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lysergia

what changed your dx? (from BP to schizoaffective)

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i am probably jumping the gun with this.  please humour me anyway.  i'm feeling anxious about what's happening with me lately.

 

i've probably said it a million times here already, that i've developed hallucinations that have so far persisted for the last 9-10 months.  for the first few months i thought the auditory hallucinations were real.  i know now that they're not, just like i can figure out that the shadow animals and the raindrops i can feel falling on me aren't real.

 

i didn't tell pdoc or tdoc until about a month ago.  the idea that someone is going to tell me i'm making it up is a huge fear for me even if i'm talking about having the flu.  it's happened so many times in my life, beginning in childhood, that not being believed is probably my biggest trigger.

 

now that they know, i'm back to taking an AAP (in the past i've used them as mood stabilizers and short term relief from mixed states).  zyprexa should take care of the hallucinations, i'm told.  which makes sense.  but pdoc mentioned at the end of my appointment that if that doesn't work, she wants to physically have my head examined.  that's scarier than being told i'm psychotic in some way.

 

i've only been on z for a week but i swear it is WORSE.  louder, more persistent, and driving me UP THE FUCKING WALL.  it gets hard to concentrate.  sometimes i can't hear people or the tv because the hallucination is too loud.

 

none of this seems to have a mood component.

 

so maybe z just isn't working YET.  maybe i need to take more (i'm on a small dose because i've suddenly developed a lack of tolerance to anything sedating).  either of those things would probably ease my anxiety about it.  but i can't stop thinking of (a)if it does work, what does that mean?  what happens with my dx?, and (b) what happens if it doesn't work at all, and in fact really IS making this worse?

 

i told you i might be jumping the gun.  doesn't matter, i'm still afraid of what is unknown territory for me.  i've only ever had hallucinations during severe mixed states before.  and it wasn't like this.  and they didn't last.

 

aaaaaaaaaaaaaaand she finally gets to the question in the title... what events/symptoms led you to have your dx changed to BP+ psychotic features, or schizoaffective features?  has anyone here been BP for a long time, then developed these kinds of symptoms? 

 

thanks for humouring me.  i just need someone to say something that will stop me from worrying about this i think.

 

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I had psychotic symptoms all along but my dx was bp1 with psychotic features with sza as a rule-out.  But, I saw a different psychiatrist at an outpatient program and I was still paranoid/delusional but I didn't have any apparent mood symptoms so he dx me as sza and when I asked my pdoc about it he decided to change it.  But, for me I think it depends on the pdoc and someone else may say it's bp1 again.My main symptoms were psychotic ones- the moods seemed minor.  It didn't change anything except my aap was increased to try to get rid of the residual symptoms.  They did eventually go away.

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I also have psychosis with my BPI--it only happens during a mood state though.  I didn't used to have psychosis, and I have no idea what caused it. At first, I chalked it up to sleep deprivation issues, but then I ruled that out as soon as I was sleeping almost all of the time (depression) and I had it, too.  I did have an MRI done to rule out anything biological.  I think that's just SOP.  My personal belief is that it just may be the nature of a degenerative disease.  I have no scientific data whatsoever to back that up.

 

Zyprexa is really the only med that works for me, but I have to take a decent dose (10 mgs), and I can only take it very short-term.  It works very quickly for me, but it has intolerable side effects.  I wrote about it in my blog, but basically, I take it and prepare to sleep for the next couple of days.  It's kind of a shotgun approach--it just knocks me out, and when I wake up, things are usually a bit better.  Kind of a "reset" in a way. I have tried a lower dose, and it doesn't do anything for me.

 

I'm sorry you're struggling with this.

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I used to have the Dx of bipolar NOS with psychotic features. Around a year ago, during a depressive episode, I woke up psychotic. Just, BAM! Psychosis. I have a theory that my depression was so bad that my brain just decided to fuck it. 

 

Anyway, I woke up psychotic and just never recovered.  The depressive episode ended, no hypomania or anything. I just continued being psychotic for months. My pdoc then changed my Dx to schizoaffective bipolar type. Since then I've had more psychotic episodes but no more mood episodes. My pdoc refers to my illness as a psychotic disorder, not a mood disorder. It seems that psychosis is my main problem. I've been in remission from psychosis for about 5 months now though. :)   

 

Technically, to be Dx'ed with schizoaffective disorder, you just have to have psychotic symptoms in the absence of mood symptoms, for two weeks. But, my pdoc says psychiatry is as much an art as it is a science, so Dx's are very individual. Maybe you'll be Dx'ed schizoaffective, maybe you won't. Hopefully your psychosis goes away though! And I hope the head examination goes well. 

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Maybe your head examination will be an MRI? I read that at first and and was like OH GOD THEY ARE GOING TO BIOPSY HER BRAIN

 

Stress really made me become psychotic. But my brain was actually deteriorating over the course of a couple of weeks--I can recall it so clearly. I did seek help but the early stages didn't look like psychosis but anxiety. The pdoc who dxed me as SZA is on maternity leave and the pdoc I see in place never mentions my diagnosis. He asks about symptoms. Same as my primary doctor. On my bloodwork though depending on who does it and the insurance needs a diagnosis to pay for labs, dxs range from Abnormal Bipolar, Schizoaffective, Schizophrenia Undiff, Bipolar 1 Psychotic Features. So it really depends.

 

I just had to change meds again so things are hard, again.

