bourhy, H. (2020). A combination of two human monoclonal antibodies cures symptomatic rabies. EMBO molecular medicine, 12(11), e12628.

Mastraccio, K. E., Huaman, C., Coggins, S. A. A., Clouse, C., Rader, M., Yan, L., ... & Schaefer, B. C. (2023). mAb therapy controls CNS‐resident lyssavirus infection via a CD4 T cell‐dependent mechanism. EMBO Molecular Medicine, 15(10), e16394.

[havin-fun-imagining-twd]

Picking a flower = saving the day

Howdy, slowpokes, mb for the late, late, late chapter again. Give yourselves about 15 and get comfy, y’all!

When - right after Better with a friend. You and Daryl are stuck in a thunderstorm while out searching for Sophia.

What - the search gets cut short due to torrential rains, you and Daryl argue a little, and goddang it but you just want to find a present for Carol. Daryl also fesses up about when he got lost for 9 days, that’s a big step for him.

Relationships - it’s you two, otherwise only T-Dog pops in at the end when you finally make it back to the farm. Y’all do radio the camp at one point, so Papa Dale and big bro Shane are mentioned.

Pronouns - she/they again

Perspective - 2nd person you, third person Dixon

Genre - it’s part of the Slowpoke Series, idk, friends

TWs - language, mention of childhood physical abuse, parental death mention, and Daryl does refer in his head to Jacqui as “the black lady” before remembering her name.

Plot points - a quarter per white lie, reader’s migraines (and the prodrome phase of getting one), reader hating feeling weak, Two idiots, It was a pragmatic cigarette, What were your nightmares about?, Daryl’s childhood cat named Eyes. T-Dog and Daryl’s growing friendship (I say it’s canon). The story “Quarter!” I’ll put more if I think of them.

Masterlist will give you all the Slowpoke news published so far, as well as a Ko-fi link if you’re able to assist my tire budget :D

“Where we heading?”

“Just follow me!”

Through the thunderstorm, he leads the way. Mud starts to cake his shoes, ankles, and calves.

It’s hard to tell which way to head, a few times he veers off-trail. He’s pretty sure he gets lost for a while.

When the rain gets so heavy that visibility drops and parts of the path turn into small pools or streams, Y/N’s hand grabs the back of his shirt and clings to it.

It’s bad outside. Raining cats and dogs and horses, probably a couple cows and pigs, too.

Then he finally sees the shed that was at the farmhouse and almost cries with relief that he’s found it again.

He leads them by the arm to the side door, crossbow ready.

Y/N gets her pistol out, good.

And as he enters first, the sounds of them shouting “Wait!” reach his ears.

He aims all around the kitchen just in case, and kicks an empty bottle across the floor to make noise so that anything in there will either be drawn to them (walkers) or will scurry away (rodents).

“Why didn’t you check the windows first?” she pants, pistol still ready, shouting, “Sophia?” He does likewise in case Sophia came back here and he’d simply missed her yesterday. He’s hoping that he simply missed her yesterday.

Y/N limps (?) around the bottom floor of the house, repeatedly calling her name along with, “If anyone’s here, we’re s-sorry if we scared you, we’re lookin’ for a little girl who’s missing!”

He jogs up the stairs and calls Sophia’s name more quietly, poking his head into the rooms.

No one and nothing answers.

He goes back downstairs.

“This is the place I found the can and the cot,” he lets Y/N know.

Pistol still out and aimed, her stance doesn’t relax as she blinks in confusion. “Hm?”

“Sit down, s’okay,” he tells them.

Soaked to the skin and covered in mud as they are, the two of them can at least catch their breath now.

Y/N looks beat, promptly grabs a chair, drops into it and starts rubbing their knee. That was new.

Their baseball cap is missing, too.

You

The drip-drip-drip of yours and Daryl’s clothes and the stiff, squidgy feeling of the wet clothes and sticky mud on your body is only propelling your agitation. And where’d your hat go?

First, Mama and Good Dog and the man you shot in the fucking head set up shop in your mind, then your fear of finding Sophia as a cold, muddy corpse decided to dance with you all afternoon. Now, how Dad got washed away and drowned is ping-ponging around your thoughts. Your heart aches. Your body hurts. Good Moses, it even hurts to breath at this point.

And you were in enough physical pain today before idiot you smacked your already-bruised knee on the way here because Dickhead Dixon over there decided to up and sprint to a place he already checked?

“Why are we here, Daryl? We sprinted,” in a thunderstorm, in a flood zone, in woods we don’t know, “all the way to this place? Not somewhere unsearched?”

But before he has a chance to answer, you feel the angry voice in your head get the better of you.

Why did you bring us here, you backwoods bastard? It’s a spot you already been to! How is this helping our girl? It’s been seventy-two hours by now, it’s-it’s too late! You stupid, stupid man!

“You just wasted valuable time, listen to the storm out there! We need to get back down to the road and find someplace to search around there before the flash flood risk gets higher!” you almost yell at him, the pain intensifying when you strain so.

“I wanted to come back here in case she was campin’ out and I just missed her,” he snarls back. “A kid would probably wanna stay out somewhere they felt safe.”

“Then why the hell would you bust in like that, guns blazing? Woulda scared that little girl half to death.”

“Because anybody else here would’ve been scared, too, but I would’ve had the upper hand.”

“Until they put a bullet or a knife in you in self-dembense—fuck, self-de-fense!” you correct, growing more frustrated and furious and feeling more and more helpless and sad by the minute. Goddamn prodrome shit is making you sound like as big of an idiot as you feel. You didn’t even hear whatever the abrasive redneck you’re stuck in here with threw back at you.

Then your mood turns on a dime, your throat tightens and your eyes start to burn. Yours hands immediately cover your face to conceal it while you calm down. Kettle off the burner, Y/N. Inhale. Exhale.

“You okay?” reaches your ears. “Not going postal or nothing, right?”

You nod, feeling the sharp, achy tug in your shoulder and neck when you do. Swallowing to make sure your voice sounds normal, you relax your hands back to your sides and open your eyes—then blink in confusion as to when it was exactly that you stood up?

“Nah, you’d know if I were going postal. But, um, sorry for losin’ my cool and yelling.”

“I asked if you were okay.”

“Overtired, how about you?”

“Quarter.”

Him

“I am overtired, ain’t a white lie,” they insist.

“You’re pretty busted up, too. You in a lot of pain?”

Y/N stares him down as if to challenge him, but there’s something about the look they have on that suggests they’re about to tease him. “No,” she states, that hidden grin starting to come out.

“Quarter.”

“No. You said quarters are for white lies.” Ah, there’s the smile. “Not outright ones.”

He finally looks up at them again but stops when he sees that their egg-stained white t-shirt is soaked. It might be dark and they have on an undershirt, but he can still see the outlight of everything.

But even when not looking, when they take their hand off that spot under their ribs, he can’t help but notice a new, red stain.

Shit.

“What’s wrong, Daryl?” They peek down. “Oh, look at that.” As if it were nothing, they turn around and lift their shirt to check. They sigh in relief. “Stitches ain’t popped, we’re good. I should slap a bandage on there, I reckon.”

This weird sensation of like guilt or whatever starts to kick him in the balls.

The first thing that pops into his head to do to make up for it is to offer them a drink from his water bottle. Then, he rummages through their backpack to hand them the first aid kit they kept in there. There’s also this, though:

“You got a jar of flour?”

“Oh, that’s for Beth, I found it at the thother—the other—house.”

Which one is Beth again? Oh, never mind, she’s ‘the teenage girl,’ right, right. “Messin’ up your words a lot today.”

They take a gulp of his water. “Pre-migraine phase, most likely.”

“You should make people sign a waiver when you head out with them,” he jokes. Not his brightest idea. Maybe he said it wrong?

It’s like he turned their power button off. Y/N gave no offended or angry comeback, no eye roll, no chuckle. She just got really still.

The imaginary knee kicks him in the balls again.

He’s back to not knowing what to do but wanting to do something because Y/N was his friend and shit. It pops into his head this time to ask them for the little walkie next so he can radio the camp in her stead, letting the group know that the two of them were fine.

“No Sophia yet,” he has to tell them.

Dale asks if Y/N is okay (“It’s unusual for you to communicate with the walkies, Daryl, that’s usually Y/N’s territory.”)(“I’m peachy, Mr. H! How are Carl and Teddy, both improvin’ still?” she calls, real bubbly about it, too.)

T-Dog and Andrea apparently went out, as did Rick and Y/N’s brother.

He crouches down beside her as Dale told her all this, holding the walkie between them. Y/N thought he was handing it to her and her fingertips brush his.

(“Daryl?”)

Oh, um, yes, yeah, they know it’s getting late, they’re gonna head back when the rains slow enough. (“Dale, can you use the police walkie for Shane and Rick? They’re usin’ that one, right? I’m just worried about them and the flood risk.”) (“They made it back maybe ten minutes ago, I’ll wave your brother over.”)

While they wait, Dale checks about their physical safety.

Yes, they’re safe inside a shelter. No, they aren’t in a flood zone anymore, so Y/N assures Shane when he interrupts Dale and specifically brings that up. Weird how that keeps getting mentioned.

“My shoulder’s doing pretty okay. Stitches good, still intact,” Y/N repeats to her brother. “I think I’m prodromin’, though, how angoying is that?” Not correcting their pronunciation mistake for the first time that day, they even add that awkward laugh people make when they don’t want to sound upset. “Least I got a warning that I’ll be a liability tomorrow or the day after.”

Stress on the “liability” part. Their eyes look wet and they seem sorta pissed. Daryl feels like he got kicked in the balls by the imaginary foot again. He’d implied she was a risk to bring along, hadn’t he?

“How ’bout you help with target practice tomorrow, then?” Shane’s voice crackles to Y/N back over the walkie.

Their face lit up in response. “Sounds good, so long as we can risk the ammo?”

“These people gotta learn how to shoot proper.”

When all was finished, she clicks off the walkie. He stands up from his crouched position and sits down across from her again. Lightning flickers outside.

“Okay?”

Then the thunder rumbles.

“Okay,” they respond, going back and forth from massaging their shoulder, to their neck, to their knee. “While we’re stuck, I think I’m gonna poke around, find me clean shirt. Hopefully find Carol a present.”

