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While in hospital my doctor suggested I might have schizoaffective disorder because I seem to have chronic delusions. So I have a few questions for people who got diagnosed SZA:

1. How long did it take from when your doctor first started to think SZA to getting a diagnosis? From what I understood from my doctors, they'd want to monitor me over time.

2. I don't really get hallucinations outside of mood episodes, and very little within mood episodes too. My main problem is delusions. Can anyone else relate to this? I aways thought for a SZA diagnosis there needed to be a lot of hallucinations on top of delusions, but maybe not.

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I had schizoaffective as something to rule out for 3 years before a pdoc decided that was the most accurate dx. I had delusions/hallucinations (more delusions) both in and out of mood swings when my meds weren't working right or before meds. Now, I have few symptoms.

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I was diagnosed while IP.  I started with my pdoc that same year, and it didn't take very long for the SZA diagnosis because he'd read my hospital records and over the years, to him, it was obvious I had it but no one had picked up on it.  So it was probably a couple years until he formally diagnosed me.

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All my episodes happened while untreated.

I was cogitated once as SZA because every manic episode that I had I become psychotic and the last episode I developed a residual delusion.

For me, this residual delusion just went too far;

I went to different PDOCS to evaluate me, after some time I just focused on my main concern that was what I thought as 'residual delusion' without acknowledging that what started as a delusion at that time was some 'post delusional stress' that I was obsessed with and struggling to let those thoughts go.

One appointment while stressed that those dualistic thoughts didn't vanish, I focused on that 'delusion' to this PDOC and PDOC cogitated me as SZA.

After a while, what I thought as 'residual delusion' become clear to be too dualistic and losing the main traits of a delusion. 

I did therapy focusing on this delusion and I was so divided because in one hand I thought 'the delusion' was something ridiculous and another part of me gave it a possibility of being true.

Therapist liked to use the term fantasies to describe those 'symptoms', giving a meaning that what I called a delusion, just a thing I was fantasying, obsessed and wanting to be true.

Sticking with treatment the progress I made just confirmed the previous diagnosed of bipolar 1 disorder but after responding too well to lamotrigine I went from Bipolar 1 to Bipolar II.

I'm back on bipolar I diagnose because lamotrigine was too activating and I just go to a rough mania if I don't treat myself right.

I don't know.

I would not stick with those diagnoses because they are based on my symptoms and how I respond to the treatment.

What apparently is working for me is focusing on the treatment of my symptoms.

Therapy played a huge role on delusional thinking and maybe the nature of it helped too, it was a remain from an episode and not something that would chronic appear outside an episode.

Took time to observe the nature of it all and no diagnose is out of the table.

 

Edited by uncomfortable thoughts
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The new diagnostic guidelines for diagnosing SZA in the DSM-5 emphasize taking time to observe before making the diagnosis. I believe you need to have at least two episodes before a diagnosis is validated (this has been somewhat hard for me to accept as I was diagnosed with SZA and now I have medical types telling me I probably don't have it, or they need more evidence to verify it, etc).

Apparently it was "too easy" to diagnose people with SZA under the DSM-IV.

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3 hours ago, Bellatrix said:

The new diagnostic guidelines for diagnosing SZA in the DSM-5 emphasize taking time to observe before making the diagnosis. I believe you need to have at least two episodes before a diagnosis is validated (this has been somewhat hard for me to accept as I was diagnosed with SZA and now I have medical types telling me I probably don't have it, or they need more evidence to verify it, etc).

Apparently it was "too easy" to diagnose people with SZA under the DSM-IV.

 

Well it sounds like your doctors are doing the right thing, then, @aura, by monitoring you over time. I wish I could help you out with this, but I still don't have a formal diagnosis of anything but "some form of psychosis".

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22 hours ago, aura said:

While in hospital my doctor suggested I might have schizoaffective disorder because I seem to have chronic delusions. So I have a few questions for people who got diagnosed SZA:

1. How long did it take from when your doctor first started to think SZA to getting a diagnosis? From what I understood from my doctors, they'd want to monitor me over time.

2. I don't really get hallucinations outside of mood episodes, and very little within mood episodes too. My main problem is delusions. Can anyone else relate to this? I aways thought for a SZA diagnosis there needed to be a lot of hallucinations on top of delusions, but maybe not.

I don't think it matters whether you are having delusions or hallucinations. I actually have the opposite presentation most of the time, and my pdoc has never suggested that I might be SZA. If I'm not mistaken, the main criterion for being diagnosed SZA rather than bipolar with psychotic features is the presence of psychotic symptoms outside of mood episodes. That's rather infrequent in my case, hence the BP dx rather than SZA. 

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@Flash Well, I talked with my therapist today and she thinks I have lots of auditory hallucinations. So I guess that part of my post isn't true. It's really hard to say if I was depressed this past episode. I was a little, but definitely not "severe." Was quite mild. Not sure what that means. 

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2 minutes ago, aura said:

@Flash Well, I talked with my therapist today and she thinks I have lots of auditory hallucinations. So I guess that part of my post isn't true. It's really hard to say if I was depressed this past episode. I was a little, but definitely not "severe." Was quite mild. Not sure what that means. 

