Gil, Bipolar I Disorder, Current or Most Recent Episode Hypomanic, Substance Use Assessment A-1

A middle-aged man has rapid, pressured speech and labile shifting affects compatible with bipolar disorder. His speech is sometimes tangential, not making sense. During a substance use assessment, he reports he drinks alcohol every day but only on weekends, in a way that makes it unclear if he is a good historian. He endorses that his judgment is not good when he drinks. He reports both blacking out and passing out. He reports he hears symphonies when he recovers. He denies driving when he drinks and denies medical problems due to drinking alcohol. He reports using cannabis and seeing pictures, but denies they are hallucinations. He reports cannabis makes his racing thoughts even faster, but then slows his thoughts for the following day. He denies opiate, IV drug, or stimulants use. He reports having been in rehabilitation for alcohol use. He reports good health, eating well, but strangely claims this is due to his drinking alcohol.

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Bipolar Version 1B – Full Assessment.m4a

OFF CAMERA: [00:00:29] Gil I’d like to ask you some other more medical questions about are you on any medications now.

GIL: [00:00:36] No.

OFF CAMERA: [00:00:37] No medications. OK aspirin.

[00:00:40] No I mean I take aspirin every day.

OFF CAMERA: [00:00:43] do you take aspirin every day.

GIL: [00:00:44] I don’t have a doctor’s note though. I was like You know it’s something you should do.

OFF CAMERA: [00:00:48] Does Your Doctor know,. knowo you take it.

GIL: [00:00:50] I told him.

OFF CAMERA: [00:00:50] Oh OK. Good to see you. Good for you.

GIL: [00:00:53] I mean it was good about.

OFF CAMERA: [00:00:54] Alcohol your alcohol intake like.

GIL: [00:00:59] But you know I drink every week every day every weekend. I’ll have champagne and then maybe I’ll have a margarita after that. And beer I mean I don’t drink in the same day. Oh every day. I mean every day not the weekdays but on other days.

OFF CAMERA: [00:01:16] But on the weekends I’ll drink.

GIL: [00:01:17] And pretty much yeah. I mean I think.

OFF CAMERA: [00:01:18] You’ll have all three of those.

GIL: [00:01:20] Yeah. Now do you ever don’t like to admit it.

OFF CAMERA: [00:01:22] Do you ever drink enough you get intoxicated.

GIL: [00:01:25] Always. I mean I like to. It’s actually nice. It’s good.

GIL: [00:01:28] It puts me at ease it takes me to the places I create very euphoric. So I get to expose myself and see. You see I said it that exposing myself and I actually did this weekend and it was a mistake.

OFF CAMERA: [00:01:40] But anyway there are some time your judgment is not too good when you’re on the alcohol.

GIL: [00:01:46] Yeah.

OFF CAMERA: [00:01:47] Yeah.

GIL: [00:01:47] I mean yeah I mean you know you get everything goes a little blurry needle crazy.

OFF CAMERA: [00:01:52] Now do you have a sound you drunk enough you pass out till.

GIL: [00:01:56] I pass out once. Aha. So we get it.

OFF CAMERA: [00:01:59] Do you have blackouts where you not remember.

GIL: [00:02:03] Yes I always do.

OFF CAMERA: [00:02:03] And that’s actually you were drinking right.

GIL: [00:02:05] And when I wake up I had these sympathies again and there they hope you know what I mean to get to catching that mood is like this little place where just lets out everything you want to do. I think everybody should drink a little you know at least a little bit a Margarita’s or even better.

OFF CAMERA: [00:02:19] And do you ever go for like several weeks or months with them.

OFF CAMERA: [00:02:23] Without drinking.

GIL: [00:02:24] No no. So every time we do that everyone actually can do that now because now that I’m old. Is in line connected with everything that I if I if I stopped that it would probably wreck all that stuff that I’ve worked on for so long. So that’s idea.

OFF CAMERA: [00:02:37] Do you ever drive while you’re drinking afterwards.

GIL: [00:02:41] I don’t drive hardly at all.

OFF CAMERA: [00:02:42] Don’t drive yourself.

