Process Experiences with Leisure Court Skilled Nursing & Return to Normalcy for Keith Torkelson MS, BS
Link to Prior
Feature Photo
Me Before and After
Assessment Tools
Sleep / Rest Harmony Score 21 Items
Roommate Matching Score 29 Items
Post-Leisure Problem Score 18 Items
Prodromal Indicator Score 16 Items
Adverse Reaction Score 10 Items
Abstract – Executive Summary
>In this study, we address our recent (2024) Episode of Behavioral and Mental Health symptoms. At the core is, as is usual, deregulation of our sleep and issues with our sleep medication. As of 2025, we are now on Clozapine, Lorazepam, and Ambien. All of these are indicated for sleep. These three medications are essential for our well-being, including: Peace and Sleep. This study also describes the aftermath of moving from a bad bed (STS) to a good bed (Aliso Ridge) to a bad bed (STS) to a medium bed (Global) to a bad bed (Leisure) to a medium bed (Harvest) to a good bed (Harvest). Our current bed at Harvest Retirement would be a Better Bed if it were affordable. This report addresses gaps in our medication and a bit of End-of-life (EOL) planning. While managing our own meds since 1989, we never had gaps. In 2024, we suffered gaps Leisure Circle Skilled Nursing (LCSN). Without medication, we were not sleeping. In addition, the environment was too noisy. At LCSN, we were also unable to keep Emergency Backup Medication. Without regular medication, our condition deteriorated rapidly. We felt that we may not be able to make it on the outside. Our original study, published 20240726-F, was part of our recovery from our 75 days bedridden in Skilled Nursing.
Resilience - Normalcy
>We hoped that the impact of the original study was such that it contributed to and for us an expedited Return to Normalcy. We give Leisure Court 3.0 Star Equivalents for their support and services. We give Samantha, our social worker at Leisure 5.0 Star Equivalents, for her support and services. As of March 28, 2025, our episode ended.
FYI > Metadata >
BMB_Ending_an_Episode_25032802_Notes
Mental Health
>In this study, we briefly address delusions, mistaken beliefs, sleep-rest-peace, problems associated with Leisure Skilled Nursing as compared with Harvest Retirement, prodromal indicators of an episode, need for an EOL MD, and advanced planning. We hope to never have a major behavioral health hospitalization-related episode again.
Define Delusion
A false belief or judgment about external reality, held despite incontrovertible evidence to the contrary, occurring especially in mental conditions. He began to experience hallucinations, delusions, anxiety, and agitation along with dizziness and nausea.
Define Mistaken Belief
The wrong idea or misconception, especially one based on unsound arguments.
Advocate
>We have secured the commitment of Dr. AS Kline, MD, PhD, to act long-term as our advocate around housing, sleep, and medication. We roughly want her to enforce a treatment plan and any directives that are in our best interest, such as our Euthanasia Advance Directive.
Doctor On-call
>We had Doctor Daniel Chue, MD, at Leisure. He wasn’t very helpful. In 75 days, he only saw us once. In addition, he denied us CloZAPine. Because we do not know his middle name, we cannot track him down. Doctor Chue followed us to Harvest. The residents say he isn’t very helpful. In the long run, if we remain or return to Harvest, he might have to take over our case. We would like to meet with him in advance to go over our treatment planning.
Sleep, Rest, and Peace
>We lived with a consumer of mental health services Ted for over 2 years. He interfered with our sleep, rest, and peace. Ted chronically stressed us and wore us out. He exhausted our coping efforts. He was angry, manic, a gambler, a bully, destroyer of property, and had personal problems with us. The first hospitalization in this episode was in January 2024. The following are our Sleep / Rest Scores: Ted at Shank’s = 33.3%; Dang at Leisure = 12.5%; James at Harvest = 86.8%. Lower scores are problematic. Dang was actually a good roommate, yet the environment at Leisure drove his score down. The environment at Leisure was torturous for us. We experienced about 7 occasions of inadequate sleep medication (medication gaps), thus we did not sleep. Next, we score problems we developed while at Leisure. Now, as of November 2025, here at Harvest, we have been: Medicated for more than one (1) year without gaps and sleeping well.
Table – Post Leisure Problems
>We compare our problems post-Leisure with 2022, a reference year. We stayed at Leisure seventy-five (75) days bedridden. Again, we suffered at Leisure: Gaps in Sleep medication, sleeplessness, lack of peace, and complications. We graduated from Leisure on June 20, 2024 (TH). On 20240717 (W), we scored our problems. Before Leisure in 2022, we scored 19.4% whereas after Leisure we scored 63.9%. Higher scores are problematic. We actually got worse in skilled nursing. The problems were associated with Sleep deprivation and Noise. Incidentally, you may have to surrender privacy in skilled nursing and or in a retirement community.
