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Confused about change of diagnosis


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My previous consultant told me that I was suffering for shizoaffective disorder. I have recently moved to a new city and my new doctor told me that i have bipolar disorder.

My symptoms have not changed and I still hear voices and have thought extraction and thought insertion yet she says this is bipolar.

I am taking 20 mg of zyprexa and this really helps. Has anyone else had there diagnosis changed by a different consultant. She wants to start me on lithium which I have been on before but it did not help.

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If you think that the diagnosis is wrong, speak up and tell them that you took lithium before and it didn't help. Ordinarily, I would say don't worry about the diagnosis, but in this case, they are trying to change your treatment. If you are taking 20 mgs of Zyprexa and it is working, you need to tell them that and emphasize it.

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Guest Vapourware

To be honest, the medical side of treating bipolar with psychosis vs schizoaffective is pretty similar, so regardless of name, the treatment wouldn't be too different. The mainstay of the treatment, for both disorders, would be something like a mood stabiliser + antipsychotic, with other meds as necessary.

That being said, if you are confused, you are within your rights to ask your new provider for the rationale behind the change of label. My former pdoc had me as bipolar with psychosis, but my current doctor has me as schizoaffective because according to him, I have displayed psychotic symptoms outside of mood episodes. My former pdoc, on the other hand, had me as bipolar with psychosis because I was "too high functioning" - so sometimes, a doctor's bias can come into play.

While the DSM's criteria of schizoaffective gives the impression that there is a sharp demarcation between it and bipolar, in reality, it can be hard to work out if someone does actually sit in the SZA or BP side of the fence. I've had numerous conversations with my current pdoc about the rationale behind my being schizoaffective and he's acknowledged that I'm a bit of a borderline case and could swing either way, really.

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If you think that the diagnosis is wrong, speak up and tell them that you took lithium before and it didn't help. Ordinarily, I would say don't worry about the diagnosis, but in this case, they are trying to change your treatment. If you are taking 20 mgs of Zyprexa and it is working, you need to tell them that and emphasize it.

Lithium does not work for everyone, even if they have bipolar. It is not a reason to say someone has SZA.

The main difference between SZA and BP is whether one experiences psychosis outside of mood states. The tricky part is that mood states can be hard to differentiate between euthymia sometimes.

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Out of interest, i was originally diagnosed with:

OCD, MDD, PD w/out agoraphobia.

Now I am dxed as having schizophrenia w/ panic attacks.

My symptoms never really changed. The interpretation of the intrusive thoughts, hallucinations and paranoia is what has changed, as well as the negative symptoms (previously believed to be depression)...

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I've had this happen, I was diagnosed schizoaffective in the hospital by one of the docs. I think it was a ridiculous dx because I've never had psychosis without an episode.

That said, I think there was some political play coming in there, and I was also so strongly and inappropriately medicated that I completely was a mess.

I've never had a doc question my dx, but when I was first dx in 99, they originally thought I had schizophrenia, I was so psychotic. Heh.

So yeah, it happens. That said, like everyone else said, speak up about the lithium and your other concerns.

Anna

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I think that confusion about diagnosis and misdiagnosis is quite common. But like has been said the treatment is similar for BP with psychosis and SZA, so it probably wouldn't matter too much which was your actual dx. But I know how it feels to not know what is going on and to want answers.

My original dx was depression, but over the next few years that changed first to BPD (WTF???), then BPD and schizophrenia (another WTF), and back to just BPD again (WTF yet again), before I was eventually diagnosed with psychosis NOS. The depression and the psychosis NOS, I have no problem with as they both cover different symptoms I've had over the years. And I can understand the sz as a misdiagnosis. But the BPD actually was utterly absurd when I have only ever had one of the criteria, which was just as well explained by my depression.

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