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How Do You Know If You're Having An "Episode?"


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Ok, I realize that the title of this post is more than a little moronic, but I couldn't figure out how to phrase it in 25 words or less. I'll give a little background first.

I was diagnosed with BPI with psychotic features about a year ago. I'd been on a dysphoric manic spell for at *least* two years before. My memory's a little fuzzy past that, which is why I say at least. It could've been more. It turned mixed around this time last year, and I bulldozed through everything I ever cared about, basically. Anyway, that's how I got the diagnosis.

My "psychotic features" consist of delusions, generally of the paranoid variety, with a sprinkling intrusive thoughts when it gets really bad. I'm currently on 150 mg. of Wellbutrin and 150 mg. of Lamictal. I feel on a more even keel than I think I've ever felt in my life. I tend to have mini-breakthroughs around *that* time of month, but that's about it.

Here's the problem: The intrusive thoughts are gone, but the paranoia isn't. I don't *think* I'm manic or mixed. No racing thoughts, no hypersexuality, no irrational rage, no inability to be still, no sleep problems, nothing like that, at least not to my knowledge. The paranoia is much better than it was...but it's still there.

I used to be afraid to go to sleep before daylight because I was scared that burglars would come in and kill me. I can sleep before daylight now, but every little noise still makes me jump and sit bolt upright in bed. I no longer think that the government is tracking my Internet usage or that there are snipers outside, ready to shoot me if they see my head in the window or anything like that. The truly out there stuff is gone.

But what remains isn't exactly pleasant, either. I'm still afraid of home invasions. I often feel like someone is watching me, but when I turn around, of course, there's no one there. I'm not 100% certain that "they" (whoever "they" are) aren't listening in to my conversations. I'm still incredibly suspicious of other people's motives. It's mild compared to what I used to experience, but I'm still pretty sure this is not normal.

So I guess my question is, how do I know if this is some kind of stealth mania or if this is an issue outside of my bipolar that needs to be addressed? I'm scared to death of the schizoaffective label, though, realistically, I know it's treated more or less the same way as bipolar.

Sorry for the tl;dr. Any thoughts would be most appreciated.

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We can't diagnose you, so you need to talk to your pdoc about this. From your description it sounds like you do not satisfy criteria for being in a mood episode right now. But you also do not seem to be experiencing hallucinations, delusions, disorganized behavior, thought disorder, etc., so I wouldn't assume you are schizoaffective. Rather, from your description you have paranoia, i.e., thinking influenced by fears. That's what I'm taking from your post: fears. Anxiety. Notably, your paranoia is of the non-delusional kind, ie non-psychotic kind.

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We can't diagnose you, so you need to talk to your pdoc about this. From your description it sounds like you do not satisfy criteria for being in a mood episode right now. But you also do not seem to be experiencing hallucinations, delusions, disorganized behavior, thought disorder, etc., so I wouldn't assume you are schizoaffective. Rather, from your description you have paranoia, i.e., thinking influenced by fears. That's what I'm taking from your post: fears. Anxiety. Notably, your paranoia is of the non-delusional kind, ie non-psychotic kind.

Muchas gracias. No diagnosis needed--I have to head back to the pdoc in October for some med refills, anyhow, so I figure I'll mention it then. It's not debilitating, just annoying as hell. Guess I was hoping the meds would get rid of this crap. :glare: I can remember having thoughts like this as far back as 8 years old, so it'd be nice to have a break.

The anxiety thing makes sense. Anxiety runs in my family, and I do have a social phobia problem that's also annoying but not pathological. Thanks for making me feel better!

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No one here can say if your paranoia is psychotic or anxiety related.

How long have you been stable, truly stable? I mean, do you honestly know what it is? You sound like you do and you sound like you are, but I was "stable" many times on my way to learning what stable really is. So, my suggestion is to talk this out with your pdoc and if you don't have one, find a tdoc experienced with bipolar patients and talk it out with that person, too. It could be that your activating cocktail has your brain a little buzzy. It could be that your brain still needs time to recover. It could be that like many with bipolar, you also have a serious anxiety disorder. It could be a few different things including that you have schizoaffective. I just wouldn't jump to a new diagnosis before investigating the rest, and your real resources are your treatment team.

