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Old Diagnosis Bipolar - New Diagnosis Schizoaffective


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Although I am bipolar myself (and luckily it's been a couple of years since my last fit of psychosis cause of the right meds and taking care of myself), I'm actually posting this on behalf of my ex-girlfriend who is a faithful member of this site. She wanted me to get some thoughts on this from you guys.

Last week we broke up (we were together 1.5 years), and I think that in addition to some other things was a little too much for her and she attempted to kill herself via lithium OD along with some other pills. With a 3.8 lithium level (15 hrs after we found her) and ~90mg's of Klonopin in her system she lived after spending several days in the ER and ICU. She has now been in a mental hospital for a few days and her doctor has diagnosed her as schizoaffective. They left her on the meds she was on pretty much - Effexor & Lamictal, but added 400-600mg of seroquel, and also upped her dose of Lamictal a bit.

What I think we are wondering if is it that she could really be schizoaffective, or if the doctor just thinks so because she was so oblivious and evil when she came into the mental hospital cause of all the pills she took. Oh, and also if you guys think this is an effective strategy for treatment in the short and possibly long term (yes I know you aren't docs here, just looking for opinions).

Thanks ;)

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It is often hard to tell sze and bp apart. I knew one kid who was diagnosed back and forth by a half dozen doctors. Took years for them to finally decide he was sze.

Regardless of the diagnosis, its more about what treatment is working. Suicide attempt means her current cocktail wasn't that effective.

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I've been through a lot of pdocs. I'm 27, almost 28, and was DXed BP1 when I was 7. So I've lived with this for 20+ years.

And during this time, especially recently, they've wondered if I'm schizoaffective or BP1 w/psychosis. What it comes down to, from what I'm told, is what is more of a problem for you- your mood bounces or your hallucinations/thought disruptions and other schizo symptoms. Right now my DX is still BP, but who knows? And who cares?

After that kind of suicide attempt, one that put her in the ICU, I kinda think they should keep her for AWHILE and really watch her and maybe try some different meds on her. Seroquel? I used to take 800mg. Maybe they should consider Zyprexa to really put the smack on the schiz. symptoms and all symptoms! I'm cooking right along with the big Z.

Loon

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Yeah, bipolar and schizoaffective can overlap a lot and from looking at the books the differential diagnosis can be tough and sometimes take years. Loonatik did a great job of describing it!!!

In the end this can be a case where having an iron-clad diagnosis doesn't necessarily matter (and may not be instantly possible). The important thing is treating the symptoms and getting the right med coctail. I guess the good thing out of this incident is that now the Pdocs realize she has psychosis symptoms that need an antipsychotic. Hopefully they will work in a timely manner and just need some tweaking, but if not there are a number of good AP's as alternatives.

Good luck,

a.m.

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I can concur about the difficulty differentiating between the two and can only speak from our family's perspective. We have gotten the bipolar under control pretty darn well, the hallucinations not. That would lead to a theory that there is something diagnosable as Schiz in the picture except for some extenuating brain anomolies and concussions that are likely contributing to all of this. Your ex may have something related to Schiz in her issues and maybe not because it seems that with every subsequent symptom or issue that comes up everything else that's already been there gets twisted in some way, shape, or form and is affected by it. I don't think our PDoc purposely attempted to treat the BP and put the hallucinations in the background....quite the opposite, I suspect, but the end result was effective treatment of the BP. What happened, though, was the ability to re-evaluate her condition once some of the symptoms related to the BP were alleviated or went away. For lack of a better term, it let the PDoc see what was left. I'm honestly not sure at how doctors deal with all these multiple symptoms and potential diagnoses...sometimes I think they just try to treat for everything and anything possible to see what works. I'm not sure I agree with that but understand they don't have a lot of other choices. In your ex's case, it would seem logical that they work on the highest priority, get that in order, and then start moving down the list of priorities. The whole consideration of schiz might fly with the wind if they get whatever underlying issue (and it might be just one adjustment to her meds, kwim?) is contributing to this setback under control.

Good luck to you and her - she's lucky to have you there to support her!

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Thanks for all the quick responses!

I guess I wasn't really clear though...she's never had any signs of psychosis as far as I know - I'm the one with that problem. Although we are both bipolar, we both have different types...mine is mainly up (and over a couple times) and hers is mainly down without delusions/hallucinations/etc. Personally I just think that because she had been through so much and had so many drugs in her system she appeared to be psychotic, but I don't know. We'll see how it goes though. Her main issue has always been severe depression but with hypomania at times. I just want to see her get better and hope they do things right. I don't really think she'll be at that hospital for long due to insurance reasons, but I think her parents will take over when she gets out if it's too soon and help her get into another one or a halfway house that can at least control her meds while she has some freedom to work and see outside doctors and therapists.

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