Quality of Life in the Face of Symptoms by and for Keith Torkelson MS

 Quality of Life in the Face of Symptoms by and for Keith Torkelson MS

Feature Image

Keith - Gloria - Dr. Bera

Abstract

Purpose(s)

Just a few purposes of this document is to introduce readers to standardized assessment as well as learning when an assessment does not fit.  We actually write assessment also.  Make note that an older adult does not have the psychiatric-social resources they once had and could leverage.  Most all of the items addressed in this paper impact one’s Quality of Life (QOL).  On May 3 2023 we scored our Mental Status Exam (MSE) at 87.5% versus 80.9% for August 3, 2024.  With the MSE high scores are favorable.  We used to get a MSE scored by our psychiatrist for objectivity.  He has discontinued sharing MSE results. We used our Vitals method to score said psychiatrist.  On January 3^rd, 2018 (our first appointment) we gave him 73% satisfied and 3.6 Star Equivalents (SEs).  Recently, on August 3^rd, 2024 we give him 84% or 4.2 SEs.

Medication

Medication is paramount with QOL.  We are on a large number of medications right now.  We’re trying a new one and it is not working our very well.  We are bothered at times suffering 11 medication related side effects. 

Conditional Health Fitness (CHF)

On February 8^th, 2016 we scored 52%, were low scores are favorable, for our Conditional Health Fitness.  CHF is a value achieved using a battery of assessments.  The assessments can be swapped about.  We suffer Moderately from our symptoms.

For July of 2024 our CHF is up to 60%.  Below we include the data used in our updated CHF-Score.

Assessments - Conditions

From > Invega 20240729 Report

Many of these assessments were recommended on the web by an Invega associated site.  They address the basics: Depression, mania, and being schizoid.

Results – Evidence – Best Fit

Below we compare two medications we encounter on our platter.  In addition we try to associate some of our after-effects from being bed reddened in for 75 days.  Low scores are favorable.

 

Introduction - Stable in Behavioral Health

“Signs that someone is mentally and emotionally stable: A sense of being in control of their personal thoughts and actions. A sense of (general) well-being. Friends and family are generally confident in the individual's ability to care for themselves physically, emotionally, and spiritually.”

Documentation

Who impacts our mental health the most: Family, shared roommate, psychiatrist, phlebotomists and med nurses?  We have hundreds of documents chronicling our mental / behavioral health history. We have a coping tool we call STR = Structured Temporal Reconciliation.  At the present-time, we are challenged to make use of STR.  Dr. Bera’s is our psychiatrist.  His practice Management system is up to snuff.  “Medical practice management software is a category of healthcare software that deals with the day-to-day operations of a medical practice including veterinarians.”  Vitals is a system we use to rate primarily health professionals.  Vitals Plus is our extended derived assessment tool.

Key Activities - Diagnosis

“Key activities are the essential things a business needs to do to bring its’ customers value. Key activities are arrived at more through discernment and enumerating the steps needed to deliver value, than by doing business research.”  Considering we have been on more than twenty medications and Clozapine works so much better we call the prior attempts with medications experiments.  On paper we have been diagnosed as: Bipolar, Schizoid, Delusional, and Major Depressive.  Right now it is Bipolar with Delusions.  Yet, in reality we suffered and suffer Anxiety disorder complicated with a Sleep Disorder.  Again, Clozapine has and is the best fix for both.

Psychiatrist

Our current psychiatrist’s name is Rimal B Bera MD (RBB).  We evaluated him in the past.  Since the last evaluation he has only improved.  We caught wind that his partner Bum Soo Lee our psychiatrist was retiring so we jumped in late 2017 to get a referral to RBB.

 

Results Up Front

QIP_OM_MSE_Actual_11011202 V2023

On May 3^rd, 2023 we modified the way we score the Mental Status Exam (MSE).  We reorganized it into our Mental Status Exam (MSE) using the 12-Item form.  This is the APS Healthcare Version (12 Items massaged into 16-Items).  Dr. Bera has his students perform triage before the appointment while using the MSE.  These assessments purtain to Buster on Buster.  The format that doctor Bera uses is not reported back anymore in the visit summary.  With this assessment: Higher scores are favorable.

Table Mental Status Exam (MSE)

Results - Service Year 2018

Over the past ten years we have published numerous external quality review (EQR) reports.  We have reported on Dr. Bera.  It was very important that he get it right with us and he did.

https://ktork46.blogspot.com/2018/07/rimal-b-bera-md-psychiatrist-treatment.html

Table – Vitals for Doctor Bera

This table was last scored August 3, 2024 (SA).  It would appear that January 3^rd, 2018 was our first appointment.  We successfully started the referral and closed the linkage.  3.6 Star Equivalents (SEs) was the baseline score for our partnership.  Currently we scored 4.2 SEs.  This is a very good Vitals Score.  It could be likened that for every 2 that didn’t like him 8 others did.