“I’ll, um, cook this up,” he says, gesturing to the sopping wet squirrel carcass on his belt. “Lemme show you what I found yesterday, first, though, tell me what you think?”

Wanting to know their opinion was one of the reasons he’d lead them back here.

“Yeah, of course.”

First, he takes them to the trash bin so they can see the can (and he notes her suppressed gag). She frowns and bites her lip.

He doesn’t like that.

Next, he shows her the little makeshift bed in the cupboard.

She frowns and bites her lip again.

He doesn’t like that either.

But yes, it’s still better to have Y/N there even when they start to bring up stuff that he hadn’t thought out. It’s much better, in fact. They’re honest. He’d wanted to know what they thought and they were telling him.

But like, he still gets angry about it, though.

“Mr. Morales taught the kids how to open cans without, but was there a manual can opener in one of the drawers when you checked?” is their first question.

And he thinks that’s a weird question. “Why’s that matter?”

Y/N moves to check the drawers, hesitating before explaining. “This is gonna slound sliy—fuck, ‘sound silly’—but with the other options of canned stuff here, that she’d go for sardines…” They trail off and seem to stifle a groan when they start to massage their neck again. “I get that sardines are in a pull-top can and are quicker, and when you’re ravenous you’ll eat anythin’—”

“Exactly.”

Okay, yes, it’s possible that he grated that back a little strong. And interrupted them. He’s just...this was a lead, had to be. There were no other damned signs of that little girl otherwise.

Not even a damned sign that she’d got killed and eaten, there’s been nothing. Why couldn’t Y/N just agree with him? They’re his friend!

He sees Y/N’s nostril do that twitch thing people do when they’re fixing to get mad but are trying not to.

“Sophia is a child, is all, and she kept things neat, too. And it, it ain’t that she’d be picky, but,” She swallows and sighs, tugging at the hair at the base of her neck. “Children and teenagers generally will avoid stuff like sardines. Hell, I avoid sardines, I ain’t British.” Yep, using humor to lessen the tension, as always.

They close the open cupboard and reach to check another drawer.

And the second drawer they open has a fucking can opener in it.

He hears them make a small curse under their breath before they whisper, “This took me seconds to find, man.”

Then they stare at the damned thing as if the can opener just told them it had terminal cancer. “I...I just imagine she would grab something like, like the can of cranberry sauce that’s right there in the pantry, and then go to the, the, um—” they can’t seem to figure out the word ‘drawer,’ so settle on “to this pully thing to get a fork or spoon, then she would’ve found the can opener.”

“Jesus—you wanna explain away the bed, then, too, Sherlock?” he snaps despite really, really not wanting to. And that’s coming after using that name that way even though he knows Y/N doesn’t like it. ‘It’s shitty to go around usin’ a deity as an expletive’ was something along the lines of how they’d phrased it.

And Y/N is trying not to snap like he did, to her credit. “When somebody’s scared, they sleep curled up, child or grown. And the pantry is on the bottom floor where the temp’s cooler and has a door.” The last part she stresses, still massaging herself. “No, please don’t you go getting mad at me, Daryl. You wanted to know my thoughts, and I ain’t done nothing but said a truthful thing, tell me I didn’t.” A deep breathe. “You’re my friend, you’re worth the honesty, so is Sophia.”

He took a deep breath like he’d seen her do and listens to the torrent of rain spattering on the house. ‘You’re worth the honesty’ threw him off. And how they repeated that they were friends.

Another flash of lightning outside, another thunderclap.

Okay. He understands what Y/N said about the clues. The ‘clues’ could be nothing, could’ve been from any person alone and hungry in this world-turned-to-shit.

The trail could be cold, just like Merle’s had turned cold.

He just doesn’t want to have fucking failed that little girl just like he failed his brother.

But since when was Y/N doubting that Sophia was alive, too? This wasn’t the time for no doubts, all those do are drag you down.

It’s hard enough to not want to give up these days, and that’s without a lost child or her heartbroken mother left alone. Especially when it’s what, not even a month after those two finally got free from that deadbeat shithead Ed?

Fuck, he’d hated that bastard. Who knows what that asshole did to his kid? Bad enough what he was doing to his woman.

So, maybe, as much as he’s trying not to lash out, he doesn’t sound too friendly or patient or like an adult when he throws back at his friend, “Still don’t mean nothin’!”

Instead of getting all angry like he’d just done (I’m sorry, Y/N…), all they say back in reply is, “Wanna grab more food while we’re stuck here, or leave it in case somebody else takes shelter here and needs it?” as they place the can opener on the counter in plain view before limping away.

The only sound becomes the rain outside hammering away at the roof and windows.

He eyes the dumbass can opener, storms over, throws it back into the drawer and kicks it shut.

Pissy little bitch Darylina.

Yeah, he gives himself a minute to cool off. Y/N seems to be doing the same.

Another bolt of lightning flashes outside, following closely by a loud boom of thunder. Storm’s closer now.

“Ah, the painkillers are kickin’ in,” he hears them sigh from their spot near a window.

Lightning flashes again, thunder at just about the same time.

He decides to join Y/N in the living room and stare out the window, too.

“M’sorry I blew up,” he mumbles.

“Friends fight,” comes out of their mouth almost immediately. They sound tired.

“Heard ya say the painkillers are kicking in?”

“Thanks be.”

More thunder. He must’ve missed the lightning.

“Ain’t gonna work out, us heading to the road today, is it?” they ask him, tone soft and defeated.

He just runs his hands through his hair and flops onto the couch. “It’s gonna get dark soon. Out in the dark’s no good, you know that.”

They’re still standing by the window. A bolt of lightning flashes. “Andrea mentioned she and you went out to search in the dark.”

Shit. “Y/N…”

“No leads, then?”

“If there were, we’d have followed ’em.”

“Alright,” she relents with a sigh. After a few moments of quiet, she offers, “I’ll get a fire going, you do your thing with that squirrel there.”

You

I’m so sorry, Sophia. You were so loved. You’re still so loved, I don’t mean to be writing you off as gone so soon, but…I’m so sorry we couldn’t find you in time, baby girl. Please be alive.

Please let her be alive. Let her end have been quick if she’s gone already. Or bring her back!

Or…I don’t know, either way please just help me find Carol a damn present.

Him

Y/N’s been staring into the flames for a while.

The squirrel meat’s cooked, he threw it onto a plate from the kitchen and left it on the coffee table then headed to a window.

He opened it up, stuck his hands out to rinse off, and is now enjoying a cigarette. Small favors this fucking storm is moving further away.

“Rain’s slowin’ down.”

“Yeah,” they hush. He sees as they perk up. “We should oughta go now, then, flash flood risk is—”

—A massive thunderclap interrupts so forcefully that the house shakes.

Oh, damn it, he dropped his smoke on the covered porch outside! Of course he was holding it out the window when a hulking fucker of a thunderclap shook the place.

Can he reach it, maybe? Oh, nah, it fell in a crack that was wet. Well, there goes that.

He quickly looks back at Y/N to find them wide-eyed, tensed-up, and breathing heavy. “That was scary. What do you think Sophia is…” She doesn’t finish her sentence, and turns back to the fire.

He’s thinking the same. How terrified must that kid be right now?

Then there’s that asshole part of himself that is thinking how after this bullshit storm they’re having, the chance of finding that little girl is gonna be that much more difficult and…and unlikely.

Screw that.

“So, remember how I said I got lost when I was a kid? When I found my cat?” he calls over.

After a few sniffs, she responds back, “Your cat Eyes?”

“Yep. So, I was wanderin’ around playing and shit. I didn’t want to be ho—um,” he pauses and pretends he sees something outside. Did he really almost tell her how he didn’t want to be home? More mopey bullshit he almost spilled, what the hell.

And like, come on, it’s nothing, it’s just that things had been pretty shit then. Ma had died and Dad was…who he was. And Merle had been dicking around so he wouldn’t have to be around their old man, which had landed him in juvie again.

Anyway, being away from home felt safer. Hurt less.

None of this Y/N has to know.

He begins to walk back to the fireplace and sees that they haven’t eaten any squirrel meat.

“And yeah, I dunno,” he continues his story, “I ended up goin’ deeper and deeper into the woods by my neighborhood. Got lost.”

“How long ’til you made it back?” Their expression warms slightly when they ask, “And when d’you find Eyes?”

He opens his mouth to tell her.

Closes it.

He just doesn’t want them to get, like, all emotional or whatever. “Don’t, um—it ain’t a big deal, okay?”

Her brows draw closer, just a little. “Maybe it kinda is if you have to tell me that,” she gently counters, her curious smile switching into a cautious sort of look.

Might as well out with it. He’d already basically blurted out how he’d hid under his bed a shit ton as a kid, she’s probably already drawn some kind of conclusion. “I found Eyes on day seven, I think?” Was it day seven or six? Maybe eight?

“How long, you said?” they question, voice casual.

“Was out there nine days by the time I made it back.” He glances over for a second to see their reaction, and to his relief, there isn’t much of one.

You

Tears forgotten and voice as level and as nonchalant as you can crack it, you wonder about the phrasing of that sentence. “By the time you made it back?”

He hums.

Does that mean he was out there and he ran into the search party, or that no search party was sent? He said nine days. Nine!

“Your mama and big brother must have sobbed so hard with relief when you came back in one piece,” you decide to respond, praying you won’t say the wrong thing or react in an unwelcome way or cause him grief.

“Nah, Ma wasn’t around then, she’d died.”

Oh my, it got worse. Oh my. Okay, keep your voice normal, Y/N, you know the drill. “How old were you?”

“It ain’t a big deal,” he repeats instead of telling you.

So, you try humoring him a little. “Ain’t never said it was.”

And it’s probably him compromising when he allows, “I was younger than Sophia is now.”

Okay.

He’s probably feeling very exposed right now, that’s a given. God knows you’ve had the hard blessing of living with and caring for a lot of kids like him; when stuff came up that kids (and grown-ups) from difficult situations didn’t like facing, they’d fight it.

So, because it isn’t anything immediately urgent as it sometimes was with your foster sibs, there’s zero reason for you to encourage, press, or pry at this moment. But because completely changing the topic isn’t the best course of action, either, you try to direct it away from the painful part.

