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I'm confused about something. I keep reading that the schizoaffective disorder dx is a waste basket dx and that there is a lot of controversy surrounding it. But I can't understand why. What do the skeptics believe people with these symptoms should be dx'd with? Does anyone know?

 

I'm not sure if this is the right forum for this, so please move and accept my apology if it isn't.

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Schizoaffective disorder is still in the DSM 5.  These were the proposed revisions, I can't get the old links to work anymore.

 

 

A. An uninterrupted period of illness during which, at some time, Criterion A symptoms of schizophrenia are present and there is eaither a major depressive episode or a manic episode.

B. During the lifetime duration of the illness, delusions and/or hallucinations are present for at least two weeks in the absence of a major mood episode (depressive or manic).

C. A major mood episode is present for the majority (> 50%) of the total duration of the illness. (Note periods of successfully treated mood symptoms count towards the cumulative duration of the major mood episode).

D. Disturbance is not due to direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition.

 

 

 

I've heard it's a controversial dx, too.  I guess they think it could really be a type of bipolar or sz (or maybe both?).  My dx was originally bp1 with psychotic features and I think depending on the pdoc it could go back to that, but sza has always been there as a rule-out.

 

This seems like the right forum to me

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I haven't seen that anywhere. I think maybe it's hard for people to understand because it's not as publicized (?) as bipolar or schizophrenia. It's one of those spectrum diagnoses that make people say it's not a real diagnosis or that doctors use it when they don't know else to use. We need to get the word out that it exists.

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I think I fit it perfectly too. It makes a lot of sense, especially explaining by I had hallucinations when I was not depressed or manic. That freaked me out. I think my current pdoc might not think that I have SZA. I have only seen him twice but he has my entire file (my previous pdoc left so I just went to another guy in the same office) though he admitted he'd just read through it a "little bit". Luckily it seems to be under control with my current medication. We'll see what this guy comes up with as time goes on.

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Thanks for your input. I also think I fit it perfectly. It explains why I've had trouble doing the basic things, but not been sad while "depressed". It explains a lot of other things too, but that's the big thing for me.

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I'm confused about something. I keep reading that the schizoaffective disorder dx is a waste basket dx and that there is a lot of controversy surrounding it. But I can't understand why. What do the skeptics believe people with these symptoms should be dx'd with? Does anyone know?

 

I'm not sure if this is the right forum for this, so please move and accept my apology if it isn't.

 

what do ou mean by waste basket diagnosis?

 

i don't know what else you'd call something that's both psychosis and affective disorder if not schizoaffective

 

isn't that ...yeah, i'm near certain that's the actual definition of those words, which describe the variety of symptom presentations...so...

 

my dear friend,with whomi started this account,was initially schizoaffective.well,initially schizophrenic, butafter three months in and they saw the mood disturbance, schizoaffective

 

he did get self recategorized to be "bp1 with psychotic features, formal thought disorder", but...that's just because nobody wants "schiz" in their diagnosis that i know...but really amounts to saying "schizoaffective, bp subtype" so far as i can see.  

 

i guess what i'm saying is that i can appreciate why an individual would push for recategorization for personal reasons...but why anyone else would try to foist something else on folkswith that diagnosis makes no sense

 

i mean, i can see if treatment would be more/less avaiable due to insurance carrying one term versus another...or if this treatment is better indicated and thus available or something...but...i guess i don't see it either.

 

seems time'd be better spent researching more options

Edited by mellifluous
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I do agree that there is a stigma to the "schiz" dx.  I remember trying to get my license here, (I am a SW) and got a rather toothy letter from the Board of SW examiners demanding my medical records. 

I TOTALLY REFUSED, BTW.   It was BEYOND an invasion of privacy.  The "investigator" had begun CALLING my MH program asking for information and stopped swiftly when I sent her a letter stating I SPECIFICALLY and CATEGORICALLY denied her access to my records in any fashion, and that she had no reason for asking for them.    Sigh.  I also called every MH program I had ever been in because some of them were state, and they are freaking bubble heads. I could totally see some secretary sending my records......

I eventually talked to her in person indicating "My doc has sent a letter stating I am fit to practice, what more do you need?  You have stated YOURSELF that this is all that is required....." (I'm pretty sure it happened because I was "flagged" as being in a public mental health center because I didn't have insurance at the time,  due to the hellaciousness of trying to transfer my license.)


She stated, "Well, if your BP, it's fine, because it IS treatable, I just want to make sure you don't have something more chronic like schizoaffective disorder, where you aren't going to be well......"