Prodromal Indicators of an Episode
>Prodromal Indicators are important to us for preventing an episode. On 20240717 (W), our prodromal indicator score was 46.9%. Higher scores are problematic. We likely became more ill while staying at Leisure.
Table – Invega Sustenna side effects
>For our 75-day stay at Leisure Court, we initially agreed to Invega injections to satisfy our family. It didn’t work, so we requested CloZAPine. The doctor would not put us on CloZAPine. Eventually, he prescribed us Lorazepam and Restoril. Yet the med staff kept running out of both of these medications. They were a medical necessity. In preparation for conferencing with our long-term psychiatrist (RBB) in the community, we compared CloZAPine, our mainstay, with Invega Sustenna monthly injections. We use Invega side effects as a reference. Our Invega Adverse Reaction Score (ARS) is 72.5% for Invega. Our CloZAPine ARS is 12.5%. Higher scores are problematic. RBB agreed to cease Invega and restart CloZAPine.
Med Continuity Gaps History (Sample)
Medication Gaps – Least Restrictive
>For the year 2024, medication gaps caused us several nights of sleeplessness that worsened our condition. There were about seven (7) medication gaps at Leisure Court Skilled Nursing. This is the primary reason we only give Leisure 3.0 Star Equivalents. Our Long Term Bed Match Score was 13 differences across 17 items (76.5%). Lower scores are favorable. This means that our Leisure bed was not a good match for us. We performed a Lockdown Comparison Score or Index. We compared Westminster Therapeutic Residential Center (WTRC 2006) with Leisure (MAY 2024). Higher scores are favorable. WTRC earned a quality score of 92.9% whereas Leisure earned a score of 35.7%. We stayed at WTRC for approximately four months had no medication gaps.
Priority – Sleep Security Systems
>Our number one priority wherever we are or go is Sleep and whatever contributes to it. We have faced too many sleepless and sleep-challenged nights in 2024. On June 5, 2024, we were searched at Leisure Court related to smoking cigarettes. We declared everything, and the searchers seized our Sleep Security System of Emergency Backup Medication (EBM). This caused us to become all anxious about the search and seizure process and our Sleep at night. Staff and processes, including the pharmacy, had repeatedly shorted us on our nighttime Sleep medications, and we were making due with our backup Ativan. They have shorted us more than six (6) nights with our Sleep Medication. We jacked their system for our own good. Not only do we feel bad about “jacking” their system, but we feel bad to have to tell Samantha, our social worker, what and why we did it. We are here all anxious with no recourse but to suffer with Leisure’s error-prone medication management system.
Medication Gaps - Bring to Samantha’s attention
Somewhere around May 2024, we brought issues with medications to Samantha, our social worker’s attention. We were having alternating problems with keeping a continuous supply of our sleeping medications, Restoril and Ativan (Lorazepam). Leisure shortfalls include: Running low, ordering on time, getting doctor’s approval, pharmacy to fill the prescription, delivery, and distribution. These errors created gaps where we the client (Buster) missed doses of these most important medications. In just over 60 days here at Leisure Circle, we have been made to miss more than 6 doses. Missed doses are associated with more than 6 miserable sleepless nights.
Medication Management – Making progress
>While at Leisure Court (April-June 2024), we get anxious not knowing if our medication will be sustained as prescribed. This has been a daily ordeal between the med nurses and us. See May 9, 2024 (TH) Update. We fear gaps (s) in medication(s).
1989-2023 No Gaps
>When Buster managed his own medications, there were no gaps. In addition, we never missed our monthly CBC lab test. At Aliso Ridge (January 2024), our medication was mismanaged to the point were up 72 hours straight. We made a mistake thinking we could get by without CloZAPine. At Global (March 2024), we also had CloZAPine associated sleep problems. Again at Leisure, there were about 7 gaps. Gaps are associated with sleeplessness. The additive sleeplessness this year, 2024, has injured Buster’s brain. We will discuss a little of our symptoms of brain damage later in this report.
May 7, 2023 (TU-PM) - Continue CloZAPine Detox
>The Leisure contracted Psychiatrist says CloZAPine is not an option anymore because it is in the same class as Invega, both being anti-psychotics. He also said, “Sleep is important”. He prescribed us trazodone for sleep. Trazodone only aggravated our Anxiety and kept us awake. For 2024, we were taken cold turkey off CloZAPine three (3) times. The first time was at Aliso Ridge, and we agreed to it. At Aliso Ridge, we were up for 72 hours of sleeplessness coming off CloZAPine. This aggravated our condition. We call the sleeplessness associated with the withdrawal from CloZAPine without adequate substitution with sleeper medication(s) CloZAPine Hell.
