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Hi --- This might sound kind of weird but here it goes:


Okay so I have been non-functional for most of my life. I mean, I have been on medications since I was 15, unable to work or finish college, anything, I have lost most of my friends. I can't seem to leave the house lately. I feel " off" I mean I feel like I might be Schizoaffecive. I don't hear voices and I don't get manic ( I think) but I do get delusional sometimes and paranoid. My Pdoc thinks it is because I got really bad insomnia and for a over a year I couldn't sleep he put me on low-dose Seroquel a year and a half ago, but I still sometimes feel kind of psychotic or off or weird, especially when I try to go out somewhere and I am around a lot of people. I feel like people might be looking at me. I think I always look different and that people are judging me based on how I look that day. Like every time I walk past my reflection I see a different person. I am completely scared because I no longer feel like myself. I'm not even sure I know who I am anymore.


I was once diagnosed as Schizoaffecive years ago from 18-26 but no longer because one of my symptoms changed and I could function fine for 4 years without an anti-psychotic. I think I was diagnosed  as Schizoaffective  because I had several pdocs and therapists who thought my " thought process" seemed off and my reality wasn't really " reality" per say I have never heard voices or seen things. My last Doctor ( who I just left) thought that all of these things I am mentioning were because of my insomnia, BPD, depression and anxiety. 


I am going to see a new doctor next week and I am afraid she is just going to keep me on Seroquel because of my sleeping problems. I am so tired all day on Seroquel and I want to switch to another medication, but I even more scared of taking a higher dose or another anti-psychotic as they all cause weight gain for me and that makes me feel worse when I go out. I feel like people look and talk about me more when I am heavier. 


How do I ask the new Pdoc to reevaluate me? Should I just go ahead and take another anti-psychotic?



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Well, look into Schizotypal Personality Disorder. It is described as "Distorted Reality". It's like Schizophrenia-Lite or something where psychosis is limited and you keep insight most of the time even while not on meds. Though from what I've seen Pdocs don't usually hand out that diagnosis for whatever reason. When I took my personality inventory test, it said schizoid, schizotypal, or Schizoaffective diagnosis recommended. And so my Pdoc just slapped the largest DX on me and called it a day. Though, I personally feel schizotypal fits me better due to my insight. In reality, it doesn't matter because it's all in the same spectrum (minus the affect in schizoaffective), treatment is usually the same.

As long as your treatment plan works for you, it doesn't matter what your diagnosis is.

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Is is possible that your psychotic symptoms are actually related to your borderline personality disorder Dx? This article talks about transient psychotic symptoms in BPD patients: http://www.jfponline.com/Pages.asp?AID=564


In the article, of particular interest is the part that talks about a girl with BPD who hears voices after her boyfriend breaks up with her:


Voice 'calling my name.'


When the psychiatric resident inquires further, Miss A says a male voice is calling her name and mumbling some short phrase she cannot understand. She says she has heard the voice the last few days, perhaps for 10 to 15 minutes every few hours, particularly when she ruminates about how she messed up a relationship with her now ex-boyfriend. The breakup occurred 1 week ago.


I'm not diagnosing you or anything. It's just food for thought. And something to possibly mention to your pdoc?


Normally psychiatric Dx's are made after periods of observation. So, if your pdoc has been observing you for a while and has not Dx'd you with schizoaffective, chances are they will not change their mind. But it's worth bringing up if you think it will change your treatment. Symptoms guide treatment, not really diagnosis. So, your diagnosis isn't necessarily as important as treating your symptoms. 


If you and your pdoc think another anti-psychotic will help, I say give it a go. It's worth a shot if it could improve your life, and address the symptoms you're describing here. 

Edited by Parapluie
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