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Unique Processing Challenges

cognition learning disability information processing attention deficit mood lability

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#1 whiteelephant

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Posted 27 June 2021 - 07:15 PM


I'm struggling to address some cognitive/EF processing issues that are limiting my ability to function both personally and professionally. This has persisted in spite of a variety of medications/nootropics, therapy (CBT/DBT), good lifestyle, and treatment with therapy, integrative providers and doctors. I've succeeded academically in rigorous solutions, and received a nurse practitioner degree and an MPH, but have struggled in job settings and planning for a job/career that matches interest/skills/limitations/strnghts. I'm not sure what issues fall into attention issues/a maybe influence of mood dysregulation induced lack of clarity/atypical cognitive process issues/an OCD/anxiety component.  I had a significant VIQ/PIQ discrepancy on neuropsych testing, perhaps suggesting some sort of NVLD type issue, or something asperger related.

 

In parallel I have mood dysregulation/lability, anxiety/depression issues. They are better addressed now. I am on lamictal 100 mg, pristiq 75 mg, and actually caffeine.

I have had great suggestions here for individual components of my issues, but given the complexity of my issues, am trying to assess the components in combination and in their uniqueness, to plan for pursuing medication/support that work in combination.

 

I acknowledge that I'll have ongoing struggles that I'll have to build support and structure for (as I already do, and have tried to do) and medications and support have their limitations. But there are certain issues that have been limiting even with that support, structure, past medications, and I feel will impair non-perfectionist functioning across settings. I struggle to process situations/events succinctly, and to plan for my future in terms of interests/strengths and limitations.

 

I'm trying to figure out how to better address these processing limitations both in terms of career planning and in terms of personal and social functioning.

 

Processing Issues

  1. I have issues noting what's important. Part of this is I have trouble seeing details when things are abstract (interests/skills and relation to specific positions), and I get lost in details.

  2. I have trouble succinctly processing experiences. So a lot of my time is spent processing things, and that's exhausting. It is really impairing my roles in basic ways. It will contribute to unhealthy codependent relationships, and I don't even dare dating now. Structure can't fully help with that.

  3. I can't remember what I processed and redredge things. Even if I write things down, it requires such an exhausting attention to these processes that I am limited.

Implications

  1. Even when working with support, I couldn't acknowledge and think through the limitations and realities of what to prioritize in a career/job (and relevant degree path) to optimize functioning of the fast paced health care settings that are real in most NP settings, and that burn out even non cognitively impaired providers. Finding an NP position that meets these criteria is like finding a needle in a haystack. Even with the structure of clinical work, I may have the reality that the settings that provide the structure I need are things that are unmotivating because I struggle with monotony.2, I spend a lot of time just trying to process overall situations/emotions. Limits ability to engage more fully in relationships,

I'm having difficulty now just thinking through the components of a career/job that provide the difficult to meet balance of routine/structure that match my interests/skills/background/limitations. I did extensive research prior to deciding on the NP degree, but didn't fully assess relevant components like the fast paced nature. It's hard to even network before having better clarity. I see an essential part of career stability as having a wide enough selection of job opportunities to explore.

 

I'm not sure what other supports to find. My past supports have had their limitations given that I seem to have processing issues that aren't addressed in interventions/assessments. I've had career planning with EF focused people, . ADD/EF focused therapists don't really address how difficult it is for some people with EF difficulties to process situations. Only ways to organize life and break down tasks. Unless I can proactively mention my issues, they're usually missed in assessments. In addition, the piecemeal focus of addressing one component at a time, doesn't take into account what combination of resource and particular medications I may eventually use, and instead results in a see saw of improving one area or the other, without adequately addressing either.  Medications have had their limitations, and I'm not sure how much it can/will help with once I return to a better optimized regimen that allows me to be more consistent with my increased/increasing self care/life balance and exercise.

I also don't even know if my issues fall into an assessment that's targeted to address these issues.  

 

Medication/nootropic wise, I've tried curcumin, lithium orotate (helps) melatonin, acetyl l carnitine (helps, but slightly hypomanic, and not focused on big picture) cocoavia (helps, but slightly hypomanic, and not focused on big picture), cdp choline (felt a bit irritated), taurine (helps), b6 (helps, but worry about toxicity).

Intuniv and strattera was the combination that helped the most overall. I've tried stimulants (overfocused, irritable, but vyvanse helped, but processing issues still prevalent), prozac (helped with emotional focus/reducing anxiety/depression, but limited in times of extra stress/depression and doesn't allow for combinations given fatigue), low dose abilify (felt a bit more focused, depression still there, overfocused, insomnia, processing issues there), imipramine (exacerbated emotional lability, processing issues persistent) trintellix, tegretol/wellbutrin (limited in terms of focus/and was cognitively slowing), memantine/strattera/pristiq. Without the intuniv/strattera combination, I seem to struggle with mood dysregulation and processing issues more. So, on strattera alone, required pristiq. Mood lability was persistent on this combo (in response to frustration/perceived rejection/), processing issues in terms of seeing details in the abstract or vice versa and filtering out what's important still there. The intuniv/strattera had its limitations.

The challenge with any intervention now: 1. is that I do have some cardiac concerns. I have exercise induced tachycardia, which is worse with stimulating substances and limits my ability to exercise moderately. Now, I also have low BP at rest, so I have trouble using a beta blocker or heart rate lowering supplements to counter the tachycardia inducing effects of stimulant type substances. 2. I am a poor CYP2d6 metabolizer limiting combinations with some medications

My unique cognitive and mood lability issues, and the BP issues, make exploring interventions difficult. Given my processing issues, I feel limited in terms of what professional options are available, given interests/skills and limitations, and have explored extensively. I am also just limited in my personal and social life. would welcome any suggestions medication/nootropic or otherwise.







Also tagged with one or more of these keywords: cognition, learning disability, information processing, attention deficit, mood lability

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