Trazadone
>On May 7, 2024 (TU), the doctor prescribes us trazodone. We hoped it would do what it was prescribed for: Sleep. On May 9, 2024 (TH-PM), there is still no trazodone. When we did get trazodone we found for us it is ineffective.
Stopping CloZAPine Error
>Why stop CloZAPine after more than 10 years? Beginning in December 2023, Buster was looking for an alternative to CloZAPine, his primary medication since 2007. At the dose we have been taking, there was a risk of falling. On one occasion, we did fall and broke a front tooth. Later, the tooth area was repaired with an implant. Beginning March 2024, we have agreed to monthly Invega injections instead of CloZAPine. We found that Invega does not substitute for CloZAPine. Our doctor agreed with us to put us back on CloZAPine, which had been successful at keeping us out of the hospital since 2012. As of July 18th, 2024, to augment CloZAPine at night, we are taking Ambien and Lorazepam. The high weight variables for controlling Anxiety and staying out of the hospital are: Sleep, Rest, and Peace. As of November 2025, we are in a great bed. Our shared roommate died, leaving us to go it solo. When the time comes, we hope our new roommate is as good a match as our last one.
CloZAPine – Emergency Backup
>During 2024, we were detoxed off CloZAPine 3 times. Buster calls Detox from CloZAPine = CloZAPine Hell. During CloZAPine Hell: CloZAPine is completely withdrawn, and we go completely sleepless until some effective alternative is put in place. The locations where we were detoxed are: Aliso Ridge, Global, and Leisure. Since July 2024, we have been working on a solid treatment plan that includes for sleep: One antianxiety (Lorazepam), one sleeper (Ambien), and one incidental sleeper (CloZAPine). In the last half of 2024, except for our Harvest roommate James playing his radio 24 7 we have slept well here at Harvest while on our new and improved treatment plan. We used to carry one day’s worth of Emergency Backup Meds (EBMs) with us. At Harvest, we had to surrender to them managing our medication. We tried to get approval to carry one or two days of EBMs, yet were turned down. From June 20, 2024, to November 25, 2025, at Harvest, there have been no medication gaps. Our confidence in them is growing.
Aside – Aliso Ridge Behavioral Health – Fond Memories (2024)
20240530-TH-First Drafted
>In the table below, we list features about sleep (S) we need. We provide for these preferences for any of our roommates also. Below we score SleepAbility (Host) and SleepAble (Environment & Agents) factors about three locations: Shank’s, Leisure, and Harvest. SleepAbility is the Host or our inherent and internal factors promoting sleep, rest, and peace, as well as sleep medication. SleepAble are the Agent (roommate(s)) and Environmental factors permitting sleep, rest, and peace. An important factor in long-term site selection is cost-effectiveness. Harvest is approximately $1,400 out-of-pocket per month. This is not cost-effective. One thousand four hundred dollars is 70% of our income.
Table – Sleep, Rest, and Peace
Scored: 20240716-TU:
HSF = High Scores are Favorable
Harvest - James Proof
>We moved into Harvest June 20th, 2024 (TH). Our new roommate, James, is a gentleman in his seventies (70s). The only grievance we had with James was that he was playing his radio 24/7 without using the mandated headphones. On July 15th, 2024 (M), we brought it to his attention. He has used headphones up until his last hospitalization. For a Sleep / Rest Harmony Score, James scored 86.8%. Higher scores are favorable. The actual matching score is a bit lower. In hindsight, we scored him too high, yet James is our proof that after Ted, we can get along with shared roommates. Due to James turning on the light in the middle of the night, Buster was temporarily moved in with Tim K. This was a poor match. We moved back in with James. Then James died. We went solo for a term after James’ death. We were matched with John B. Then John B. passed away. As of August 5th, 2025, we have been going it solo. We hope our new shared room roommate is a great match, like John was.