Most of my psychosis happens while depressed, for whatever reason. It's curious that your therapist thinks you're having auditory hallucinations when you yourself don't. I would think that you need to have the perception of hearing in order for it to be a true hallucination, which should be pretty straightforward. But when the knives were "whispering" to me 2-3 weeks ago or so, I didn't physically hear the sounds (or have a false perception of such). They were inside my head, rather, sending messages. It was as if I heard them, but not really. Hard to explain, I suppose. I considered it a delusion, in any case, but I guess some would call it a hallucination. When I do have a "real" hallucination, it is 100% real in effect. I can't tell the difference between that and the actual sound in real life whatsoever. But perhaps that just illustrates the difference between a hallucination that's inside the head and one that's outside the head.

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52 minutes ago, aura said:

@Flash sorry, my post was a bit unclear. I did think they were hallucinations, but my IP pdoc didn't. Then tdoc took my side and said they are hallucinations. Very confusing!

Oh, I see. That would be confusing indeed! Perhaps it is less important that you can recognize the specific form of psychosis, as opposed to just recognizing when you're having some form of psychosis, however. 

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It might be SZA. Only your pdoc who you've worked with for the past years can decide on that. I'd be leary like you feel to trust a temporary IP pdoc and a temporary tdoc who don't see you regularly or for very long like your OP pdoc and regular tdoc. Also your regular tdoc should have a say too (that has been my experience). I know you are seeing a temporary tdoc who focuses on and specializes in psychosis as her main focus. So that's good anyway. As many agree here it is the proper treatment that matters the most. 

Regarding the auditory hallucinations, I've always been told the same as flash. I always am asked by drs if I hear voices outside of my head like through my ears. I know others here disagree with what I've been told by many pdocs however. So I don't know what to think regarding a voice thought in one's head as hearing a voice. It is very confusing you are right!

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Yes, I've been told hearing voices in my head was a hallucination, and it's weird to me how much some people on this forum insist that it's not, or that it's a "pseudo-hallucination" or any other variation of making them sound less serious than they are.

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About voices, my experiences and why I'm not fitting SZA in the progress or recess of my mental health.

I had one episode that voices were involved.

If the other ones had it, the voices were just too subtle.

I can't recall hallucinating outside an episode or without inducing it.

Describing the episode that I hallucinated the most and included voices:

First I went to a very acute manic stage where I become sleep deprived for some days.

It started with just one voice making some funny comments about things around me.

This voice was inside my head.

I wasn't trying to find where it come from and it differ from my own voice because I could not shut it down or had control over it.

After some time or a day, it become clear that I was hallucinating that voice and this voice could also tell me what people were thinking and also had a little bit of prediction powers.

That voice become more than one as more stressful I got not only because of the first voice.

As I got a head full of voices, those voices talked to each other, narrated things, made some jokes and even impersonates public figures. 

I knew I was having a sort of 'breakdown' but I thought that my brain was readjust itself and healing so I would have to go trough that process and everything would eventually be over.

It started very harmless but I was becoming very stressed.

Unfortunately from very entertaining, those voices become judgmental and I started having more types of hallucinations.

The voices started demanding some actions and that was it, I broke down in a subway cab after going against that f#cking voice.

After getting some sleep, the voices were the first thing to go.

The main delusion that every episode that I have had are delusions of reference.

I can see/hear messages from anything. (TV, music, internet and even random small talk with strangers.

Those delusions for me are tougher to treat.

Again, all my episode were untreated and this last one with voices, a bunch of hallucination and delusions.

I only went to treatment after almost a semester of it's acute phase, which could be the reason why took me so long to 'solve' my 'delusions'.

I put "delusions" like that, because I was more intrigued with what happened to me than having symptoms.

I hope this helps out.

I truly can't remember voices outside of my head as something as trouble as the ones that were inside my head.

I think what helped me was accepting that I had something wrong going on.

Took me some episodes to fit in some diagnose, not every episode had the same 'stressors'.

First one had drugs.

Second one, life stressors were high and I was drinking too much coffee and smoking almost four packs of cigarettes a day.

Third I smoked some weed but I truly can't connect it because what made me snap was a life opportunity that I was clearly not ready to take.

Edited by uncomfortable thoughts
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2 hours ago, uncomfortable thoughts said:

After getting some sleep, the voices were the first thing to go.

That is the way it was for me too.  Lack of sleep would worsen the voices (and delusions).  But once I got some sleep, they'd go away.  Not for good, but even temporarily was a little break from them.

 

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Just being up for longer than 16 hours can result in paranoia for me. Not necessarily voices that I can recall, but missed sleep nearly always results in me sliding into some degree of psychosis.

And I mean paranoia like "My 12-week old kitten is plotting to keep me awake" thoughts. Fortunately, I was able to cut that off before it got serious and convince myself that there's no way a 12-week old kitten could be that diabolical, she just wanted to sleep next to me and wasn't very good at it.