Standard Features per RB Bera MD VITALS (Observations Results)

Table – Vitals for Doctor Bera – Last Scored: 20240803-SU:

(*) Compare with Vitals Online Score

20180319-TU: Vitals Stars = 3.3 with 11 Ratings

20240804-SU: Healthgrades = 2 with ‎8 Reviews

Ethical Considerations

Transparency & Accountability

Transparent might be defined as “open and honest, without secrets: We are committed to being totally transparent about our charges. Example: Telling the truth and able to be trusted.”  Accountability is a Key Virtue in Mental Health and Human Services.  “Accountable people are open to input from others in legitimate roles, take responsibility for their own attitudes, thoughts, emotions and actions, and work to improve or correct their responses to have a positive impact.” Mar 23, 2022.  This report is a product of Accountability and transparency.  It is part of Keith (Buster) Torkelson’s medical record.

FYI

https://www.hopementalhealth.com/blog/accountability-and-mental-health

https://muse.jhu.edu/article/850952#.

Side Effects - Annoyances

We are having trouble with numerous side effects some are related to Invega and others are complicated by Nicotine.  Later we calculate our Behavioral Health Fitness Score (BHFS) or Conditional Health Fitness Score (CHFS).  At this stage in the game we don’t foresee huge gains.  We are surrendering competencies such as fluid typing.  We are focusing on the most disabling ailments such as: Anxiety and Sleep and hand-eye coordination.  It would be in our best interest to quit smoking.  We have cut down by a quarter of a pack per day.  Smoking interferes with our walking.

Side effects of Invega

Most bothersome effects associated with Invega

(*) These interfere with our walking and writing, thus, quite disabling and frustrating.

Things Can Change - Adjustment

After living some odd eleven years at the same location we have finally Moved.  We went from a BadBed to a Better Bed.  The only thing that keeps it from being a GoodBed is the cost.  We have adjusted well to our new Rent a Shared Roommate (RASR).  His name is James.  He has: Diabetes, fibromyalgia, and kidney damage.  He is also an amputee.  James is in his seventies.

Associated Documents

10_Assess_BHFS_16010701_Indexing V2024

DX-Battery-03C-20160208

Results - Findings from Diagnostic Assessment Cluster (DAC)

This table is used to calculate our Conditional Health Fitness Score (CHFS) AKA Behavioral Health Fitness Score (BHFS).  Low scores are favorable.  It doesn’t take into consideration the side effects of medication.

Keith Torkelson on Keith “Buster” Torkelson

Last Updated: 20230927-W:

Table – Results for Exhaustive Diagnostic Assessment Cluster Investigation

Yields a ConFitScore of 52%. 20160208-M: Results Matrix for Chapter-03C Study.  DX-Battery-03C-20160208 About TheDAG participating as a member in GB DEATH Program.  Early in 2016 we were was doing pretty well.  We still had Joan our Most Significant Other Ever (MSOE) in my life.  We lost her to dementia during the summer of 2016.

NLZD = Normalized (percentages)

SE = Still Evaluating

(*) = Used in calculation

Calculating A ConFitScore

February 8^th, 2016

In this case from our history we are suffering moderately from our symptoms.  Our CHFS is 52%.

Select the three (3) worst scores in battery and average them > derive a percentage

(48% + 54% + 55%) / 3 = 52.33 (Etc.) % [Round to tens] = 52% = CHFS

Cool Diagram

We needed to give a break to the verbal intelligence portions of our brain by using the graphic intelligence part.

Results – Assessments - Conditions

From > Invega 20240729 Report

Low scores are favorable

20240804-SUN-Select the three (3) worst scores in battery and average them > derive a percentage

(89% + 47% + 43%) / 3 = 179 / 3 = [Round to tens] = 60% = CHFS

In this case, we are currently suffering moderately from our symptoms.  Our CHFS is 60%.  It feels a lot worse than moderately. 

Results – Evidence – Best Fit

Below we compare two medications on our platter.  As doctor APD would say: “in our cocktail". In addition we try to associate some of our side-effect with the time and place where we were bed-reddened in for 75 days (Post Leisure Problem Score).  Low scores are favorable.

 

Clozapine V Invega

For reference information we took the Adverse Reactions to Invega and compared Invega and Clozapine.  Before we did this we tallied out defects we associated with the harsh treatment at Leisure.  We attributed the majority of our problems to our bed-reddening and maltreatment at Leisure.  There we several gaps in medication.  We were transferred from Leisure to Harvest on June 20^th, 2024 (TH).  After a month the bothersome Leisure features persist.  This is in great part the Invega is working against us.