What John Baer and Keith Torkelson Agree Upon
1.00 = Yes 0.50 = SoSo & 0.00 = No
## | Items
| Agreement | 2025 0228 (F-RT) |
01 | Blinds | Open or Closed | 1.00 |
02 | Center light | None | 1.00 |
03 | Contain coughing | Best we can | 1.00 |
04 | Conversation | Talk a lot | 1.00 |
05 | Desk light(s) | Dim | 1.00 |
06 | Door | Slightly open while here | 1.00 |
07 | Down time in the day | As Needed (Peaceful) | 1.00 |
08 | Earplugs | As Needed | 0.75 |
09 | Getting out of the room | Both did it a lot | 1.00 |
10 | Headphones | Always | 1.00 |
11 | In and out the back door | No | 1.00 |
12 | Lights at night | None | 1.00 |
13 | Loaner items | Such as tools - OK | 1.00 |
14 | Locking the front door | When not here | 1.00 |
15 | Matching | We were an excellent match | 0.95 |
16 | Natural light | Yes | 1.00 |
17 | Next door noises | Out of our control | 1.00 |
18 | Phone calls | Not too loud and keep them short | 1.00 |
19 | Quiet time | All the time | 1.00 |
20 | Repairs | As needed | 1.00 |
21 | Cigarette Smoking | Both yes - outside | 1.00 |
22 | Sleep | A high priority | 1.00 |
23 | Sliding glass window | Open or closed | 1.00 |
24 | Temperature | Cool | 1.00 |
25 | Towel | Each have own | 1.00 |
26 | TV | Prefer a small screen, such as phone or tablet | 1.00 |
27 | Upstairs noises | Out of our control | 1.00 |
28 | Wake up | Alarm OK sometimes | 1.00 |
29 | Office Noises | Such as printer OK | 1.00 |
|
| CALC | =28.7/29 |
|
| Roommate Matching Score 29 Items = | 99% |
Figure – Roommate Matching - AHE Qualities Brainstorming (Draft May 2024)
20240509-TH – Leisure - Medication Management - Medication Gaps
>For the reasons listed below, some odd 7 incidents of running out of our sleep medications (Restoril and Ativan) occurred at Leisure Court. Each incidence was associated with sleeplessness. By the 5th occasion, we were suffering noticeable burning in our brain. The burning was associated loss of competencies, aggravated Anxiety, and challenges walking.
Some responses from the Leisure nursing staff
The pharmacy did not deliver
The order was not put in on time
We do not have it yet
The doctor needs to renew it
Will tell you when it comes
Here, this is emergency medication
Are you sure you want to take it the way the doctor prescribed it
Our coping – Emergency Backup Medication (EBM)
>Once we discovered our Emergency Backup Medicine (EBM) Lorazepam (Ativan), and CloZAPine with our property, we were empowered to get some sleep. When Leisure shorted us, we just took EBM Ativan when they missed. Eventually, we worked CloZAPine to take the place of missing Restoril. This was working, and we were getting sleep and improving. We thought we would be out of Leisure on Monday, the 3rd of June 2024. This fell through, and we were showing signs of snaking their cigarette-smoking system. We were searched twice and had to surrender our EBM. Leisure confiscated: Our EBMs, lighters, and our sewing kit. None of these items was returned to us. This was clearly a search and seizure. Note - We were given no policy sheet describing what we could not have.
Continuity Problems Persist
>We were back to trusting Leisure’s continuity of care (medication), and wouldn’t you know it, for June 5, 2024 (W), overnight, they had no Ativan. The doctor prescribes us Ativan to sleep. We have a sleep disorder at the foundation of our health issues. We were made to stay up all night. Staying up all night on so many occasions here at Leisure has impaired our recovery and confidence that we can make it on the outside. You would figure they would want to graduate us as a success.
Definite Brain Burning & Damage
>To begin a sleep deprivation cycle, we awoke at 7 am June 5, 2024 (W). Sleeper meds were finally administered on June 7 (F) at 1am in the morning. The nurse said it was an emergency medication. If they had emergency medication before, why let us go sleepless on some odd 5 nights. On this last incidence, we could sense that hour by hour we were suffering brain burning (damage) and impaired cognitive function. We were up more than 40 hours. The whole time we were dwelling on how we broke the rules while coping for our own well-being, as well as how stupid we were becoming. When we were compensating for the gaps our own way, we were making noticeable progress. Our family indicated we were making progress. At this point, every medication cycle is wrought with uncertainty and stress. In 75 days, there were about 7 medication gaps.
40 Hours of Sleep Deprivation
After 40 hours with no sleep, your body and mind are severely impaired, leading to intensified symptoms like poor judgment, impaired cognitive function, and emotional instability. At this point, your immune system is weakened, your stress hormones are elevated, and you are at a high risk for accidents, similar to being under the influence of alcohol. You may also experience more severe effects like hallucinations, and your brain may trigger microsleeps, brief, involuntary periods of sleep that you may not be aware of.