“You mentioned you’re from northern Georgia, right? We talking by Gainesville or far up like Dalton or Clayton?”

“In between, I guess.”

In between those are a whole lot of trees and not too much else. “Ellijay? Helen?”

“You got a map out or somethin’?” he snorts. He appears more comfortable now, which is good.

But shit, nine days lost in the woods? Whoever was meant to be his caregiver dropped the ball so hard it cracked the mother-fucking pavement—ohh, great and here goes you getting all huffy. Good Moses, you can feel your blood pressure going up!

You know, you know, you should be used to this kind of thing, but every time it still hurts to acknowledge that people can abuse or neglect kids. Sometimes, you swear, people don’t care about young humans half as much as they care about dogs.

Daryl could’ve been one of yours just as easily as Sophia could have.

All you want to know is where the fuck was this guy’s dad was—where was Merle, for that matter?—or, you don’t know, an auntie or grandma or whoever was supposed to be taking care of your poor mangy hick and didn’t notice he was gone for over a w—

“—Anyways, I told you that so you’d get it into your head that that little girl could still be fine,” your poor mangy hick’s voice interrupts.

Just a sec, did you just think of him as ‘your’ mangy hick? Twice? That isn’t gonna be your term of endearment for your new friend, right? Sure you’ve had that in your head since the day your group left the quarry, but it’s kinda rude. Plus, he’s not a child, he’s like six and a half years older than you.

Anyway, your curiosity gets the better of you. “What’d you do for food when you were out there?” you ask your poor mangy hick.

“Berries mostly. Wild onion, too,” he grunts back, picking up his food-knife (separate from his walker-knife) and taking a big bite of squirrel meat off it. “I overheard you doin’ a lesson with ’em about edible plants once.” He says this as if it means Sophia would know all the plants off the top of her head now.

More thunder interrupts, and thankfully it doesn’t shake the house like the last one did. And yet, your hope gets washed away with the rain and leaves dread in its place.

“But only one lesson, Daryl,” you begin to panic, efficiently tumbling down into worst-case scenario thoughts as the memory of her crying out in terror that day on the car-packed highway floods your mind. “We only went over poison sumac versus edible, poke versus elderberry, and, um, w-wild carrot versus hemlock.” Calm down, calm down...

His shrug might have come across as rude if he wasn’t staring so intently into your eyes. “Sophia’s smart, said so yourself.” With a shake of the plate, he seems to be encouraging you to eat some of the meat.

“Smart only gets you so far when th-there are dead people who chase and eat us,” you falter, pulse rising.

“Y/N, c’mon, zen,” he says, but not in the way he’s been speaking. The gentleness in it catches you off guard.

Plate put aside, he holds up nine fingers. “Nine days. That was me.” Then he points to himself, then toward the window. “Sophia’s on day three. She’s got the creek as her landmark and water source, and there are plenty of farmhouses she could be crashing in. Don’t go gettin’ your panties in a bunch just yet.”

As well-intentioned as the first half might have been, that last part gets you snapping, “Bitch, don’t patronize me or my panties,” as tears (not now, idiot!) pool in your eyes and threaten to slip down. Feeling weak and stupid and useless and helpless, you promptly turn your head and tuck your lips in, determined to cry too obviously and give credence to Daryl’s (*cough* sexist) choice of phrase.

His apology comes out annoyed, but one comes out nonetheless. Plus, he follows it up with, “I didn’t mean it like that…”

Then another rude-ass, mother-fucking, loudmouth thunderclap booms through the air and all you can do is whimper, “Oh, baby girl, I’m so sorry,” as you close your eyes and pray (scream inwardly) again and sink onto the couch.

Him

Y/N is quick to apologize for calling him ‘bitch,’ as if it were a big deal.

“I’m sorry, you don’t like being called that especially and here I go sayin’ it. I’m sorry.”

“Don’t sweat it, we all say shit we don’t mean.”

He takes another bite of squirrel, thinking how he’s gonna have to pilfer around for some hot sauce to help choke stuff like this down. After another two bites, he tosses the rest back onto the plate and sits down on the opposite end of the couch where Y/N is. He doesn’t want to make her uncomfortable. More uncomfortable, that is.

The rain sounds like it’s slowing down.

There’s still a stack of magazines from when she got the fire going. He grabs one, rips out a page. Crumples it. Pelts it into the fire.

Rips another. Crumples it. Pelts it into the fire.

Rips a third. Crumples it. Looks at Y/N. Nods his head toward the magazine.

Glancing back, they mutter, “That’s a good idea.”

He puts the magazine on the middle cushion between him and them before pelting his third paper ball as hard as he—fuck, it hits the glass fireplace door and lands on the floor.

It’s Y/N’s usual delicate teasing when they hint, “That’s how I felt when you chucked that rubber band ball too hard and I didn’t catch it.”

That happened back at the CDC. Fucking cosmic-level crazy day. And that black lady, uh, Jacqui, right? She was decent. Liked root beer as much as he does, so he found out while there. Too bad she chose to check out with that scientist bastard.

More thunder outside brings him back to the present. Based on the sounds of it, the storm’s finally moved its ass away.

Y/N’s attempt at tossing their paper ball ticks the bottom grate first but still flops into the fire.

He rounds up a fourth ball of his own, throws it—hell yes—and sends it straight into the flames.

“Ow,” Y/N hisses, dropping her second one. “Tried to throw with my bum arm.”

He figures he’ll do some teasing of his own. “Idiot.”

As expected, they bug him back. “Mangy hick,” they snark, and lightly toss the paper ball at his head.

He’s about to inquire why that, um…kinda weird nickname instead of ‘bitch,’ but she speaks up.

“Daryl?”

When they don’t say anything for several seconds, he looks over. Their chest is rising and falling slowly and controlled. Then he realizes he’s staring at their chest and turns away.

“We tell Carol we found somethin’, yes or no?” she finally speaks. “I don’t think we should, but do you think she'll need that?”

“Nah, we ain’t lying to her.”

“W-we can tell her about the old couple’s house.”

“We can.”

“And we can find her a present.”

A gift? Trying not to sound like a dick, he wonders, “What the hell kinda present?”

“I dunno, dude, I’ll look around.” Y/N massages their temple for a moment. “She likes modern art,” they trail off.

“So ya wanna bring her back a painting or some shit?”

She shrugs her good shoulder and closes her eyes. “Daryl, what sorts of signs might could there still be tomorrow of our girl?”

His answer is coming out before they’re even done asking. “Plenty. The wet ground will help us see way better, if she’s out in it leaving tracks. Just don’t—” What is he trying to say? “Don’t write her off just yet is all I’m askin’. From you of all people,” he adds, really not liking how…naked he felt in saying that.

Partway through making another paper ball, the crinkling noise slowly stops as Y/N pauses. She licks her lips, then tells him “It’s not me writing her off. That ain’t never gonna happen, she’s just a child. And I love her, it’s j-just me tryin’ not to be blind about her situation. It’s been seventy-two hours, man.”

“What’s that got to do with anything?”

He feels her turn to look at him for a moment. When he starts to return her gaze, she’s already standing up. Her voice comes out low and rough. “Stats say we’re most likely gonna find a body now.”

Um…wasn’t expecting that. How is he supposed to react? And who cares about some statistics bullshit?

Luckily, another damn thunderclap interrupts and helps him take a figurative step back before he gets pissed again.

So, he knows, alright?

These past three days, he’s known how slim it’s been getting. He isn’t stupid.

But it still doesn’t mean the worst. There are plenty of places for her to hole up and keep safe, fed.

Sophia’s surprisingly good at throwing punches, too, from what that little lesson Y/N was giving the kids that time showed. That means she can defend herself, at least somewhat.

Well, Y/N’s gotten up and is searching this dump to find useful stuff. And a present for Carol, for what good that’ll do.

Well, he’s gonna take this as another opportunity to have a smoke. And not drop it out a window this time.

You

A jug of cooking oil and a jug of bleach. Neither are for Carol, but both will benefit your group and the Greenes (and whatever Patricia and Jimmy’s last name is).

You think you took too many ibuprofen, your ears are ringing and you’re feeling kinda nauseated. Another idiotic thing you did, overdoing it on pain management so you could pretend you weren’t the liability you are for going out.

It was hard enough getting the fresh shirt on without resorting to asking Daryl to help pull it off (hell no), but you managed to get a clean, unstained one on yourself along with a pair of all-cotton jeans, one size too small but the cotton will loosen up, right?

“Ain’t that top kinda warm?”

“It’s comfy. Don’t you go snippin’ the sneeves—sleeves—off my new button down, hear?” you try to joke, eyeing his own cut-off shirt. Every sleeved shirt that man had had with him he ended up ripping the sleeves off. It was one of the first thing you and Amy noticed. She did enjoy peeking at his arms.

“You good?”

“I’m good. You good? You look tired.”

“Same to you. Ready to head back?” he puts to you, already shouldering his crossbow and—oh, shouldering your backpack as well. He also grabs the jug of cooking oil.

Okay, Carol really called it. There is a good man hiding underneath all that anger.

Him

“Yeah, the flood risk only gets higher the longer we wait,” they reply under their breath, dark circles under their eyes more noticeable in the light. She notices her bookbag on his shoulder but doesn’t protest. Then she picks up the gallon of bleach with her uninjured side and follows him on his way out the door.

“What’s with y’all and flash floods, anyways?” he’s curious to know.

Their brows go up just a little as they heft the jug, but their response nearly causes him to drop the one he’s holding. “Dad drowned in one.”

Shit, they serious?

They sound almost amused. “Oh, Dary-bear, are you freezin’ up? Relax, you’re fine. People die.”

“My bad,” is the only response that comes into his head.

“Make it up to me by lettin’ me carry my backpack?

He doesn’t think that’s a good…fine, he gives it back—but he takes the jug of bleach from their hand first. He just doesn’t want her to hurt too bad later. He can carry the cooking oil and the bleach, she can be the spotter, and he’ll just drop a jug if he has to aim his crossbow. Easy. “How old were ya when that happened? To your dad?”

With a pointed glance, she repeats the same reply he gave her earlier. “Younger than Sophia is now.” She adjusts the bookbag. “Maybe we can both share when we have that beer at some point.”