GIL: [00:02:43] I can’t anymore. Aha. So now it’s hard I don’t like it there’s so many people the that, and cops are there.

GIL: [00:02:50] So I’m not going to get behind the wheel because a drink and I would only drive on the weekends because you it.

OFF CAMERA: [00:02:54] Have you had any medical conditions medical problems because of the alcohol.

GIL: [00:02:58] No not today. Not that I know of. I mean I think sometimes our heart exploding or something but I’m.

OFF CAMERA: [00:03:04] Vomiting blood no anything God NO LIKE NO GETTING shakes, tremors.

GIL: [00:03:10] Like a fish shakes. Haha yeah but that goes with it right to let go that.

OFF CAMERA: [00:03:15] Is it when you stop drinking it’s an excess that shakes us.

GIL: [00:03:17] The next steps. So the whole time it’s all right. And then the next day it’s kind of like Mooloolah where do you go to get everything.

OFF CAMERA: [00:03:24] You ever drink in the morning.

GIL: [00:03:25] When aimed at bringing in your ears and stuff like that.

OFF CAMERA: [00:03:28] So that next morning you have to drink something to not have the shakes.

GIL: [00:03:33] Just Milk just milk but not about alcohol anymore.

OFF CAMERA: [00:03:36] No more alcohol.

GIL: [00:03:37] Like I said it’s only one weekend and everything’s another.

OFF CAMERA: [00:03:41] the Beer and the champagne and the margarita. What about marijuana. Do you smoke marijuana or use marijuana.

GIL: [00:03:50] No. You’re like I said smoking those younger really like teenagers I think then we’ve got hallucinogenic like with my friend John he used to like all this kind of stuff and I follow him because I want to be going off like him.

[00:03:59] But I was like oh I have to say it’s Pol Pot and I don’t like smoking pot because it has made me feel paranoid like extremely paranoid and then lately I’ve been someone has been you know right that pen right. So I tried that and there’s creativity. Aha. Seriously that is great creativity. I mean it doesn’t stop when you’ve.

OFF CAMERA: [00:04:18] Had the marijuana.

GIL: [00:04:19] Yes with the pot and then.

OFF CAMERA: [00:04:20] You said hallucinogenic do you mean seeing things or hearing things, what do you mean?

GIL: [00:04:26] I mean you are taught. I mean not hallucinations. Right. Good pictures pictures.

OFF CAMERA: [00:04:34] Aha. Aha.

GIL: [00:04:37] My friend the other day was talking I branch came out of his mouth over a tree. I saw what he saw. And that work is horrible.

OFF CAMERA: [00:04:45] Had you been smoking.

GIL: [00:04:46] Did. There was the dot the margarita which I don’t think I should be does.

OFF CAMERA: [00:04:51] Does the marijuana what does that do to your racing thoughts you’ve been on I’m sorry.

GIL: [00:04:57] Oh not really that I shouldn’t know. But I like if I if I just keep it if I just keep it under control like everything in a musical kind of way I just keep it like bump up a breather. Then I’ll be I’ll be able to cope with that and not feel like I’m abusive because I feel like I’m abused. I mean someone probably would say if they looked at me they would say Oh you are abusive you know what does.

OFF CAMERA: [00:05:17] Does marijuana do.

GIL: [00:05:18] I might Do more of the marijuana due.

OFF CAMERA: [00:05:20] To your racing thoughts.

GIL: [00:05:22] You know I asked her about it it goes faster with the marijuana that’s great. But the pictures are the best little creatures are the best.

OFF CAMERA: [00:05:29] A lot of people say it slows down their thoughts. Does it ever slow down your thoughts.

GIL: [00:05:34] And the next day like I said.

OFF CAMERA: [00:05:36] The next day one marijuana then slows it down and drinking the milk. OK yeah. Any other field that any other drugs are made of any opiates heroin. Oxycontin be it it’s for pain medicine. No it’s prescription medicine except for a heroin no only natural stuff ever any I.V. drugs for you use a needle.

GIL: [00:06:03] Oh god here oh my god.

GIL: [00:06:06] Give me to my eyes is when you know I would never do something bad. That’s crazy stuff. You think you do that. You don’t do that.