20240605-W-ON without Ativan up 42 hours straight
>First night without backup (EBM), we were given no routine Ativan that night (June 5, 2024 (W)) for sleep. This led us to involuntarily staying up over the course of June 5th and past June 6th. We include an awake-time calculation below. Without CloZAPine, our sleep from June 6th to June 20th, 2024, was very light. We graduated from Leisure on June 20th, 2025. In sum, we had periods of medication deprivation at Aliso, Global, and Leisure. In the beginning at Harvest, we weren’t on a sound and effective treatment plan. After seeing Dr. Bera, we found it necessary to augment with CloZAPine. Since July 1st, 2024, we have followed our inclusive of CloZAPine sleeper treatment plan. Buster still needs to work on daily Anxiety & Fatigue management.
Break Policy – Guilt
When we were admitted to Leisure, we were given no policy information. On admission, they let us keep our lighter. Because no one else had a lighter, we knew that using our lighter was probably wrong. Using our Emergency Backup Meds (EBMs) to help us sleep was a choice we don’t regret. What bothered us was that Buster let Samantha, our social worker, down while she was gone on vacation. We, with Samantha, had some one-on-one meetings, and we grew quite fond of her. Until she came back from vacation, we made a big deal out of medication management. Below is a note to Samantha (Sam) regarding our transgressions. On June 7 (F), we gave the note to Sam’s Assistant.
2024-6-5-W-Samantha
Who is Samantha?
Leisure Circle Skilled Nursing Social Worker (Our friend)
20240610-M-Samantha Returns
June 5th, 2023
Search and Seizure
Given to Samantha
>I was smoking between breaks, so they searched us and found our Emergency Backup Meds (EBMs). They skipped our meds so many times that I took control back with our own meds to sleep. They [the EBMs] were unknowingly dropped off in my backpack because I keep Emerge Meds all over. Now I am at the fate of the [Leisure] Med Mgmt. System again. I don’t have much faith right now. I missed you while you were gone. I didn’t mean to cause trouble. Sorry, I broke any rules.
6-5-24 Keith Torkelson
Kline’s visit to offer Advocacy
>On June 6 (TH) 2024, the Kline’s (Buster’s family) visited. We had on our to-do list many things. We hadn’t planned to spend so much time for them advocating for our Medications. With this visit, they found out firsthand the medication challenges we have been facing at Leisure. After hours of resistance, we got our medication. After being awake for some odd 42 hours, and were given our prescribed medication at 1am June 7, 2024. The current medication problem began the morning of June 5, 2024. On June 7, 2024, the medicine we were given was not routine: The nurse said it was Emergency Medication. Charley, our brother-in-law, pushed it to the limit and pulled through for us after hours of advocating.
20240606-TH-Shopping – ALFs - Graduation
>Early on, Samantha had directed us to Harvest Retirement. For this day on our list was shopping for Assisted Living Facilities (ALFs). At the last second, we were redirected to Sea Crest in Fountain Valley. Sea Crest was located on a good corner for us, yet when we visited, it had too many undesirable features. Aside - Epi is the new owner at Sea Crest. After Sea Crest, we decided to go look at Harvest Retirement. About a month ago, Samantha mentioned Harvest, which on this day we: Charley, Lanaii, and Buster, toured. We agreed that Harvest is a better fit. We found Harvest, as compared to Seaside, livelier, smoking area user-friendly, less depressing, cleaner, more orderly, as well as the sales rep, Betty, is more empathetic. Eventually, on June 20th (TH), we graduated from Leisure and were transported from Leisure to Harvest via our friend Kulle. Our first two nights at Harvest, our roommate was gone, and we were still relying on an ineffective treatment plan.
On June 6 (TH) 2024 - Sacrifices
>On June 6th, 2024 (TH), we also visited Julie Paulino, our old landlord circa 2011. Julie says when Buster stabilizes, and there is an opening, he is welcome at Hillview (Julie’s) again. She quoted $700 a month. This would be cost-effective and assist in returning many of the things we sacrificed while living at Harvest. Since, unfortunately, Julie’s husband Romer died and she closed her operation.
UMP=Ultimate Move Plan
>Our ultimate move plan ends with us moving back to Harvest. We hope that doesn’t occur for ten years or more. Currently, we are at Harvest. We plan to wean down our storage then move it to Public Storage across the street from Harvest. We have decided that it is in our best interest to remain at Harvest as long as possible.
Budget of Spending Money-Restrictive
>Our Ultimate Move Process Checklist (UMPC) has some forty (40) items. We were used to paying $700 per month for a Rent a Shared Room (RASR). At Harvest, our share of the rent is around $1400 (70% of income), which cuts severely into our spending money. Right now, we are hoping for $100 per month in spending money. In terms of finances, Harvest for us is not the Least Restrictive. Here at Harvest, we have used many coping strategies to adjust. Our goal is to have this revised report mostly done before December 2025. We actually did move from Leisure into Harvest on the 20th of June 2024 (TH).