You

The skies are darkening and the birds are starting to leave their nests to get worms since the rain has finally slowed to a light drizzle. The air smells nice.

Dead tired, you’re already ready to ask for a break and you two only have a quarter of a mile from the farm, so Daryl estimates.

You two pass a big cinder-brick farmhouse-looking thing. He already checked the inside yesterday (“It’s stripped bare, Y/N.”), but the two of you pop in for one final sweep. ‘Stripped bare’ is the perfect description for it. After maybe five minutes of calling Sophia’s name and looking under and inside possible hiding places, it’s time to leave.

You trudge outside. And as you’re daydreaming about leaning against that tree while you try to wrangle enough willpower to make the walk back, he checks out of the blue, “Hey, you find that present for Carol like you were after?”

“Other than the red shirt from the highway and an unopened box of peach tea, no. Why?”

He’s staring at something. “She like flowers?”

“Very much.” She’d had the kids pick wildflowers more than a few times back at the quarry. And that Daryl is offering is something.

He bends down toward a scraggly wild shrub and picks—oh, it’s one of those? Those are the official state flower. They smell kinda like Christmastime.

“Ready to head back?” Daryl asks, holding just the single bloom.

“I guess.” You nod at the flower, intrigued and a little confused. “Why only the one? There are two.”

“I think it’s a sign,” he says quietly without looking at you. His gaze is fixed on the flower.

Your gaze is fixed on him. It’s—it’s weird to think, but you don’t want to look away. He whole appearance is unlike his usual self—he seems shy. He looks gentle. “What do you mean?”

“You know the story behind the Cherokee Roses, right?”

Of course, you were Georgia born and raised just like he was. “Yeah, that the, um, the Cherokee prayed for a sign of hope for the future, and those sprung up wherever they cried for their lost ones.”

“On the Trail of Tears,” he reminds you, still staring at the petals and delicately running his finger along the tips of them as if lost in thought. “All those people were dyin’, the kids especially. After the elders prayed for that sign to keep hope, every time a mother’s tears touched the ground for her children, one of these bloomed.” And it’s almost too soft the way he mumbles to himself “These bloomed for Sophia,” that you nearly didn’t hear it.

Your stomach does a flip. Your cheeks get all warm. You’re just about ready to start crying again, to be honest. Also, you get slightly turned on for a sec, but that’s neither here nor there—and you pay no mind. You’re overtired.

Carol called it. There’s a very good man hiding under all that anger.

“Y/N, you good?”

“I-I’m great, um—tell Carol that story when you give it to her. Okay? Daryl, it’s perfect.”

The flower in his shirt pocket, he doesn’t reply, he just picks up the jugs again and makes a half-grunt while inclining his head toward the farm.

“It’s perfect,” you repeat, but still are given no semblance of a reply as you both continue walking the final stretch back. You get the urge to bug him. “Since when do you get shy, mangy hick?”

The trudge back grows quiet.  

Him

They hadn’t called him ‘mangy hick’ in a while. He even kinda liked it. It didn’t sound like an insult when they said it, probably because it wasn’t. If Y/N was mad at somebody, their mouth would run, sure, but without fail they would then apologize for that shit and mean it.

“We’re almost back,” he lets them know.

“Good. Because really, man, what you told me about that flower will mean a lot, like, a whole lot to Carol. She needs that right now.”

He doesn’t know how to respond to this. It’s a flower, big deal. “Yeah.”

“How is it that you,” she sighs, “got to save the day two days ago, now you’re savin’ the day again?”

Not this again. I remembered leftover pills two days ago, Y/N, and today I picked a flower. How are you gonna swing this as meaning anything? “Pickin’ a flower is saving the day?”

She doesn’t even hesitate. “Today, for that woman, might could be.”

The two of them finally make it to one of the farm’s fields.

He doesn’t get it. “Tracking down her daughter might could’ve been better.”

A slight huff. “We’re working with what we got, Daryl, take the compliment. Carol needs comfort. Life’s beaten her down enough,” she mutters under her breath. Then she speaks clearly and almost as if she’s scolding him. “And now life has taken her daughter, at least for a few days. Carol needs comfort right now, and you found somethin’ deep and real to comfort her with.”

Before he can grumble or make any kind of lame reply such as “Picking a goddamn flower ain’t saving nobody,” a figure in the distance shows up from around a hay pile. He drops the jug of cooking oil and aims his crossbow within a second.

Oh, it’s just T-Dog. Does he look happy, did they bring back Sophia? He turns his head toward Y/N, who looks back at him and shares that same hopeful expression for just a moment until she waves and appears to be about to shout over to him. But she hesitates.

“You realize Carol ain’t gonna hate you that we didn’t find her girl yet? The one she—well, the person she hates right now, it’s herself. That’s why we need to remind her we don’t agree, okay? Especially comin’ from somebody as,” a slight pause, “as independent as you. That’s why you have to do it.”

There’s no time to process this idea or grate back anything he’d probably regret and kick himself in the balls for before Y/N finally does shout, “Teddy! I hope you and Andrea made it back before that free shower from Mother Nature!”

“It washed off the sweat, I’ll give it that.” T-Dog calls back, his voice sounding…disappointed. “Y’all find any leads?”

That answers why he sounds disappointed. No Sophia. Again. Fuck, fuck, fuck, fuck, fuck, son-of-a-bitch, fuck!

“There weren’t signs of her back at the little shelter y’all made at the highway, either?” Y/N falters.

“We’ve got a new road to check out tomorrow,” Daryl cuts in, and states it loudly and as confidently as he can scrape up for both Y/N and T-Dog. “I don’t think that area was checked yet, right?” he adds with a toss of his head toward the east.

“Nah, Andrea and me did a sweep of the woods in that direction,” T-Dog gestures to the far end of the farm, then to another. “Shane and Rick searched that way. And y’all did that direction.”

“They find any signs?” he presses, knowing he sounds desperate.

T-Dog shakes his head.

After this, he reaches his hand down for one of the jugs Daryl is holding. Daryl hands it over without a word and without looking at him. He’s only finally let himself believe that Y/N was actually his friend, he isn’t gonna start assuming everybody will want to. That he thought T-Dog was a decent dude didn’t mean it was mutual.

“Teddy, how’s my Carl?” Y/N checks sadly.

“Still doing great. Little man’s itching to get out of bed already.”

“He ask about Sophia all day?”

“His parents told him.”

She coughs. “What? How did, h-how did he take it?”

“Good. He took it real good.”

“I gotta go see him—wait, I forgot to ask about you! You gonden dinzy—ahem, gotten dizzy spells at all? Are your stitches still clean and—ohh, how’s your stomach, those antibiotics can wreck—”

“—Okay, we good, slow down. To answer, my arm’s fine, and Glenn gave me the probiotics you put on the drug store list.”

“Glenn got back okay? Margaret, too?”

“Both good as far as I know. But to be honest about my stomach, yeah, it only been a day and a half on them antibiotics and that shit’s messed up,” he cracks to try and break the tension.

“Literally, huh?” she deadpans back at him, causing him to make a genuine laugh. Daryl gets the feeling he should smile or something, but he feels too out of place as T-Dog and Y/N have their conversation.

“Hey, Lori was looking for you, Y/N. Glenn, too.”

“Okay, I’ll go find them after checkin’ on my Carl. Oh, and I’ll try to find a vase for you, okay, Daryl?” she adds, taking off at a faster pace that Daryl didn’t realized she still had in her.

T-Dog slows down and nudges his arm, then nods over at Y/N. “They okay? No sling on today.”

“They overdid it.”

“You both look bone-tired.” He chuckles. “I’m guessing they was the one who wanted to bring these back with y’all, right?” he guesses, holding up the jug and grinning.

“Mmhm.”

“Was that flower you got there what she meant about the ‘vase?’ Not many Cherokee Roses this time of year. That’s what that is, right?”

“Ain’t nothin’,” comes out of his mouth before he can rethink it and not act like some asshole white-trash redneck.

T-Dog slows for a second, then rolls his eyes and shrugs. “A’ight, brother, I’ll leave you to it.” He maintains his distance from Daryl after that and walks along at his own faster pace.

No wonder no one fucking wants you around or is gonna. And throw out the damned flower, who the hell will care? You failed again at doing the only thing you’re supposed to be good at.

And he almost does throw the damn thing out. But…Y/N would be upset, for one.  But more than that, the thing she said about it being something Carol needed right now? That much is plain, the poor woman does need some kind of something to keep her going.

And those two flowers, they fucking did bloom for Sophia. Two single blooms, one for every night she’d been missing and her mother cried for her. There’ll be one more in it’s place tomorrow, try and tell him there won’t be.

When he sees Y/N across the field slow to a stop and lean over to catch her breath and forgets about the goddamn flower-drama in his head.

Y/N thought it was obvious. Carol needed a present, something to give her comfort. In their opinion, Daryl finding that flower was “perfect” for Carol, and was “saving the day again.” They said it without a lick of sarcasm, too. Then, when he turned into pissy Darylina and tossed it back in her face anyway and told her she was wrong, she didn’t even blink.

“Today, for that woman, it might could be,” she told him. “Life’s beaten her down enough, and now life has taken her daughter.” Then came the part where she seemed disappointed in him. The imaginary knee kicked his balls again. “Carol needs comfort right now, and you found somethin’ deep and real to comfort her with.”

He can’t chicken out. That woman—Carol—if there’s a chance she’ll get some kinda comfort out of this, it’s worth him feeling stupid and unwelcome or blamed.

Hot damn. What would Merle say if he could stare into his thoughts and read this shit, right?

You

You’d meant to go to Carl, but Maggie found you first. Wanted to talk.

You wish you’d waited to talk to her until after seeing Carl. And Lori and Glenn, or maybe after a good night’s sleep, like, what the fuck, Glenn? Never mind whatever was going on in Margaret’s mind, but as for Glenn: did he even think before getting himself into this?

Shoot—the pun wasn’t intended, it wasn’t, but really! What the hell were they thinking?

Maggie and Glenn had sex?

__________________________________

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[headpainmigraine]

Migraine isn't a Headache Part Two: it seemed to last for hours, it seemed to last for days

Migraine isn't just a bad headache that makes you puke and have to lie down in the dark for some hours.