Lady, WHA????  Who are YOU to make that kind of assessment?  Schizoaffective is not treatable?  That's total crap.

It made me rather grateful I had not changed my dx as I had considered doing at one point when I fell of insurance and had to pay out of pocket for shit for a year, dude.  It was really tempting to go the schizoaffective route, but I simply don't have the dx and it just smacked of..... "don't do that."

 

But yeah, had I done so, i'm sure I would have had quite a fight on my hands and the need for a lawyer to accompany me to board hearings to keep their sticky fingers off my medical records.  So invasive.  And GOD, these are SW.   They are supposed to, you know, KNOW shit.  And advocate for people.

I have never had ANY other board treat me that way.  AZ is known for its chocolaty goodness that way, but wow, that was something I was NOT expecting.

Anna


And yes I got my license only they made me redo my 2 yrs of supervision hours.  Sigh.  It blew.

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I've read multiple academic papers that claim to disprove SZA, and claim that SZA is not a valid dx (unfortunately I can't post them here, because you need to pay to read them).

 

The main argument is that SZA is really just a psychotic mood disorder, with pronounced psychosis. They argue that SZA is not a proper disease, it's just a severe mood disorder. They argue for the dichotomous distinction between mood disorders and schizophrenia. Some also argue that SZA is simply the unfortunate state of having two disorders, not a single disorder called SZA. 

 

This is basically a moot point in my opinion. SZA accurately describes a state that a patient can be in which isn't a mood disorder alone and isn't SZ alone. I believe SZA is an invaluable diagnostic tool. It is not a wastebasket dx, it perfectly describes my condition. 

 

I do believe that the diagnostic criteria for SZA should be tight, however. For SZA to be a valid diagnosis, I agree that the mood component should make up at least 50% of the illness. Otherwise, you would be dx'ed with SZ with a superimposed depressive/manic episode, which is entirely possible. What that means is, if you have schizophrenia for 10 years and then suddenly have a manic episode, you are not SZA. You are SZ with a superimposed manic episode. That's the distinction between SZA and schizophrenia, the amount of time the mood component is there. 

 

And, thus ends my rambling. 

 

tl;dr

 

SZA is not a wastebasket Dx, it's an accurate description of many people's lives and conditions, that is distinct from both mood disorders and SZ. 

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hmm. yeah I don't know. I have schizophrenia and know bp1 peoe and really the one with schizoaffective was different in a way I can't explain. I think it's a legit diagnosis because it's different. and yeah there are differences in presentations of everyone and lots of overlap between things but there really does seem to me to be a specific and different thing calked schizoaffective.

with the person with the job: what horse shit that you had such difficulty as that's horrible! though not such a surprise to me in a sad way because are fucking bastards sometimes, you know? even those who ought to be most primed not to be. or you'd like to think so in social work. but I know a lot of bastard case managers and I try not to just unleash the cynical. bur hard not t

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I've never heard of such controversy. I've been diagnosed with all three, from different doctors. Old fashioned doctors prefer to call my bipolar some kind of schizo running on some certain apexes and greek words, I can't recall.

I think the identity crisis for the diagnosis, are because bipolar and schizophrenia are so similar in the book. In fact, if you were bipolar in the 1970's, your diagnosis would have been schizophrenia, because doctors had not yet differentiated the symptoms (even though both disorders are still often classified of the same chemical imbalance).

Edited by him
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I have been diagnosed SZA by three different psychiatrists, and I agree that sometimes it's the diagnosis that most fits some people. I have heard of this controversy before, and was quite worried.

 

What would I be diagnosed then? BP with psychotic features? Or both BP and schizophrenia? It doesn't make sense.

 

I feel like this is heavily influenced by the marketing of drugs. There are drugs to treat specifically BP, and specifically schizophrenia, but (as far as I know), only Invega has been officially approved to treat SZA.

 

I would hate it if they incorrectly labelled me, but in the end, it's recovery that matters, not the label.

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I'm becoming more and more sceptical of psych diagnoses as time passes by; the diagnoses change as the diagnosing doctor changes, and the most comical example of the messed up diagnosis system is from the book "Henry's Demons", where a doc wonders whoever diagnosed a clearly bipolar patient as SZ - turned out it was he himself. So yeah.

 

I doubt there are exact labels anyone can fit under, when it comes to the human psyche. I understand the patient's (and the family's) need for an exact diagnosis, but don't think we are quite there yet :)

Edited by Ohmy
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