20240610-M-Samantha Returns
>Returning to Leisure Court, Samantha came back after she took two weeks of vacation. I saw her in the afternoon, yet did not say anything about our blunder. Her assistant had our letter to Samantha - a letter of guilt. I tried repeatedly to get Benadryl added as an OTC med. Now we are down to 3 Restoril. The med nurse says the order was placed a couple of days ago. Since the intervention by Charley and Lanaii, we have been reporting daily on meds to Lanaii. Lanaii (LAK) is Buster’s oldest sister and advocate. So far OK. For June 5 through 7, LAK, CSK, and ASK are our heroes for helping us get our medications back on track.
20240611-TH-Nurse Admin & Harvest
>This morning at Leisure, the Nurse Administrator was still pushing Sea Crest Assisted Living. Buster described for the third time the decision to go with Harvest and how Samantha recommended Harvest about a month ago. Now Samantha’s assistant is working with Betty. Betty does sales for Harvest.
20240613-TH-Dear Nurse-Medication
>We are down to only 1 Restoril. Along with Lorazepam, Restoril is our other sleep medication. The nurse says it is ordered. This time, things resulted in no gap in the continuity of our Restoril.
20240620-TH-Key Event - Transferred to Harvest
20240626-W-Linking with Our Psychiatrist
>We got out of lockdown in Skilled Nursing on June 20th, 2024. On June 26, 2024, we saw Doctor Bera, MD. Dr. Bera has been treating us for some odd five years. Together, we reworked the treatment plan exactly as we a team, felt prudent. Our presenting problem was back to concerns about Anxiety and Sleep. We didn’t discuss psychosis or mistaken beliefs at all.
20240626-W-Treatment Plan-Bera Rework
Table – Treatment Plan Bera Rework
20240701-M-Treatment Plan and Harvest
>It took five days of promoting to put our new (Bera) Treatment Plan into effect at Harvest. In the interim, in order to sleep, we needed to augment the original plan so we could sleep. On July 1st, 2024, the new plan was implemented after Harvest received “Doctor's Orders”.
20240713-SAT-No Gaps
As we did for years, restarting on July 20th, 2024, we hoped to carry emergency medication with us. Why must Buster have emergency medication? Having emergency medication helps him with his Anxiety. We will get anxious if there is a Med Continuity Gap (MCG). Here at Harvest, we were denied emergency medication. Here at Harvest, as of November 25, 2025 (TU) we have had no MCGs.
Table – Post Leisure Court Skilled Nursing Problems
LSF = Low scores are favorable
Metadata > 20240717-W
Reference: 10_BMBBS_Pro_Dromal_Indicators_24052805_Psychosis
Table – Finding Prodromal Indicators of Melt Down
Since 1989, we have suffered symptoms of all of these things
LSF = Low Scores are Favorable
Long-term Medication Choices
Choosing the best Psychotropic Medications
What does Invega do?
What does Invega do in the brain?
“Invega works by restoring the balance of two neurotransmitters in the brain: serotonin and dopamine. Serotonin helps regulate anxiety and mood, among other actions. Dopamine is important for central nervous system functions such as movement, pleasure, attention, mood, and motivation. Apr 27, 2023.”
Table – Invega Reactions
Does Invega calm you down?
Contraindicated for Anxiety
“Invega is not approved to treat anxiety or depression. In some cases, the drug may be used off-label for these conditions. Keep in mind that, rarely, Invega may cause anxiety as a side effect. So it is possible the drug may worsen this condition for some people. Jan 16, 2022.”
20240717-W: Reevaluate Invega Dosing - Adherence
>When we agreed to take Invega, it was due to our family wanting such and Buster’s desire to find an alternative to CloZAPine. We agreed on the highest dose of Invega. We thought it was benign, so we agreed to it. Years ago, starting in 2017, we had proven how Invega was not right for us because risperidone had no beneficial effect on us. Risperidone is the parent of paliperidone, whereas Invega actually contains paliperidone. From the graph above, it looks like Invega, over time, can reach toxic levels. We have known many people who did not do well on Invega (Mikel and Ted, for example). We are going to discuss the costs and benefits of Invega with Dr. Bera. Our family thought our episode in part was caused by non-adherence. This is wrong. The episode was caused predominantly from problems with sleep, rest, and finding peace.
What is in Invega?
The ingredients in Invega vary depending on the specific product formulation (e.g., oral tablet, Sustenna, Trinza, or Hafyera injectable suspensions). The active ingredient in all formulations is paliperidone.
What is in rispiradone?