They can actually start days in advance, while you don't even realise it, lying in wait like a sleeper agent.

Migraine can have four stages:

-Prodrome (lasts a few hours to days) -Aura (5 to 60 minutes) -Headache (4 to 72 hours) -Postdrome (24 to 48 hours)

I've got a lot to say, so I'll break this into two and look at Prodrome and Aura first.

The American Migraine Foundation gave me those timelines, HOWEVER, like most things with migraines, these can differ from person to person.

I have daily migraines, and I still don't have a good hold on whether:

I'm just not actually getting all four stages,

if I'm getting an elongated Headache stage,

if they're all overlapping,

or if they're just cycling so fast I can't tell the difference.

Chronic daily migraine can be a dick like that, so I'm going to be talking about the 'Typical Migraine Progression' in this post, unless otherwise specified.

Remember, this is just what is TYPICAL for a migraine, and so many migraines can be atypical. Migraine can be so different to each person, its a wonder any two cases are the same.

PRODROME

Like birds ditching before an earthquake happens, your brain actually gives you a warning that the pain is coming (sometimes)

The prodrome can be the hardest phase to spot, but is actually where your migraine starts.

It's also the best time to take preventative meds and/or acute meds, locking the door before the horse bolts, so to speak.

They're more likely to be effective if you catch the migraine early.

Symptoms?

Generally feeling grumpy and irritable or depressed

Yaaaaaawwwwwning

Neck pain and muscle stiffness, feeling 'creaky'

Constant. Peeing.

Inability to settle, restlessness, lack of concentration

more sensitive, to sensory stimuli, but also emotionally

fatigue, but also difficulty sleeping

aphasia/communication difficulties, incl slurred speech, difficulty selecting the right word, stammering

Reporter Serene Branson experienced migraine-caused aphasia on live TV

It can also be an aura symptom.

People also get food cravings in the predrome stage.

***Researchers are now questioning whether 'trigger foods' are truly migraine triggers, or if they're just a correlation between eating a specific food during the prodrome phase before the headache phase hits.***

It's easy to overlook those symptoms, especially if you have other health issues.

I can usually realise I'm going to get a migraine when I start stammering and lose my words, but in hindsight I can see how I was feeling restless and irritable as well.

I've found that I =still= mostly only realise prodrome in hindsight, but it's still worth noting if you can remember having those symptoms even after you've had a migraine.

Taking your meds at the earliest opportunity is most effective for a migraine, and a lot of knowing when to take them, and understanding your migraines at all, is pattern recognition.

Unfortunately, that involves a lot of tracking and recording, but every little helps (with diagnosis too, but more on that another time)

AURA

Common misconception, especially among people who know of migraine but don't GET migraines, is that YOU DON'T NEED TO EXPERIENCE AURA TO BE HAVING MIGRAINES

I think the number is 1 in 4 people with migraines do?

I had aura without headache for about 6 years before I suddenly started getting auras, and even now I only get them sometimes.

They can be scary, even if you know what they are, and terrifying if you don't.

If you haven't taken your migraine meds, especially triptans, before now in the prodrome stage, taking them during an aura is the second best time to take them.

You can experience this stage at the same time as stage three, the headache, so they're less effective than taking them during predrome, but better than leaving it any later!

Typical aura comes on slow in about 5 minutes, lasts an hour, then goes away before the headache.

Of course, nothing is simple in migraine world, so auras can also come on fast and/or happen alongside headache.

The stereotypical migraine aura looks like this:

Grey blobby visual disturbance you can't see through and/or spiky zig-zag lines of colour like an old TV set going wonky.

Visual auras can also present as blurred vision, waves, spots, partial loss of sight, flashes - I've had times where I get tunnel vision, or blinkered vision.

Auras can also come in other flavours - remember that a migraine is a cascade of overactive brain activity, and many parts of the brain can be lit up and sparked off during a migraine.

You can have olfactory hallucinations; some people get a strong smell of flowers, but burning and bad smells are more common. I got burning electronics for a while when I had them.

You can become more sensitive to sound, hear a ringing noise, lose hearing, or struggle with listening.

You can have full blown auditory hallucinations too - I had a line of Portishead repeating in my head, and you can't drown those suckers out with external stimuli, because again, it's being produced internally.

Sight, smell, sound, aphasia affecting your speech, the fun doesn't stop there.

What else does your brain do? What else can a neurological storm rile up?

Allodynia is common during aura and headache phase, although not a phase in and of itself, and can also be it's own thing.

In basic terms, your nerves start sending pain signals to your brain in response to non-painful stimuli, eg, brushing your hair, or washing your face, etc, experiences that wouldn't normally be expected to cause pain.

You can get burning, pain, tingling, numbness, in the extremities, but also numbness.

I don't see dizziness or vertigo mentioned a lot in these conversations, but that can also happen during an aura phase too.

Vestibular migraine is a type of migraine on it's own - more on that another time.

The brain is both incredibly intricate and incredibly stupid.

I think about it like my migraine peeling back the coating on my nerves and leaving me more raw to everything. Everything feels MORE and the MORE is often uncomfortable.

NB: IF YOU EXPERIENCE AURA FOR THE FIRST TIME/A NEW SYMPTOM OF AURA THAT YOU DIDN'T HAVE BEFORE, YOU SHOULD SEEK MEDICAL ATTENTION TO RULE OUT SOMETHING MORE SINISTER (transient ischemic attack, which is a type of stroke, among other things)

Prodrome and aura are the best times to get ready for the migraine.

-go home from work and/or retreat to somewhere quiet and dark* -Taking your acute meds -Drinking water -Eat something (I usually do something salty and something sweet. Hot chocolate helps for some reason) -Applying ice packs/heating pads -Retreating to a cool, dark room -Trying to get a nap in before the main man arrives

Whatever you do to get comfortable during the headache, it's worth preparing and starting now.

*I worked with migraines for some years before they eventually fired me because of them. They were as accomodating as they could be, offering a meeting room where I could lie down if I had to, among other things, but a) that wasn't practical for me and b) that's far, far more than I expected. A lot of employers don't understand what a migraine is, and certainly won't give you the time to lie down somewhere, if there is anywhere TO lie down. Working with Migraine is a whole other topic, and I'm not going to get into it here.

================================================

I don't really want to talk about meds yet, but I don't think it'd be fair to talk about taking your acute meds early without noting the fact that the number of migraines you experience in a month can outnumber the amount of tablets they give you. (This is assuming you can even access acute meds)

I get 6 triptan tablets a month, and have migraines daily.

Likewise, you can't take OTC painkillers for migraine every time you have a migraine if you're having them chronically. I'm not talking about debateable things like damage to your liver, or addiction, or 'psychological weakness' or anything else, this is purely the fact that taking too many OTC painkillers as a migraineur can cause medication overuse headaches AKA rebound headaches.

It's a beautiful little piece of evil truth, because this apparently only occurs in people who already have headache-type illnesses.

I know.

And then you're argument is, "I have a migraine every day anyway, why does it matter if I get another type of headache every day?"

I can say, just from my experience, that rebound headaches are nasty, acid feeling things, and there is a noticable difference between those and migraine headache. Also that they hurt more than they help in the long run, and if you're migraines aren't daily, they are now.

The only way to avoid this is to keep your painkiller use to a minimum, that is:

paracetamol and NSAIDS (ibuprofen, aspirin, etc) less than 15 days a month

triptans, ergotamine, opioids, combo painkillers less than 10 days a month

And you're still expected to keep under these levels too.

The only way to stop having rebound headaches if you're already in a routine of taking them every day for your daily migraines is to… stop taking them. Cold turkey.

If that sounds cruel and difficult and painful, that's because it is.

It absolutely sucks.

Not only does the pain get worse (!!!) before it tapers away, but you're also leaving yourself unmedicated for your migraines.

The golden lining is that you really can tell when the rebound headaches stop, and when you DO take acute meds, they do seem to work a little better.

So what? What am I supposed to do, being in constant pain and not able to take painkillers?

That's where the headache specialists/neurologists are supposed to come in with preventative meds. The idea is to reduce the number of headache days so that you don't HAVE to medicate with OTC drugs.

In real terms, that puts you in a situation where, sometimes, you won't be able to take painkillers, your preventative meds won't be the ones that work for you, and you'll have to suffer through the migraine.

Non-medicinal techniques can help during those stages, but in all honesty, it's just something difficult that you have to go through.

That or take more acute meds and fall back into rebound headaches - which is understandable!

Everyone with chronic migraine knows the feeling of being exhausted and wrung out, at the limit of your cold compress/heating pad/aromatherapy/earplugs/lying down/non-medical assisstance and just needing to take the painkiller to just escape the pain, just for a little, maybe it'll help.

Sometimes that'll happen.

We're in constant pain, and when you have to wait for preventative meds to start working, when you're in agony, it's only natural that you'll reach for the bottle of ibuprofen, even if you know it's not going to help in the long run.

All we can do is give ourselves a break, inform ourselves, try to balance help and harm as best we can and hope that the next treatment works a little better than the last.

[takeyourcyanide]

I cannot call myself a schizophrenic, as that will only further enrage the static, but I genuinely think I was born with it. You often only hear of people developing it, especially because little is still known about the illness, but I was born with every negative and even some positive symptoms. What came a little later - and by later, I mean when I was about six - were the supposed “hallucinations.” It essentially worsened over time. My beliefs aren’t delusional by any means, but I had always had supposedly “paranoid delusions” about people and about pretty much everything, but by the time I was around six, they began worsening to a point of no control. I had always been an insomniac, but once the “”paranoia”” and “””hallucinations””” got worse, any possible rest was thrown out of the window. I resembled greatly a schizotypal/schizoid individual when I was a toddler, and those symptoms were only further exacerbated and grew to be become an even worse hell. I’ve been the same since I was born. I’ve just been observing as I slowly deteriorate. I don’t think I ever had a prodromal phase. I was simply thrusted into it. Is medication really worth it? They only want you to take it to conform. And who would I be without the static?

[the-drug-addicts-diary]

My first manic episode

They told me, that despite my bipolar medication, I can still get mood swings. Most likely, I can still get depressed. And i did during winter. Nothing severe, it was just seasonal stuff. So I am always kinda ready for depression, but I wasn't ready for mania. I thought it couldn't happen to me.

