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Conflicting views on my diagnosis


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I was diagnosed bipolar in late 2005( Had extremely high energy levels for months then crashed into depressive psychosis). I put myself in the hospital soon after and after a few days the doctor in the hospital changed my diagnosis to schizoaffective. She said I had alogia, delusions and did not know i was ill. I got out of there in 2 weeks. Since then I have have seen 4 other psychiatrists and all have said I am bipolar. Yet when I went into the hospital earlier this year again, she said I was schizoaffective again. I am just confused by it. Why is she saying one thing then my outpatient doctors are saying another. 4 outpatient psychiatrists say bipolar and an inpatient psychiatrists says schizoaffective. Any thoughts I'm not looking for anyone here to diagnose me or anything. Just to give me some ideas as to how this could be and who is probably right. Shouldn't outpatients doctors be able to tell?

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I've had different diagnoses in and out of the hospital. It's harder for the inpatient doctors to get a real good picture of what you may have since they only see you for only a short period of time, where as your outside doctors see you over periods of time and can get a better idea. I've been told to trust what my outside psychiatrist says as opposed to what I may be told while inpatient, as they have been able to see me longer, so that's what I would suggest.

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Could it be that bipolar is your main DX and every thing else are just symptoms I don't think I have your symptoms I'm bipolar 1 with gad but every time I end up in the psych ward I'm all the above I have quite literally lost it and have several symptoms and mostly I don't remember anything except my latest suicide failure

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Do you have psychosis outside of your mood episodes?

The answer to that question probably is what explains the difference between your doctors' diagnoses. So it begs the question, when you presented in the hospital with psychosis, were you then in the midst of a manic or depressive mood episode or not? It sounds like the hospital docs concluded you were not in a mood episode, therefore labeled you schizoaffective, whereas your regular pdocs's conclusion was that when you have psychosis it's always concurrent with a mood episode, therefore you get the bipolar label. As others have said, the two disorders are very close and the treatment is the same for both

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When I was IP after a suicide attempt the doctors took me off my AD and told me I just needed to get a job. I believed them but it doesnt seem they were right.

That is terrible. Jeez, you could go down to a corner pub or coffee shop to get lame advice like that. And dangerous advice seeing that you were suicidal.

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Guest Vapourware

Personally, if you've seen five doctors and four of them say bipolar, while one says schizoaffective - then I would probably side with the majority and say you are bipolar. Especially if they are outpatient doctors and therefore have a bit more of your medical history than an inpatient doctor who is really only looking at how you are currently presenting.

The concept of diagnosis is still something of an artform, in the sense that the practitioner is largely interpreting what name fits best for a cluster of experiences. There's no scan or blood test to find out whether someone falls within the bipolar spectrum or the schizophrenia spectrum. The line between bipolar with psychosis and schizoaffective can be pretty blurred at times, so a person can go either way. I know I was diagnosed with BP with psychosis by one psychiatrist and schizoaffective by another, so you can go to different professionals and get different responses.

I also suggest perhaps doing some mood tracking - there's a lot of mood tracking places available [i.e. moodtracker.com] and seeing if you can track a pattern over time. You might also want to read up on schizoaffective and bipolar a bit more and see which one you think fits you better.

Treatment with BP with psychosis and schizoaffective are pretty similar, so whether you fall one way or another doesn't matter too much on the treatment side of things.

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Do you have psychosis outside of your mood episodes?

The answer to that question probably is what explains the difference between your doctors' diagnoses. So it begs the question, when you presented in the hospital with psychosis, were you then in the midst of a manic or depressive mood episode or not? It sounds like the hospital docs concluded you were not in a mood episode, therefore labeled you schizoaffective, whereas your regular pdocs's conclusion was that when you have psychosis it's always concurrent with a mood episode, therefore you get the bipolar label. As others have said, the two disorders are very close and the treatment is the same for both

I was in severe psychotic depression my first stay. This year I was in deep depression and sinking deeper so committed myself then. For some reason when I am really depressed I don't even know I am. Usually when I am that deep in depression I start looking up illnesses to try and figure out what is wrong with me. Happened before the first time I was hospitalized and this year again.

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No shit, you sit in a room with someone or they talk to people you know and then comes an OPINION.