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I agree with the stress, and also lack of sleep, contributing to making delusions and hallucinations 100x worse.  I still have them even on meds, but with stress and no sleep, at times it seems sometimes like I am on nothing.

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My diagnosis was changed after I took an MMPI. It showed a lot of SZ symptoms and that lead to a discussion about my psychotic symptoms. Then it was determined that I had SZA because I still had bipolar components in addition to the psychotic episodes.

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I started rattling off my psychotic symptoms to my pdoc, and I could tell he was frustrated that this was the first time I mentioned it. So he changed it to SZA. He said that it's probably why I don't stay stable for long.

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Hi there,

 

First, my MRI was not so bad, mostly loud. It is nice to have a little rear-view mirror so you can look out the back of the tube.  I also had a lumbar puncture, not bad. I was at the point where I was hoping it was something physical.

 

While no one ever said SZA to me, I have had hallucinations in the absence of a mood episode (I have also had the visionary mixed-state thing).  I think they were  from med changes (add Lamictal, d/c AP) or just from emotional triggers. (Oddly, the genuine crises have not been a problem, but strange little memories were, before my meds got settled).  I am sorry for what you are going through -- it is much more intrusive.

 

Zyprexa helped me greatly.  I think I need 7.5 or 10 mg for at least 3 days.  Haldol helped too, but not as much, and it made me too sleepy as a maintenance med.  I do know that Abilify made me much worse, but not strictly hallucinatory.

 

This is worth a phone call. You should not have to put up with it.

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thank you all.  it helps a lot to know other people go through this.  i struggle with the idea that i should have had these symptoms all along if i were psychotic in any way... but i suppose it doesn't always work like that, then, if i'm not the only one.

 

heh, my first thought wasn't that they were going to biopsy my brain - it was OMG I HAVE A BRAIN TUMOUR.  obviously that's REALLY unlikely.  i think she meant just standard tests (MRI, cat scan, EEG).  it just freaks me out a little because i've never seen a neurologist.  i'm used to having a bazillion blood tests from the lithium, lamotrigine, and synthroid.  but not actual scans of my head.  i admit i'm a little curious, though, underneath the anxiety.  i'd like to see my brain in pretty colours. :)

 

i see my pdoc again next week.  until then, i'll find ways to tolerate the noise.  clonazepam will probably lessen my frustration at least.  you know i'm desperate when i resort to those.  after two bouts of benzo withdrawal (hell on earth, second only to mixed states), i hate the thought of taking them again.  then again if it's a neurological thing, the clonazepam might make it stop altogether for a little while.

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I was the opposite. I was dx'd sza (schizoaffective) and it was changed to bipolar disorder with schizotypal PD. Which is currently being changed to BP with psychosis.

It's all crazy!

It also depends on the doctor.

Quite honestly, schizoaffective and bipolar with psychosis are so similar they should be the same thing but that is MY opinion, not that of the DSM, and what else.

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thesystemisdown, i can't quite parse what the difference is either.  which i suppose is unimportant as long as something actually works, right?

 

Wonderful Cheese (i wanna call you Cheesy so bad!), i'll be seeing my pdoc this coming Tuesday (four more days!).  thanks for asking :)

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My BP recently got changed to schizoaffective + BP. When everything first started for me, the mental health team that assessed me ran all the tests but neglected my constant/daily complaints of my chronic lack of sleep and feeling anxiety all the time. I guess my chronic insomnia + me complaining about my job all the time but at the same time enjoying my career, just hating the people around me = BP diagnosis. Wish they woulda just gave me some xanax and sleeping pills while under close observation from the beginning, but that's all in the past now. I experienced both true mania and depression for the first time in my life when I started BP meds(Lamictal, you can read my earlier posts on this forum to see how that went lol), so deep down, I knew there had to be more to this than just BP.

 

Anyhow, after finally talking with a certified psychiatrist and telling her that I've been seeing shadows and feeling paranoia/anxiety for over a year and a half, she quickly addressed those concerns immediately and got me on meds that are attacking these issues head-on, Thank God. I'm not out of the ballpark yet but I get 8 hours of sleep at night now and don't see creatures/people/shadow things invading my reality anymore, so that's a start. I'm on a low dose of lithium and take Seroquel at night. I also take micro-doses (0.25mg) of klonopin throughout the day to keep my head in the game. It's all I can tolerate for now since I still have to hold down a full-time job involving heavy machinery and not so bright people  :closedeyes:

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thanks for sharing that, Check.Mate.  i'm glad someone took you seriously eventually, but damn a year and a half is a long time.  heavy machinery?  you're a brave soul - i can see why microdoses would make sense for you.  i'm scared of big machines heh.  i'm also afraid of my lack of concentration, so the heaviest machinery i operate is a coffeemaker. :D

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Quite honestly, schizoaffective and bipolar with psychosis are so similar they should be the same thing but that is MY opinion, not that of the DSM, and what else.

 

You are not the only one with this opinion. Many people in psychiatry actually believe there is no such thing as schizoaffective disorder, only psychotic mood disorders. They have interesting arguments!

 

But yeah, they are so similar that the Dx doesn't really matter, cause treatment is exactly the same. 

 

Thinking of you, Lysergia. :)

Edited by Parapluie

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thanks :).  two more days and i get to dump my bazillion questions on pdocs desk!

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I hope all goes well lys. I see my pdoc on Thursday the 23rd, to hopefully clarify things and get me off the f'ing Depakote.

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