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No one here can say if your paranoia is psychotic or anxiety related.

How long have you been stable, truly stable? I mean, do you honestly know what it is? You sound like you do and you sound like you are, but I was "stable" many times on my way to learning what stable really is. So, my suggestion is to talk this out with your pdoc and if you don't have one, find a tdoc experienced with bipolar patients and talk it out with that person, too. It could be that your activating cocktail has your brain a little buzzy. It could be that your brain still needs time to recover. It could be that like many with bipolar, you also have a serious anxiety disorder. It could be a few different things including that you have schizoaffective. I just wouldn't jump to a new diagnosis before investigating the rest, and your real resources are your treatment team.

I've been truly stable for about 4 months now. So I suppose there could still be some residual stuff going on. I'm not sure that I honestly know what "stable" is, which is partly the motivation for this thread, LOL. I'm definitely planning on consulting with pdoc about it. I haven't had the best of luck with tdocs, so the thought of having to go through all that again makes me groan, but I'll make myself do it if need be.

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Guest Vapourware

Firstly, schizoaffective is not scary at all. You are right - the treatment for schizoaffective is very similar to the bipolar w/ psychosis label.

I wonder if you've done some mood tracking since your diagnosis. If not, there are a lot of mood tracking sites and the like available. Moodtracker.com is an obvious choice, but there's a lot out there. If you happen to own an iphone, there's also various mood tracking apps you can download, both free and paid. When you have a mood disorder, gauging your moods can help with working out what is happening, and whether or not you might need a med tweak.

I'm surprised that you're not on an antipsychotic due to your symptoms. I remember when I was still viewed as bipolar with psychotic features, the mainstay of my treatment was a mood stabiliser + antipsychotic. Perhaps an antipsychotic of some sort would help get rid of your residual symptoms.

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Firstly, schizoaffective is not scary at all. You are right - the treatment for schizoaffective is very similar to the bipolar w/ psychosis label.

I wonder if you've done some mood tracking since your diagnosis. If not, there are a lot of mood tracking sites and the like available. Moodtracker.com is an obvious choice, but there's a lot out there. If you happen to own an iphone, there's also various mood tracking apps you can download, both free and paid. When you have a mood disorder, gauging your moods can help with working out what is happening, and whether or not you might need a med tweak.

I'm surprised that you're not on an antipsychotic due to your symptoms. I remember when I was still viewed as bipolar with psychotic features, the mainstay of my treatment was a mood stabiliser + antipsychotic. Perhaps an antipsychotic of some sort would help get rid of your residual symptoms.

I actually have tried to some mood tracking in the past. I sucked at it. I wasn't so great at judging my state of mind at the time, but I also wasn't altogether stable when I attempted it, either. Maybe I need to try again.

I think there are several reasons for the lack of antipsychotic. A.) Pdoc is a firm believer in "one thing at a time." B.) No insurance, and, from what I remember from the research I've done, there aren't many of the AAPs that are generic. C.) I'm already pretty overweight, to put it nicely, from a disastrous bout with Depo-Provera. She's already mentioned that the metabolic stuff wouldn't be so great for me, which I tend to agree with.

That doesn't mean things won't change on my next visit, though.

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Guest Vapourware

If you are in America, you might to have a look at Needymeds: http://www.needymeds.org/ That site has information on how to get low-cost meds, and perhaps you might find something of use there. I'm not American, so I can't really comment on the services listed on the site, but I'm sure someone can come along with explanations.

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If you are in America, you might to have a look at Needymeds: http://www.needymeds.org/ That site has information on how to get low-cost meds, and perhaps you might find something of use there. I'm not American, so I can't really comment on the services listed on the site, but I'm sure someone can come along with explanations.