Paliperidone is the main active metabolite of risperidone. This means that when risperidone is taken, the body metabolizes it into paliperidone, which also has a therapeutic effect. While they are similar, there are differences in how they work, such as different half-lives, binding affinities for certain receptors, and side effect profiles.
Comparing Invega Sustenna with CloZAPine
Below, we compare Invega Sustenna to CloZAPine. We address problematic side effects. The majority of them we took from the Janssen site below.
The most common side effects of Invega Sustenna® include…
FYI - Side Effects & Safety | Janssen Portfolio of LAIs - Invega
https://www.janssenschizophreniainjections.com/side-effects-and-safety/
20250708-TU-Table found to have errors
Invega Discontinued: 20240821-W: Injection Reaction Site still hurts: 20250412-F:
In Teva & Mylan we Trust! - CloZAPine
The phrase "In Teva & Mylan we Trust! - CloZAPine" is likely a slogan referring to clozapine, a medication manufactured by pharmaceutical companies like Teva and Mylan. Clozapine is an important antipsychotic drug used to treat severe schizophrenia that has not responded to other treatments, and it also reduces suicidal behavior in some patients. The slogan emphasizes trust in these companies for providing this life-saving medication, though the use of this specific phrase isn't official or universally recognized.
What does CloZAPine do?
CloZAPine is an antipsychotic medicine that helps to adjust the levels of dopamine and other chemicals available in your brain. CloZAPine reduces dopamine activity where it is too high, helping with symptoms like hallucinations.
Why is CloZAPine so effective for schizophrenia?
CloZAPine produces lower and more transient D2/D3 receptor occupancy than most other antipsychotics. This allows the dopamine supersensitivity of the motor system to gradually resolve, and tardive dyskinesia to slowly fade.
FYI
https://www.mayoclinic.org/drugs-supplements/CloZAPine-oral-route/side-effects/drg-20066859?p=1
Brainstorming - Update
20240801-TH-Milestone
>We will have one month stable on Bera’s treatment plan in the face of suffering potential unwanted side-effects from Invega.
Aside - August 2024 Follow-Up Appt with Dr. Bera
Table – Treatment Planning (June 2024)
Use daytime Lorazepam roughly every other day
Buster found it rather difficult to get off Lorazepam as prescribed during the day. Yet we accomplished it!
Summary
The following discusses the goals we have for August and September 2024, and again, for November and December 2025.
Briefs
Presenting Problems
>We have been on a high dose of Invega Sustenna since March of 2024. We agreed to Invega because we were reserved about CloZAPine and our family wanted it so. As of July 25th, 2024 (TH), we have had five (5) Invega injections. At the present time, Buster is overly anxious. Our problems with sleep have been remedied since July 1st, 2024. On this date, we started a new treatment plan. We are showing signs of Akathisia among other side effects. We want to discontinue Invega in favor of CloZAPine and potentially Seroquel. Eventually, Seroquel was applied, then dropped, and Wellbutrin was added.
Address prodromal signs
>Of course, one of Buster’s highest priorities is vigilance about the prodromal signs of an episode.
Prodromal Signs of an Episode
Prodromal signs are the subtle, early symptoms that appear before a more pronounced episode of an illness, such as a psychotic episode, migraine, or manic episode. They can include changes in mood (like anxiety, irritability, or depression), sleep disturbances, social withdrawal, and difficulty concentrating. For some conditions, physical signs like fatigue, head or neck pain, or even visual disturbances can occur.
Argue for no Invega
>Yesterday, July 24 (W) 2024, with Dr. Bera MD, we began our argument against continuing on Invega. In response, he lowered our dose. We have a history of being 100% adherent with our mainstay CloZAPine. Back in 2012, Dr. Bum Soo Lee swapped out Invega and went back to CloZAPine. We were stable from 2012 to 2023, or eleven (11) years. During this period, Buster’s home life was horrific. Invega has been ineffective for us, as well as for a few other people we knew. For Buster, the side effects of Invega are intolerable.
Follow up with Dr. Bera
>We followed up between appointments on July 24th, 2024 with Dr. Bera. When Buster was stable, he used to see Dr. Bera every three (3) months. Now, because of the injections, we must see him monthly. We wanted to focus on how well our sleeping concoction was working. Instead, we contested the Invega. He did not see it fitting to eliminate Invega. We brought the miserable Invega-induced adverse reaction of Akathisia to his attention. We suggested swapping two meds out and Seroquel in. He asked about our family’s position on Invega. Today, July 25th, 2024, we spoke with our niece, a double doctor, about Invega. She seems to think that since we have done well (since 2012) on CloZAPine that CloZAPine is the keeper.