Until there's a blood test or a machine to be hooked up to or a sample that can be tested that's what it ultimately comes down to.

I don't consider my migraines an opinion.

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No shit, you sit in a room with someone or they talk to people you know and then comes an OPINION.

Until there's a blood test or a machine to be hooked up to or a sample that can be tested that's what it ultimately comes down to.

There are a number of medical conditions that have no tests and are identified by symptoms or exclusion. That does not make the diagnosis and less in value.

nf

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Guest Vapourware

Regardless of the actual opinion, when a cluster of symptoms reaches a state where you require medical intervention of some sort...you do have a PROBLEM. Just the name of it might vary a bit between providers.

Ultimately, it's the treatment of the symptoms that matters - at least in my mind.

I do understand the feeling of confusion when you hear conflicting opinions, and it's frustrating, but as long as your symptoms are being helped, then the name doesn't matter that much in comparison.

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bp can present very similar to sza. Did you ask the other pdocs about the differing opinions? The main difference with sza is that you can have psychosis outside of mood swings. The treatment and prognosis are pretty much the same. I know it must be confusing getting two different dx, but if your pdoc treats the symptoms it doesn't really matter what the label is.

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I agree with the others that the doctors that see you most often would be the ones that have the best idea of your overall health. The last time I was IP, the asshole doctor there wrote in my discharge paperwork that he didn't think I have BP, because I was not exhibiting signs of mania. Um, duh, I was suicidally depressed! (If he had looked at my records from the last time he had treated me IP, he would have seen that he himself had written that I have BP. Sigh.) Anyway, I agree with the advice to chart your moods, and make sure to write at least a brief note about your thoughts for that day. It can be hard to tell what is delusional when you're actively delusional, but it might give you an idea of your thought processes over time.

The line between bipolar with psychosis and schizoaffective can be pretty blurred at times, so a person can go either way. I know I was diagnosed with BP with psychosis by one psychiatrist and schizoaffective by another, so you can go to different professionals and get different responses.

It's been very hard to tell if I have psychosis outside of mood episodes, because I am rarely not going up and down like a yo-yo. Looking back, I think it's pretty clear that I have had psychotic symptoms my whole life. My pdoc is aware of this, however, I can't take antipsychotics, so it doesn't much matter what my label is. I almost wonder if he carefully *doesn't* change my Dx because he can't treat me for the psychosis with the usual meds...

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I think it's less important what the dx is and more important that you tell your doc all the symptoms and that you get the right treatment for your symptoms. Labels are just labels- it's how you feel that matters. I had this problem a little when I was just getting dxed. I finally got stuck with Bipolar NOS with psychotic features, but I have a really great pdoc who doesn't treat based on my dx, he treats based on what I tell him. Good luck to you! I hope everything works out. :)

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I agree that getting the right treatment matters more than the diagnosis. That being said, I know it's frustrating to have to deal with differing opinions from different professionals. I have dealt with this bipolar/schizoaffective argument before with my own dx, and it hasn't changed the course of my treatment much. It's most important that your doctors get a full picture of you as a person and how your illness affects your quality of life. It's hard for doctors in the hospital to get that kind of thorough picture in a few days/weeks. I wouldn't worry about the actual 'name' of the illness too much, not so long as your treatment is helping.

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I agree that getting the right treatment matters more than the diagnosis. That being said, I know it's frustrating to have to deal with differing opinions from different professionals. I have dealt with this bipolar/schizoaffective argument before with my own dx, and it hasn't changed the course of my treatment much. It's most important that your doctors get a full picture of you as a person and how your illness affects your quality of life. It's hard for doctors in the hospital to get that kind of thorough picture in a few days/weeks. I wouldn't worry about the actual 'name' of the illness too much, not so long as your treatment is helping.

I talked to my doc last year and asked him can you tell if someone is schizoaffective and he said yeah. I'm not sure if its true or not. and not sure what he could see to know. I will say though that my sister is schizoaffective and I notice she has poor attention span. Poor memory, and poor ability to delay gratification. She also has regressed to a 5 year old. Not sure if you guys can give me more insight into these symptoms. She also talks to herself when she thinks no one is around. I don't have any of those issues yet not sure if you need those symptoms to be clinically schizoaffective.

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