And I was wrong.

My medication works perfectly and I'm very responsible when it comes to it. I got into full remission for a long time, so i really didn't see it coming. My lithium levels most likely dropped a bit, which should be fine. We'll just wait for the results to come and increase the dose. I'm not afraid much about that part.

But there were signs. Many weeks before that. Signs i didn't pay attention to, because it didn't occur to me that this could happen. I never heard of the prodromal phase of mania before. For example, depression is one of many possible symptoms, i mean, what the f...?

In 12 years of being treated as a bipolar patient (and 7 of being diagnosed) i never even got manic before. I had mixed episodes or depressions.

I had a couple of cases of hypomania as well, but it was so rare and mostly harmless, that i never really cared.

Most of it happened during active addiction and it pretty much made me believe that since I'm clean and medicated, it won't happen again.

Hypomania was laughter and higher self esteem.

It was buying stuff i didn't need. It was high heels and a minidress, and drinking with strangers. It was bright and pure. It was creativity and stupid impulses, with more or less severe consequences. It was fun.

But mania was a killer.

My heart was so full, that if i'd get any happier, I'd explode into millions of pieces of joy and rage. It was gaining more and more energy from any attempt to get rid of it. Mania was not being able to think or speak coherently, because every single thought shattered into thousands of others. Mania was "I'm not bipolar" thinking.

It was two weeks of my life i have almost no memories of.

It can still be a part of a mixed episode, but i'm starting to doubt that.

Thankfully, I didn't do anything I would have to regret. I learned to love myself so it would probably take much more to make me do anything, that could harm me in any way. Mostly, I was just making videos as a "project" for youtube (which was, luckily, forbidden by my wife) where i was trying to describe how i felt, and got frustrated every time, because i couldn't speak.

It makes it easier to remember, but really hard to watch.

But i finally understood how nasty this disease is. A part of me always thought that I am "faking it". I had these thoughts during the episode, and I kinda have them now, while not even sure if the episode is truly over, or if it's just a temporary effect of the antipsychotic pill i took 2 days ago. Anyway I tried to really fake it yesterday, just so I'd know, and it's not physically nor mentally possible.

Which means, it was real.

Those signs i talked about earlier, they are still here. I don't need much sleep. I'm forgetting to eat, but still have lots of energy to keep me going. My thinking is different. My cognitive functions are one big mess. I can't focus, I'm easily distracted. My memory sucks. But it's still much, much better than it was a couple of days ago.

It wasn't fun. It was horrible and i wanted it to end, while being eternally grateful that i get to experience it. It was inability to hold a thought long enough to share it out loud. It was a shadow, appearing in the corner of my eye, but disappearing before i could take a good look at it. It was being frozen in one moment, just a second before my reality was about to collapse. It was creepy... and it was loved.

There are so many words i could use for describing what it was like. I could precisely describe it in many ways. But I can't say how i feel about it right now.

There are no words for that.

(Update: yeah, i was definitely manic while writing that, but I'm still gonna keep it here.)

[gray-gray-gray-gray]

Chapter 6 of Schizophrenia, Third Edition: The prodrome of schizophrenia

Typically, early psychosis work targets people presenting with a first episode of psychosis. However, there are identifiable signs and symptoms before psychosis has onset and there has been a worldwide movement to develop comprehensive early intervention programs for schizophrenia. Is it possible to intervene before the onset of the full disorder? Studies that focus on pre-onset are controversial because the development of a disorder remains a possibility.

Many that seek help during the prodromal phase are already debilitated by their symptoms despite them being sub-threshold for psychosis. Reducing the duration of untreated psychosis in the first episode may prevent or limit the future severity of symptoms, chronicity of the disorder, or resultant collateral damage. Many people who receive treatment for their psychotic symptoms and go into remission still find themselves disabled. It's believed this disability formed during the prodromal period.

For those with a psychotic illness, the prodrome is the time period where there is a change from a person's premorbid functioning up until obvious psychotic symptoms occur. 80-90% of patients with schizophrenia report a variety of symptoms including changes in perception, beliefs, cognition, mood, affect, and behavior that preceded psychosis.

Ideally providing treatment during the prodrome would delay or even prevent the transition into psychosis. Even if it can only delay the development of a psychotic episode, early intervention may minimize the impact that the episode has on functioning. However, in the absense of infallible markers of vulnerability the ethics of early intervention research needs to be seriously considered.

[yardsards]

i think i talked about it before but it's fucking me up again so

in high school my migraine problem was way worse than it is now. i got one almost every week. and sometimes they'd be bad brainstem migraines that fucked up my mental capacity and motor control so badly i couldn't function and/or would be so painful i couldn't stop myself from audibly whimpering in pain (which. the noise of that was not good for the auditory hypersensitivity). and even the ones that weren't like that still basically drained me and put me in too much pain to function

(and of course the doctor didn't do jackshit for me)

and it was apparently very noticeable to outsiders. i remember overhearing the school nurse talking concernedly because i looked halfway lifeless every time i came to her with a migraine. and those who knew me well could sometimes even tell Something Was Up in just the prodrome phase of the brainstem migraines because i would just seem Off somehow (tho they didn't know enough to identify it as a migraine).

even my ever-unobservant parents could tell how bad my migraines were, remarking how i seemed completely drained when they had to take me home from school. they even said it was worrying

but. neither of them did ANYTHING to take care of me when i was having a migraine.

i couldn't do much to take care of myself. the pain was too much to function. standing always made the pain worse, and so did leaving my dark, quiet room. my brain was halfway out of commission, whether from the pain being too distracting or from the brain fog. when it was a brainstem migraine, my motor function would get so bad that walking would get difficult- i've definitely had to *crawl* to the bathroom before.

i could barely walk downstairs to the kitchen, let alone prepare food for myself. even something as simple as microwaving a bowl of soup was far too much for me.

neither of my parents thought to regularly check in on their visibly very ill and suffering child. both of them either didn't notice or didn't care that i hadn't eaten. neither of them ever offered to bring me food or anything

i kept a stash of nonperishable snacks in my nightstand at all times because being hungry but bed-bound with no one around to help was such a regular occurrence

it was fucking scary sometimes, being so helpless AND knowing no one was going to take care of you while you were unable to take care of yourself

i wanted -and needed- real parents to be there for me. ones that would periodically pause what they were doing to check on me when they knew i was unwell. ones that would make sure i was eating and drinking enough and would bring me the things i needed.

ones that would massage my neck or run their fingers through my hair because touch was the only sense that didn't hurt upon receiving stimuli, and i always needed some sort of distraction to keep my mind off of the pain (normally i just settled for scrolling through my phone with an intense dimmer and red filter or listening to very quiet music; the small pains those caused me were worth the value of a distraction). and because i was young and in pain and scared and i just needed *comfort*

(of course, the above paragraph could only really happen if they were good enough parents that i could trust and love them enough to enjoy their touch. as it stood, their touch had made my skin crawl since middle school and had stopped feeling at all comforting before that)

the closest i ever got to that was a friend in high school -one i wasn't even that close to- offered to massage my shoulders and neck and upper back because that had helped one of her boyfriends when he got migraines. it didn't make the pain go away, but it distracted from it, and i felt warm inside and cared for from it the rest of the day, even after i got to leave school (early) and go home

[leebird-simmer]

Psychopathology, Ch. 11

{Note: I tend to use identity-first language because it usually flows better than person-first language. I’m open to changing this habit if y’all prefer “people with schizophrenia”; let me know!}

Schizophrenia: a chronic psychotic disorder characterized by severely disturbed behavior, thinking, emotions, and perceptions.

Hallucinations: perceptions occurring in the absence of external stimuli that become confused with reality.

Delusions: firmly held, but inaccurate beliefs that persist despite evidence that they have no basis in reality.

Describe the course of development of schizophrenia.

Schizophrenia usually develops in late adolescence or early adulthood. Its onset may be abrupt or gradual.

- Gradual onset involves a prodromal phase (a period of gradual deterioration that precedes the onset of acute symptoms).

- Acute episodes, which may occur periodically throughout life, are typified by clear psychotic symptoms such as hallucinations and delusions.

- Between acute episodes, the disorder is characterized by a residual phase in which the person’s level of functioning is similar to that which was present during the prodromal phase, but deficits still remain in cognitive, emotional, and social areas of functioning.

Prodromal phase: in schizophrenia, the period of decline in functioning that precedes the first acute psychotic episode.

Residual phase: in schizophrenia, the phase that follows an acute phase, characterized by a return to the level of functioning of the prodromal phase.

Describe the key features and prevalence of schizophrenia.

- The key diagnostic features include disturbed content of thought (delusions) and form of thought (thought disorder), as well as perceptual distortions (hallucinations) and emotional disturbances (flattened or inappropriate affect).

- There are also underlying dysfunctions in brain processes regulating attention to stimuli from the external world. Schizophrenia affects 0.25 to 0.64 percent of the general population.

Positive symptoms: flagrant symptoms of schizophrenia such as hallucinations, delusions, bizarre behavior, and thought disorder.

Negative symptoms: behavioral deficiencies associated with schizophrenia, such as social skills deficits, social withdrawal, flattened affect, poverty of speech and thought, psychomotor retardation, and failure to experience pleasure.

Thought disorder: a disturbance in thinking characterized by the breakdown of logical associations between thoughts.