Woot! Thank you. =)

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If you are in America, you might to have a look at Needymeds: http://www.needymeds.org/ That site has information on how to get low-cost meds, and perhaps you might find something of use there. I'm not American, so I can't really comment on the services listed on the site, but I'm sure someone can come along with explanations.

I don't know if this site will help you but it's another one related to Rx: http://pparx.org

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...

B.) No insurance, and, from what I remember from the research I've done, there aren't many of the AAPs that are generic. C.) I'm already pretty overweight, to put it nicely, from a disastrous bout with Depo-Provera. She's already mentioned that the metabolic stuff wouldn't be so great for me, which I tend to agree with.

That doesn't mean things won't change on my next visit, though.

B. I can get risperidone for around $25 for a month's supply. You have to shop around, but you can find it pretty cheap. And, as other's have mentioned, there are prescription assistance programs out there, especially for the newer meds.

C. Risperidone didn't cause me to gain weight. Some AAP's are known to cause weight gain, but not all.

I tend to agree that an AAP could be of help to you. It could help stabilize your mood, take care of any paranoia that you might have, and maybe even help with anxiety. Talk to your pdoc about it. I don't think that it should be out of the question.

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Risperidone (Risperdal) is a great AAP. I did not gain weight but it was a little difficult to lose which I did, just very slowly. A lot of people with bipolar take an antipsychotic, often in addition to a more traditional mood stabilizer like Lithium or Lamictal. Usually (?) the amounts are low or lower doses to deal with reducing chatter and anxiety as well as helping clarity. That's only based on anacdota from these boards, btw. For me, it also helps stability which is another very common reason why they are taken.

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Bp I will rarely be controlled with that amount of lamictal and wellbutrin IMO. I needed lithium and risperdal (as talked about in the generic name in this thread) to even touch the delusions and paranoia. My advice is to be honest about your symptoms and ask why they aren't being treated.

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Maybe you just need more time or need to challenge this stuff and get over it. It sounds to me like things are on the improve, maybe they will keep improving. Really the picture is positive from what I see.

Maybe so. I hope so.

I don't know if this site will help you but it's another one related to Rx: http://pparx.org

Yay, another one! Thank you.

B. I can get risperidone for around $25 for a month's supply. You have to shop around, but you can find it pretty cheap. And, as other's have mentioned, there are prescription assistance programs out there, especially for the newer meds.

C. Risperidone didn't cause me to gain weight. Some AAP's are known to cause weight gain, but not all.

I tend to agree that an AAP could be of help to you. It could help stabilize your mood, take care of any paranoia that you might have, and maybe even help with anxiety. Talk to your pdoc about it. I don't think that it should be out of the question.

Risperidone is one of the specific ones she named when discussing metabolic issues, but I *do* know it's not as bad as some of the others. I definitely intend to talk to her about what can be done about the paranoia, be it an AAP or not.

Risperidone (Risperdal) is a great AAP. I did not gain weight but it was a little difficult to lose which I did, just very slowly. A lot of people with bipolar take an antipsychotic, often in addition to a more traditional mood stabilizer like Lithium or Lamictal. Usually (?) the amounts are low or lower doses to deal with reducing chatter and anxiety as well as helping clarity. That's only based on anacdota from these boards, btw. For me, it also helps stability which is another very common reason why they are taken.

Interesting about the risperidone weight loss. It could be a possibility, as could some of the newer AAPs with "assistance." Screw the health care system in this country. :glare:

Bp I will rarely be controlled with that amount of lamictal and wellbutrin IMO. I needed lithium and risperdal (as talked about in the generic name in this thread) to even touch the delusions and paranoia. My advice is to be honest about your symptoms and ask why they aren't being treated.

Well...I'm a cheap date. It takes very little of anything to knock me on my ass.