OFF CAMERA: [00:06:14] No absolutely not. You know you would never do this dangerous and go see you know about any stimulants like Ridalin.

GIL: [00:06:22] Now I don’t know that these were handed things.

OFF CAMERA: [00:06:24] It’s OK for attention deficit. That is I don’t know I don’t know what’s pretty much OK.

GIL: [00:06:30] OK I don’t understand. OK.

OFF CAMERA: [00:06:33] So you. Have you ever been in a drug rehab alcohol rehab program.

GIL: [00:06:38] Yes by mistake.

OFF CAMERA: [00:06:41] I mean they brought me there but I was a mistake. I was probably in the middle of all that you know.

OFF CAMERA: [00:06:47] How how long were you in rehab.

OFF CAMERA: [00:06:52] Week oK.

GIL: [00:06:55] Weekend because I was out for drinks today. I mean there.

OFF CAMERA: [00:06:59] Was there for the alcohol.

GIL: [00:07:02] Yes.

OFF CAMERA: [00:07:03] Who put you in there. What did you say.

GIL: [00:07:07] Aunt your and my cousin. Oh OK.

OFF CAMERA: [00:07:11] is the same aunt you told me about. You travel with us.

GIL: [00:07:13] No is it other and you live in Florida. And she was visiting and she said you know yes I did. I think she did.

OFF CAMERA: [00:07:19] She thought you were drinking too much.

GIL: [00:07:21] My cousin who worked with you because when I grow up with we smoke pot. And he told me to do it. He told me to go to rehab. He went to rehab once too when he was younger.

OFF CAMERA: [00:07:32] Now do you think you’ve ever lost any friends because of drinking too much alcohol or.

GIL: [00:07:37] Probably. No really I probably have.

OFF CAMERA: [00:07:41] What about losing a job.

GIL: [00:07:41] I never thought about that.

OFF CAMERA: [00:07:43] What about losing a job.

GIL: [00:07:45] But a bunch of jobs. This is crazy.

OFF CAMERA: [00:07:47] Is that because of alcohol because of the.

GIL: [00:07:50] Oh everything was bad my bad way to talk to people I don’t because because I’m it because I know what I’m doing and advance people get a little paranoid around me so they don’t want to hang around with me. So I don’t connect well with human beings connect more with the earth in music and things like how I’m trying to do that. You’re right.

GIL: [00:08:08] I’m trying to get that more in line. So it’s it’s a work in progress.

OFF CAMERA: [00:08:13] And do you have any medical illnesses at all.

GIL: [00:08:16] Me. No.

OFF CAMERA: [00:08:19] Heart problems, lungs, cancer.

GIL: [00:08:23] No God no.

OFF CAMERA: [00:08:24] Lung problems breathing no heart no.

GIL: [00:08:27] No no no thank god no.

OFF CAMERA: [00:08:29] So you’re in pretty good health.

GIL: [00:08:32] Yes I’m a great help. Everything’s great.

OFF CAMERA: [00:08:34] And your diet.How’s that.

GIL: [00:08:36] Really well that’s a good thing too about alcohol because it makes you not eat.

OFF CAMERA: [00:08:40] Makes you not eat.

GIL: [00:08:41] I don’t eat a lot of big food because the alcohol kind of takes care of me. Your hunger’s gone.

OFF CAMERA: [00:08:46] Right well do you think you get enough. Good nutrition.

GIL: [00:08:50] Always a broccoli, lettuce, tomatoes.

[00:08:55] Pretty much that ate fiber.

GIL: [00:08:57] Fiber pills good documents vitamins. Yeah. Yeah I take her myself.

OFF CAMERA: [00:09:02] Good exercise.

GIL: [00:09:04] Yup. I walk around town lot and when I’m doing the shows I mean there’s a lot of activity when you’re on the stage. You know a hundred and round and low you don’t have a really great gives me a lot of time to get you know to get my heart going.

OFF CAMERA: [00:09:20] Well thanks for talking with me.

GIL: [00:09:21] Oh thank you. This has been nice. All right. Thank you. Feel better once I get that lobby of yours worked on.