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i don't have schizoaffective as my diagnosis (it's (fmrly paranoid) schizophrenia), but i did want to comment on the whole whether hallucinations count/voices count.

 

the new criteria actually makes less sense to me in this respect as it did away with single qualifiers. 

 

i found this on "the new dsm 5": 

Quote

Schizophrenia: Criterion A lists the five key symptoms of psychotic disorders: 1) delusions, 2) hallucinations, 3) disorganized speech, 4) disorganized or catatonic behavior, and 5) negative symptoms. In DSM-IV 2 of these 5 symptoms were required. However, only 1 of the 5 symptoms was required if delusions were bizarre or if hallucinations included a running commentary on a person’s thoughts/behavior, and/or two or more voices conversing. This exception has been removed for lack of specificity and poor reliability. This change makes intuitive sense. The notion of what constitutes “bizarre” is rather vague, and its removal reduces cultural bias. In DSM-5, two of these five symptoms are required AND at least one symptom must be one of the first three (delusions, hallucinations, disorganized speech).

the reason i think it pertinent is that that commentary isn't specified as being internally located or outside of one's mind (even if from another part of the body). and i've always thought that the two or more conversing could just as easily be inside as out. that said, only one of my voices has had internal access, but that was the one that was identified as giving "command hallucinations", so certainly wasn't dismissed diagnostically in my case. not by a longshot. i wouldn't say that those originating outside of my head ...well, they all come from outside my head, it's whether they can access me directly inside, too, or if i hear them but they're not in there...it's hard to explain.

 

anyway, posting to say that the old criteria and the subtypes still make more sense to me and maybe didn't have the same tendency to discount internally located voices when they're clearly not "you". hope that makes sense. best to you xx

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@mellifluous

I think in the DSM-5 those criteria in schizophrenia have to meet a chronic, not an episodic or even a single 'appearance'.

To make a better diagnose, the patient would have to be monitored.

Those chronic symptoms has to differ from mania.

Mania alone would make someone schizophrenic if only this part of the DSM would be take in account.

Delusions of grandeur and mania walk together, and to be honest I would like to know how to be manic and not having delusions of grandeur and not having disorganized speech, because depending on the 'audience; and the velocity you're speaking this would also make a symptom in almost every manic episode.

What could be a disorganized speech, could also be pressure to speak and to distinguish from that would take someone with experience to rule a pressured speech usually characteristic of mania.

For me it doesn't make sense without the nature of the symptoms, so this "fit one of those three" would have to be placed on remission or evolution of symptoms and have to exclude induced symptoms.

Would be risky to work on those guidelines without monitoring the patient.

-----------

The type of auditory hallucinations that I had at least for me was clearly 'me' and 'in my head'.

I don't think it's something supernatural or from a sci-fi movie rather than my brain not working properly, I can be wrong, but this makes more sense to me.

I think if it come from somewhere else I would seek those voices and also, most of the voices that would do impersonations were also the same impersonations that with 'conditioning' I could also do and vocalize.

I hope this makes sense.

Edited by uncomfortable thoughts
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32 minutes ago, uncomfortable thoughts said:

@mellifluous

I think in the DSM-5 those criteria in schizophrenia have to meet a chronic, not an episodic or even a single 'appearance'.

To make a better diagnose, the patient would have to be monitored.

Those chronic symptoms has to differ from mania.

Mania alone would make someone schizophrenic if only this part of the DSM would be take in account.

Delusions of grandeur and mania walk together, and to be honest I would like to know how to be manic and not having delusions of grandeur and not having disorganized speech, because depending on the 'audience; and the velocity you're speaking this would also make a symptom in almost every manic episode.

What could be a disorganized speech, could also be pressure to speak and to distinguish from that would take someone with experience to rule a pressured speech usually characteristic of mania.

For me it doesn't make sense without the nature of the symptoms, so this "feet one of those three" would have to be placed on remission or evolution of symptoms and have to exclude induced symptoms.

Would be risky to work on those guidelines without monitoring the patient.

-----------

The type of auditory hallucinations that I had at least for me was clearly 'me' and 'in my head'.

I don't think it's something supernatural or from a sci-fi movie rather than my brain not working properly, I can be wrong, but this makes more sense to me.

I think if it come from somewhere else I would seek those voices and also, most of the voices that would do impersonations were also the same impersonations that with 'conditioning' I could also do and vocalize.

I hope this makes sense.

i don't think i understand the top half of your post. i mean, i don't know what velocity you're speaking of. maybe there's confusion because, like i said, i don't have schizoaffective. i have schizophrenia, formerly the paranoid subtype. i've also gotten the undifferentiated subtype and once the disorganized one. i've never been diagnosed manic but i do realise that for a schizophrenia diagnosis you need to have the symptoms for a period of time. 

 

i'm just confused, i don't think i understand the top part. as far as how your auditory hallucinations work, i think they're just somewhat different from mine, but thank you for sharing your experience. that part does make sense as you wrote it, it's just not the same as mine, but i see where you're coming from there.

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