Keep writing and publishing
>Buster has much less motivation to publish than he used to have. Publishing is not quite as rewarding as it used to be. Yet, soon we will finish this revisit paper and publish it. We found errors in the original. The overarching theme of this paper is the nature of medication gaps. We thought our mental problems were due to gap-associated sleep deprivation, yet it looks like Invega itself is also a culprit.
Aside - Leverage and adjust to the car
On July 19th, 2024 (F), our car was returned. Thank goodness Invega doesn’t impair our driving directly. The day our car was to be returned, our brother-in-law (DNF) locked the keys in the car while it was running. This stressed Buster out quite a bit. We are lucky our sister found money in the budget for gas. The car has huge resource value. Our first long drive was 7-22-24 (M).
Move ahead with the move plans - Adjustment
>It is time to begin putting our experiences at Leisure Circle behind us. The most important steps are not having anxiety about Harvest or suffering gaps with our medications. We visit Leisure periodically for closure. We are adjusted to Harvest in the face of Invega-associated problems. We may have adjustment disorder symptoms. As of November 18, 2025, or even before this time, we have adjusted to Harvest, and our episode is over. We give up on renting a single room. Our major move effort is moving some odd 1000 pounds of belongings from Tustin to Anaheim.
No drinking
>Buster stopped drinking on July 1st, 2012. While in Global Hospital, without adequate sleep medication, we dipped alcohol hand wipes. We ran this slip by our sponsor, and he said we are not accountable for things occurring in the hospital. So we get to keep my 12 years. Now in 2025, it is 13 years sober.
No medication gaps
>We need no medication gaps with CloZAPine, Lorazepam, or Ambien. As we did for numerous years, we hoped to carry Emergency Backup Medication (EBM) in the form of CloZAPine. Harvest denies us this choice. So far, Harvest has maintained medication continuity.
Present at the Behavioral Health Advisory Board (BHAB) meeting
>Part of our recovery is to resume presenting in front of the OC Health Care Agency BHAB. Our sister said to wait until August (2024). On the day of our July 2024 presentation, we had an Emergency Appointment with Dr. Bera. During 2025, we have been attending and presenting via Zoom.
Aside - Publish photos of Joan – Content Warning
We miss our Most Significant Other Ever - We have gathered many photos of Joan.
https://psychiatry4dummies.blogspot.com/2024/11/playbook-of-joan-zhorne-swimsuit.html
Regular visits to the gym
>Since July 1st, 2024, we have been using our free Planet Fitness membership. In 2024, we have been attending at a rate of once every two days. We paused when our family the Kline’s, visited. We are working out the pain in our left shoulder associated with Invega injections. This is called an Injection Site Reaction. As of November 18, 2025 (TU), we have worked out the pain in our left shoulder. In 2025, we have been avoiding the gym.
Renewing Medication
>We would find it empowering if Harvest let me renew my medication, yet they say they will do it. This causes us to rely on them when we may be more reliable. For renewing our medication, we were cooperating with Harvest, yet the pharmacy Gilbert Drugs sent our August (2024) meds all on their own. As of November 18, 2025, our medication stream has been flowing unimpeded.
Socialize with others, including James
We have been trying our best to be social in the face of moderate anxiety. Our relationship with Betty, who runs the front at Harvest, is stable. Our relationship with James, our shared roommate, is strong. Unfortunately, James passed away. We used to call our oldest sister each day. Now it is down to three times per week. We talk as much as we can with the cigarette-smoking guys. We try to keep up with Facebook and messaging. James expired, and we moved in with John, then John expired. We are going it, Solo, right now (November 18, 2025).
Spend our Calfresh
>Due to our high rent (70% of income), we qualify for a food allowance. We use our CalFresh to eat out periodically. This is a much-needed resource. It helps Buster eat healthier.
Talk to the Harvest Psychiatrist
>The Harvest contracted psychiatrist is Daniel Chue, MD. Dr. Chue was also our doctor at Leisure. At Leisure in 75 days, he only saw us twice, and that was only because we approached him. There is a chance Dr. Chue covers Harvest also. Here at Harvest, we would like to talk with him about Dr. Bera’s treatment plan.
Work around Lorazepam
>From 2012 to 2023, we never took Lorazepam during the day. In addition, we didn’t take it daily. Leisure Court Skilled Nursing sort of got us dependent on Lorazepam, prescribing it every 4 hours. We took Lorazepam nightly as needed for sleep. Currently, on November 18, 2025, we take Lorazepam only at night.
Takeaway
>Hospitalization is preventable if I am provided with Sleep. To sleep, I require adequate sleep medication with no gaps.
Appendix
20240605-W-Search and Seizure