   A. Aberrant Content of Thought = false beliefs that remain fixed in a person’s mind, despite their illogical bases and lack of evidence to support them. They tend to remain unshakable even in the presence of evidence to the contrary. Common types include:

      (1) Delusions of persecution or paranoia (e.g. “The CIA is out to get me”)

      (2) Delusions of reference (“People on the bus are talking about me” or “People on TV are making fun of me”)

      (3) Delusions of being controlled (believing that one’s thoughts, feelings, impulses, or actions are controlled by external forces, such as agents of the devil)

      (4) Delusions of grandeur (believing oneself to be Jesus or believing one is on a special mission, or having grand but illogical plans for saving the world)

      (5) Thought broadcasting (believing one’s thoughts are somehow transmitted to the external world so that others can overhear them)

      (6) Thought insertion (believing one’s thoughts have been planted in one’s mind by an external source)

      (7) Thought withdrawal (believing that thoughts have been removed from one’s mind)

     B. Aberrant Forms of Thought:

      (1) more common = looseness of associations, poverty of speech (speech that is coherent but so slow, limited in quantity, or vague that little information is conveyed)

      (2) less common = neologisms (made-up words that have little or no meaning to others), perseveration (inappropriate but persistent repetition of the same words or train of thought), clanging (stringing together words or sounds on the basis of rhyming), blocking (involuntary, abrupt interruption of speech or thought)

    C. Attentional Deficiencies:

        (1) difficulty filtering out irrelevant stimuli

        (2) hypervigilance (acute sensitivity to extraneous sounds)

   D. Eye Movement Dysfunction

   E. Abnormal Event-Related Potentials

   F. Perceptual Disturbances

      - command hallucinations (voices that instruct a person to do certain things)

   G. Emotional Disturbances

      - flat affect (absence of emotional expression in the face and voice)

   H. Other Impairments:

      (1) confusion around ego boundaries = difficulty recognizing oneself as a unique individual, difficulty adopting a 3rd party perspective, difficulty with affective empathy

      (2) disturbances of volition = difficulty translating desires & goals into effective action; loss of motivation, initiative, interest, drive

      (3) significant trouble with interpersonal relationships = withdrawal from social interactions, absorption in private thoughts & fantasies, or desperate clinging to others that makes them uncomfortable

Catatonia: gross disturbances in motor activity and cognitive functioning.

      (a) common features include fixed/rigid posture, odd gestures, bizarre facial expressions, unresponsiveness, lack of spontaneous movement, highly excited but seemingly purposeless behavior, or stupor

      (b) less common feature is waxy flexibility, which involves adopting a fixed posture into which they’ve been positioned by others. They will not respond to questions or comments during these periods, which can last for hours. However, they may later report that they heard what others were saying to them.

DSM-5 Criteria

   A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):

      1. Delusions

      2. Hallucinations

      3. Disorganized speech (e.g. frequent derailment or incoherence)

      4. Grossly disorganized or catatonic behavior

      5. Negative symptoms (i.e. diminished emotional expression or avolition)

   B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas – such as work, interpersonal relations or self-care – is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).

   C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e. active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g. odd beliefs, unusual perceptual experiences).

   D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either…

      1. no major depressive or manic episodes have occurred concurrently with the active-phase symptoms

      2. if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

   E. The disturbance is not attributable to the physiological effects of a substance (e.g. a drug of abuse, a medication) or another medical condition.

   F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations – in addition to the other required symptoms of schizophrenia – are also present for at least 1 month (or less if successfully treated).

Describe the psychodynamic perspective on schizophrenia.

In the traditional psychodynamic model, schizophrenia represents a regression to a psychological state corresponding to early infancy in which the prodding of the id produces bizarre, socially deviant behavior and gives rise to hallucinations and delusions.

Describe the learning-based perspective on schizophrenia.

Learning theorists propose that some forms of schizophrenic behavior may result from lack of social reinforcement, which leads to gradual detachment from the social environment and increased attention to an inner world of fantasy. Modeling and selective reinforcement of bizarre behavior may explain some schizophrenic behaviors in the hospital setting.

Overall, evidence based on psychodynamic and learning-based models of schizophrenia have limited value in explaining the development of schizophrenia.

Describe the role of biological factors in schizophrenia.

Compelling evidence for a strong genetic component in schizophrenia comes from studies of family patterns of schizophrenia, twin studies, and adoption studies. The mode of genetic transmission remains unknown. Most researchers believe the neurotransmitter dopamine plays a role in schizophrenia, especially in explaining the more flagrant features of the disorder, such as the hallucinations and delusions.

Dopamine hypothesis: the prediction that schizophrenia involves overactivity of dopamine transmission in the brain.

Viral factors may also be involved, but definite proof of viral involvement is lacking. Evidence also demonstrates that schizophrenia involves both structural and functional abnormalities in the brain.

The diathesis-stress model posits that schizophrenia results from an interaction of a genetic predisposition (the diathesis) and environmental stressors (e.g. family conflict, child abuse, emotional deprivation, loss of supportive figures, and early brain trauma).

Describe the role of family factors in schizophrenia.

Family factors such as communication deviance and EE may act as sources of stress that may increase the risk of development or recurrence of schizophrenia among people with a genetic predisposition to the disorder.

Patterns of Family Communication

   A. Communication deviance = a pattern of unclear, vague, disruptive, or fragmented communication. Difficult to follow, difficult to extract shared meaning from.

      1. High-communication deviance parents often have difficulty focusing on what their children are saying.

      2. They verbally attack their children rather than offer constructive criticism. They may also interrupt the child with intrusive, negative comments.

      3. They are prone to telling the child what they “really” think, rather than allowing the child to formulate their own thoughts and feelings.

   B. Expressed emotion = a pattern of responding to the schizophrenic family member in hostile, critical, and unsupportive ways.

      1. Schizophrenic people who live in a high EE environment have more than twice the risk of relapsing compared to those from low EE (more supportive) families.

      2. High EE relatives tend to believe that their schizophrenic relatives can exercise greater control over their disturbed behavior; they demonstrate less empathy, tolerance, and flexibility than low EE relatives.

      3. High EE in relatives is also associated with poorer outcomes in people with other psychological disorders, including major depression, eating disorders, and PTSD.

      4. Living with high EE relatives appears to impose greater stress on mentally ill people. Low EE families may protect the schizophrenic family member from the adverse impact of outside stressors and help prevent recurrent episodes.

      5. High EE families are more common in the “first world” vs. the “developing world”.

      6. In a study of cultural differences in EE, investigators found that high levels of EE in family members were linked to more negative outcomes in schizophrenic patients among Euro-American families, but not among Mexican-American families. For Mexican-American families, the degree of family warmth (not EE per se) was related to a more positive course of schizophrenia in the affected family members, whereas in Euro-American families, family warmth did not relate to such outcomes. In another study, investigators reported that high levels of EE were actually associated with better outcomes among Black patients. Those investigators suggested that in Black families, intrusive critical comments may actually be perceived as concern and care, not rejection.

   C. Negative family interactions do not directly cause schizophrenia. However, people who have a genetic vulnerability to schizophrenia may be more likely to develop the disorder if they live in a stressful family environment.

   D. Families of schizophrenic people typically receive little to no preparation for their care. They need resources and support to keep their EE level low (and thus, create better outcomes for their schizophrenic relative).

Treatment Approaches

At this time, there’s no cure for schizophrenia, though treatment can help control the symptoms. Treatment is generally multifaceted, incorporating pharmacological, psychological, and rehabilitative approaches. Most people treated for schizophrenia in organized mental health settings receive some form of antipsychotic medication, which is intended to control symptoms such as hallucinations & delusions and decrease the risk of recurrent episodes.

Describe biomedical approaches to treating schizophrenia.

Contemporary treatment approaches tend to be multifaceted, incorporating pharmacological and psychosocial approaches. Anti-psychotic medication is not a cure, but it can help control the more flagrant features of the disorder and reduce the need for hospitalization and the risk of recurrent episodes.

1st generation anti-psychotic drugs: chlorpromazine (Thorazine), thioridazine (Mellaril), trifluoperazine (Stelazine), fluphenazine (Prolixin), haloperidol (Haldol)

         - Antipsychotics block dopamine receptors in the brain.

- They’re effective, but they don’t work for all patients with schizophrenia. Relapses can and do occur in patients who are medicated.

Tardive dyskinesia (TD): a disorder characterized by involuntary movements of the face, mouth, neck, trunk, or extremities caused by long-term use of antipsychotic medication.

         - most common among older people and among women

- tends to improve gradually or stabilize over a period of years, but many people with TD remain persistently and severely disabled

- The risk of this potentially disabling side effect requires physicians to carefully weigh the risks & benefits of long-term antipsychotic treatment.

2nd generation anti-psychotic drugs (atypical anti-psychotics): about as effective as 1st gen anti-psychotics, but with fewer neurological side effects and a lower risk of TD

- ex. include Clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa)

- These drugs relieve acute symptoms of schizophrenia in about 2 out of 3 cases. Hallucinations and delusions may recede into the background or disappear altogether.

- Chronic schizophrenia typically requires maintenance doses of anti-psychotic drugs for extended periods of time once acute symptoms abate. Patients face a higher rate of relapse if they stop taking their medications. That said, relapses may occur even in patients who take their medications as directed.

- Atypical antipsychotics still carry risk of significant side effects, including sudden cardiac death, substantial weight gain, seizures, and metabolic disorders associated with increased risks of death due to heart disease & stroke. Clozapine specifically carries the risk of a potentially lethal disorder in which the body produces inadequate supplies of white blood cells. Because of this, patients taking clozapine need to have regular bloodwork.

Psychiatric drugs are not enough. Medication needs to be supplemented with psychological treatment, rehabilitation, cognitive (memory & attention) training, social/communication skills training, and life skills training.

Sociocultural factors in biomedical treatment:

- Asian-American & Latin-American patients may require lower doses of neuroleptics than European Americans do. Asians also tend to experience more side effects from the same dosage.

- Medical racism also impacts patient treatment; Black patients in one study were less likely to receive the newer generation of atypical anti-psychotics than Euro-American patients were.

- Family members of Asian-American patients were more frequently involved in the treatment program compared to non-Hispanic white Americans (whose families are more likely to emphasize individualism and personal responsibility).

- Maintaining connections between the schizophrenic person, their family, and their community is culturally traditional in many parts of the world.

Describe psychosocial approaches to treating schizophrenia.