Pdoc wrote me a prescription for 200 mg of Lamictal. (I was on 100 at the time it was written.) She told me to go up by 25 until I got to a place where I felt I was stable. I first stopped at 125. Then, because I have a history of struggling in the fall, I went up to 150 a few weeks ago as a pre-emptive measure. So I still have wiggle room within the existing prescription, and I'm going to go back to see her soon, anyway. Not to worry, I will discuss the paranoia with her.

Lithium is probably not an option for me at this point, as I don't really have the money for the regular blood testing.

I dunno. It's weird to me. I really don't feel like I'm manic or mixed, and the delusions have sure lessened, but the paranoia still hangs around.

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Well...called pdoc yesterday. Left a message with the nurse. When the nurse called me back, she told me that pdoc wanted to give me a referral and then told me not to go up on my Lamictal anymore. I was like, "Uh, I'm not supposed to go up, even though I have a prescription for 200 mg and am only taking 150 mg?"

Then, the nurse told me I only had a prescription for 100 mg, so I had explain that that was the old prescription and that now there is a new one. So she pulled up my file and found it and was like, "...oh."

So God only knows what kind of message was left with the doc herself. I am, however, still considering getting a referral. I live 2 hours away from my current pdoc, anyhow, so maybe if I found someone here, it'd be a little easier. There *is* that whole money thing, though.

Anyway, I was just updating to let everyone know that your thoughts about meds, etc. will most likely come in handy soon.

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I've been pretty consistently sick for most of my life, so I generally am in some version of an episode (I can tell I'm stable when I look back a few weeks and realize everything is A-OK). But I do track my moods so I can see if a pattern starts emerging, often before I realize it on my own. I think knowing when you are having an episode is such an individual thing, you really just need to learn about your own pattern.

Part of my symptomatology is paranoia (along with hallucinations, delusions, intrusive thoughts, etc.), and it tends to stick with me even when I am feeling basically OK moodwise. My thoughts are that it is a learned behavior bolstered by our internal chemistry-- we get a surge of adrenaline, for instance, for no reason, and it makes us jump and scream. So our brain thinks SOMETHING'S THERE and tries to make sense of it. If it happens often enough, our brain starts to look out for this "danger" all of the time to protect us. Even if we can quell our internal chemical issues, we then need to retrain ourselves psychologically.

When I am not going totally crazy with mania or depression, I can usually remind myself that these dangers are not likely to be real and give myself a time out before responding. Over time, I have become better able to have fewer fear responses and feel less paranoid overall. That doesn't mean I am always hunky dory-- a week or so ago I checked the entire house for someone hiding under a bed, carrying a knife to protect myself. So yah, it takes some time, but it can get better if you work at it. DBT has been invaluable to me in terms of reframing how I see the world.

I hope you get something sorted out with your meds. It does sound like you might need an AAP. I would love to take one, but am unable to (long story). If you tend towards mania, Wellbutrin + Lamictal doesn't sound like the best of mixes. I wonder if that is causing you to continue feeling paranoia?

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Yeah, two hours is far. I would say that if you are having paranoia or delusions, they need to be treated. They only get worse without treatment, and I should be an idiot who knows as I've been going untreated and shit is getting bad, bad, bad. Get that referral ASAP.

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Paranoia is one of my biggest symptoms too, so I know how much it sucks. Like some of the others have said, it might be worth trying an AP. Out of what I have tried, that has definitely had the best results (I was on AD a few years ago). Definitely bring this up with your pdoc next time you go. Because the sooner you can get this treated, the better you will feel. My biggest regret is not getting treatment sooner.

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Sorry to bump this thing yet again, but I'm back to wondering how you know you're having an "episode."

I've been having sleep problems the last 2-3 days. That's usually my first indication that something's wrong. It's been brought to my attention that I'm perhaps hypomanic. I don't think that's ever happened to me before--it's always been full-blown batshit in the past. So I'm thinking that's why I didn't recognize it. I'm so used to absolutely bouncing off the walls when I'm manic that this didn't seem like anything to me.

Blech. I suck at self-awareness.

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