Discussion - Bibliotherapy – Anxiety and Depression Workbook Bourne

2006-2007

Back in 2006 the stakes were high.  We were in Westminster Therapeutic Residential Center (WTRC).  WTRC was a semi-lock-down.  We also were on LPS Conservatorship.  We had a small business that needed our attention on the outside.  As is always almost the case we suffered Anxiety.  We needed a way to gain some ground quickly.  We including the staff decided to go with Bibliotherapy.  The workbook we chose was Bourne’s Anxiety Phobia Workbook.  Our condition responded to our hard work and we were released and off conservatorship in four months.  At the time we were strong about all of Bourne’s categories.

FYI - BMBB_Bourne_Anxiety_Contents_12022801 V2024

Discussion - Why is anxiety back?

It has been more than fifteen years since our work with the Bourne authored workbook.  We have forgotten most of the tools we learned.  We were in skilled nursing (2024) for seventy-five days.  Many of our defects came back.  This also is parallel with agreeing to be put on Invega Sustenna.  Now we find our defects are those that are side-effects to Invega.  Dr. Bera and I are working to titrate us off Invega.  In the meanwhile we are stuck with the annoyances such as problems writing, typing, using the mouse and walking.  Our anxiety about sleep is subsiding.

Discussion - Sample of Tools

There are thousands of assessment tools in Health & Human Services.  We have vetted more than 100.  We have used them off-the-shelf as well as writing our own.  It is time to rely on what we have used thus far.  We will continue to write tools as needed.  Below is a list of tools.  We have used less than half.  We include them as an FYI.

Mental Health Scales: How They Work

Proem Health

https://blog.proemhealth.com/scales-for-measuring-mental-health

Selecting a Tool

Once you find or make a good assessment instrument it is a good idea to stick with it.  A complete battery would be about ten assessments.

Table - What Assessment Tools Are Used in Mental Health?  Low scores are favorable.

“There is a myriad of psychological assessment tools. Here are some of the most common scales for measuring mental health and their area of application:”

Last Reviewed: 20240803-SA: QSM = Quick Score Method

Discussion - QOL and Diagnoses

Differentiate Bipolar from Anxiety

Clinically Speaking: How Bipolar Disorder and GAD Differ

https://psychcentral.com/anxiety/clinical-distinctions-between-bipolar-and-generalized-anxiety-disorder#:~:text=Differences&text=While%20anxiety%20can%20be%20ongoing,hypothetical%20worst%2Dcase%20scenario%20event.

“Differences. While anxiety can be ongoing, mania will ebb (in people with bipolar disorder II, cyclothymia, or mixed episodes) and is usually followed by an episode of depression. A person with anxiety often dreads the hypothetical worst-case scenario event.”  May 14, 2021

4 Common Bipolar Disorder Misdiagnoses – Healthline

https://www.healthline.com/health/bipolar-disorder/bipolar-misdiagnosis#:~:text=A%202018%20review%20found%20that,borderline%20personality%20disorder%20(BPD).

Can anxiety be misdiagnosed as bipolar?

“A 2018 review found that up to 40% of people with bipolar disorder are misdiagnosed. Similarly, it's possible to get a diagnosis of bipolar disorder when you actually have a different mental health condition, such as depressive disorder, anxiety disorders, and borderline personality disorder (BPD).” Feb 1, 2023

 

Appendix

Selected Burn’s Depression Checklist

Why choose Burns Depression?

This study is partially on Depression.  We have used Burns Depression Checklist (BDC) several times it is reflective of our presentation of Depression.

Hamilton Depression Rating Scale (HAM-D)

MDCalc

https://www.mdcalc.com/calc/10043/hamilton-depression-rating-scale-ham-d

The Hamilton Depression Rating Scale (HAM-D) assesses depressive symptoms.

Hamilton Depression Rating Scale (HDRS) 

https://dcf.psychiatry.ufl.edu/files/2011/05/HAMILTON-DEPRESSION.pdf

“University of Florida - The HDRS (also known as the Ham-D) is the most widely used clinician-administered depression assessment…”

Appendix - Measurement-based Care in Psychiatry

Past, Present, and Future

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380611/. 

“These four scales are 1) Positive and Negative Syndrome Scale (PANSS), 2) Young Mania Rating Scale (YMRS), 3) HAM-D, and 4) Montgomery-Asberg Depression Rating Scale (MADRS). The vast majority of the surveyed participants attributed their avoidance of rating scales to “lack of time.” Many other authors have noted that clinicians do not use standardized scales in clinical practice.57–63 Barriers to implementing MBC are summarized in Table 1.”