         - Psychoanalysis doesn’t seem to be effective in cases of schizophrenia, although “promising results” are reported for a modified form of psychodynamic therapy grounded in the diathesis-stress model that helps patients cope with stress and build social skills. {Note: the in-text citation indicates this is based on (Bustillo et al., 2001); does anyone have information on how this methodology is coming along 22 years post-study?}

Learning-based therapies

   (1) Selective reinforcement of behavior, such as providing attention for appropriate behavior and extinguishing bizarre verbalizations through withdrawal of attention {note: this is psychological abuse, not therapy, and I don’t give a fuck how “effective” it may be.}

   (2) Token economy, in which individuals in inpatient units are rewarded for appropriate behavior with tokens, such as plastic chips, that can be exchanged for tangible reinforcers, such as desirable goods or privileges. {Note: this strategy has fallen out of favor in mental hospitals, not because it’s (in my opinion) coercive, but because its success requires strong administrative support, skilled treatment leaders, extensive staff training, and continuous quality control, which are “impractical” expectations, according to the textbook.}

   (3) Social skills training, in which clients are taught conversational skills and other appropriate social behaviors through coaching, modeling, behavior rehearsal, and feedback.

Other therapies:

   (1) Psychosocial rehabilitation = many clubhouses (self-help clubs) and rehab centers have been launched by non-professionals and/or by schizophrenic people themselves to do what mental health agencies have been unwilling or unable to do. A clubhouse is not a home; rather, it serves as a self-contained community that provides members with social support and help finding educational opportunities and/or paid employment.

   (2) Family intervention programs

      a. focus on the practical aspects of everyday living

      b. education about schizophrenia

      c. improving communication between family members

      d. teaching effective problem-solving & coping skills

Describe the key features of brief psychotic disorder.

Brief psychotic disorder: a psychotic disorder lasting from a day to a month that may follow exposure to a major stressor.

Describe the key features of schizophreniform disorder.

Schizophreniform disorder: a psychotic disorder lasting less than six months in duration, with features that resemble schizophrenia.

Describe the key features of delusional disorder.

Delusional disorder: a type of psychosis characterized by persistent delusions, often of a paranoid nature, that do not have the bizarre quality of the type found in paranoid schizophrenia.

Erotomania: a delusional disorder characterized by the belief that one is loved by someone of high social status.

Describe the key features of schizoaffective disorder.

Schizoaffective disorder: a type of psychotic disorder in which individuals experience both severe mood disturbance and features associated with schizophrenia.

[c0rpseductor]

i went to lie down bc i couldnt speak well and figured i was probably in the prodromal phase of another migraine and just started crying and freaking out bc i got confused about what's been happening the past few days. i'm still not sure what i'm missing. great morning.

[chocolate-failure]

Man, the shrink has been so fucking hard like goddamn. I feel like my resolve can only last week or I go too hard and get sick and gain a bunch of weight back. And I don't think it's due to Ed though I suppose it could be. But I'll get an HS flare or covid flare and can't get out of bed. A couple of those days in a row followed by my period really fuck up my progress. It's like every week there's a fucking crisis and I just don't have the energy to keep at it or I'll have one day where I gain weight in the tub. Like of course I have times where I just overeat or overdrink during the night but a lot of the issue has been being sick because I can always purge, I can't keep however make up for a day where I can't hit the gym or do my extra long baths.

I usually lose about 2 pounds in 2 hours of bathing but if the water is real hot like at hotels I can lose 3 or 4 in the same amount of time. I refuse to do cold baths even though I know they help with weight too. There's just something's I can't give up and my comfort in the bath is one of them.. and having the water scalding hot isn't necessarily comfortable 🥴

But yeah progress has been fucked up mostly because I'm having a hard time acclimating with changes from week to week as far as my physical health goes. It sucks.

I also had a migraine last week (prob Feb 22 or smn) which is the reason why I'm making this entry. I don't have a lot of insight into my triggers or well... When my triggers become an issue. I definitely know what they are with humidity and heat exhaustion being the biggest one but I've gotten migraines after a 2hr walk and not gotten one after a 5hr walk where I'm on the brink of passing out and lost several pounds. Idk what conditiins must be in place along with the heat exhaustion for it to culminate in a migraine. I've had a flash from a camera cause a migraine but have had several encounters with flashing cameras that resulted in nothing. I once ate one of those Louisiana sandwiches with olives in it and got a migraine almost immediately after it but I've eaten olives several times and never got sick. So I end up for the most part not really avoiding my triggers because they more often result in nothing than a migraine. But I still have 2 or 3 a year.

So instead of concentrating on my triggers I try to minimize stress because it feels like that's a common denominator for a lot of my ailments. And the next best thing for migraine management after tigger avoidance is early detection which is only marginally more trackable to me. Unlike some diseases show the symptoms of migraine mean the migraine is happening. Once the symptoms start there's nothing you can do to stop it. You can take meds to take some of the edge off but it's not going away.

A hallmark symptom of the prodrome phase is jamais vu, the opposite of deja vu which just means the world you've come to know feels unfamiliar rather than feeling like you've been here before. But of course this is very similar to dissociation, an experience I have in some capacity nearly all the time. So it's hard for me to discern the difference between premigraine jamais vu and my daily experience of jamais vu. I also experience the confusion and agitation but those things happen directly before the blindness and aura which isn't particularly helpful for predicting a migraine cuz like when I say directly I mean the pain will start within the next minute or so. As the aura expands the headache gets worse but once it's done the headache typically doesn't get worse from that point. Sometimes it's debilitating whole other times it's a dull ache. The headache hat and exposure to cold is helpful. Pain meds are a little helpful if I take them early enough.

[kindwordsorbees]

So I have Can't Put 2 And 2 Together Disorder, aka ADHD, undiagnosed for decades. What did get diagnosed was the severe depression and eventually also migraines.

Now that I've been on Concerta and off the tricyclic for awhile, I'm beginning to wonder if my whole (adult) life is a lie.

Because I've been floating along, enraged at how EASY life is for NTs but mostly just trying to put my life in order now that I am treating the Can't Do Shit Disorder, when I suddenly flip out and start crying silently in the kitchen so as not to disturb my child over the fact that I am a useless POS but fairies aren't real so they won't take me even if I could get to the woods alone.

6 hours later, the stabbing pain in my left eye wakes me up. Thank God for US Excedrin.

Two weeks later, it happens again.

So, yeah. "Mood swings" is a terrible way to describe the prodrome phase of migraines, and I need to know who to punch. And how to qualify for a more effective preventative from OHIP than propranolol, magnesium, and prayers. (And possibly the Seasonique, if it's still doing more good than harm. I would absolutely drop it if that let me have something better, PCOS and perimenopause be damned.) I cannot be raising a 7 year old (a sensory seeking one, no less!) with a brain that tries to kill me every time it gets over stimulated.

[livewithherpes]

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[venovenous]

I really want to start reflecting on my time in sixth grade through the beginning of middle school. it's difficult because I have significant memory loss around this time in my life. I was watching a lecture on clinical diagnosis of schizophrenia, where it was said that most people present with many years in the prodromal phase throughout childhood and adolescence with hours spent in daydream and overly relient on imaginary friends to cope, but still manage to hang on by a thread. then it's usually around the transition to young adulthood where some crisis happens, a loved one dies, they break up with their first serious boyfriend/girlfriend, or something significant stressor happens that triggers a psychotic break. To this day, I don't know what happened to me to cause me to break from reality for the first time.

When I look back, it seems more like a gradual decline. I can remember clearly my first panic attack in the sixth grade during English class. My teacher had sent one of my close friends Naomi after me as I was walking to the school nurse, because she was so worried about how I had presented, it was so out of character for me. Before that point, I was incredibly high functioning. I was social, had plenty of friends, was involved in sports and did well academically. I can't remember the summer between grade school and high school. I can't remember when I first became ill in seventh grade. I am almost sure my first hospitalization was in 8th grade after months of outpatient therapy. I was gone for more than a month. I was thirteen. when I came back, my English teacher, someone I had been somewhat close to because I really enjoyed her class, had everyone make me a poster where they had signed notes saying they hoped I would feel better soon. everyone in the whole school avoided me, my best friend through grade school included. I had special privileges to leave class whenever I wanted to go to the counselors office, but I usually just went to the bathroom to cry and use toilet paper to dry off the massive amounts of sweat I shed constantly. I won't get into my experience of psychosis, that's not the point. I want to know what happened to me that made me break.

My mom had been consistently abusive my whole life, but it didn't get too bad until she started drinking after my diagnosis. I doubt it was something she did. My (step) dad wasn't home often, and I didn't have much of a strong relationship with him until the end of high school. Before that, he was a good, caring father to me but we weren't all that close. There was a time in our old house around the holidays where I was sleeping in the attic in the room attached to my sister's because we had friends and family staying over. There was one morning I woke up and took off my blanket to find my wool pajama bottoms and underwear had been removed sometime overnight. I thought this was strange but figured I might have gotten hot sleeping in the carpeted floor and kicked them off in my sleep. I have a memory of being extremely paranoid about being pregnant whenever I looked at my body while showering, and worrying that my parents would find out and kick me out of the house. I can't recall if this fear began before or after the attic incident. I place the attic incident after age 13 because I remember having a tumblr account then, and I used to blog on my grandpa's laptop in that attic as I hid from all the holiday company. The last time I was hospitalized, this forensic psychologist who took immense pity on me and always fretted about my high suicide risk as a trans person told me that I had the behaviors and presentation of someone who was sexually abused. I remember him leaning in and holding my hand I was picking at and asking me if I had ever been hurt by someone badly. and I said something about how my mom was always hard on me growing up and he just shook his head and changed the subject. I don't know if I was hurt badly, or experienced some traumatic event around the ages 11-13. I truly cannot remember.

I think it makes sense, but I also can't point fingers at anyone without any clear memory. When I think back to the attic, I always start towards my uncle Andy, who isn't really my uncle but my dad's close friend who has been accused of sexual assault before and is an alcoholic who my dad has since cut contact with for beating his wife and running off to another state with another woman. It wouldn't be out of the box thinking, but I feel no strong way when I think of him in mind. I can't rationalize it. I can't think of anyone in my life who would hurt me that way, though it wouldn't surprise me. Maybe I'm making things up by thinking too hard about them. Maybe I wasn't sexually abused, but some other traumatic event happened around that time I can't think of. My memory is very boggy from the surrounding trauma of the sudden rejection and loneliness I faced in school, the unsupportive home environment I had, and the daily prescription Klonopin I was on at the time. Whatever happened was a very formative moment in my life that changed my trajectory forever. It's the seed inside me that all my current deep troubles have grown from. I don't know what it is. I have to keep digging.

I don't know what it is.