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So I have been in this spot before, 2 years back with my old pdoc. She diagnosed me with Schizoaffective. Well then I saw my recent old pdoc for 1.5 year(s) and she kept flip-flopping between Bipolar I Disorder- With psychotic features, and Schizoaffective Disorder- Bipolar Type. Well my recent old pdoc stopped taking my insurance. Being on a fixed income I could no longer afford to be her patient. So today I met with my new pdoc, who was absolutely wonderful, and she is confident in her decision of schizoaffective disorder- bipolar type. 

 

I understand why I have this dx however, coming to terms that you have more of.a psychotic disorder than a mood disorder is scary...

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Properly, all schizoaffective disorder bipolar-type means vis-a-vis bipolar I disorder with psychotic features is that you get psychotic symptoms in normal mood; plain old bipolar I disorder with psychotic features is just as psychotic, it just means that psychosis only occurs in the context of a mood episode. Of course I assume you already know this. The main implication of this is that psychotic symptoms need to be treated as themselves rather than just through treating mood symptoms. But if one is already on a mood stabilizer, an antipsychotic, and an antidepressant I do not see what would necessarily change. So then it comes down to just one feels about the dx itself, and I do not know what to say there. All in all, it is better to have a dx that more closely fits one's symptoms because then one's symptoms are more likely to be treated effectively (e.g. by trying to treat psychosis rather than just mood), which is my thought on the subject.

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56 minutes ago, Butterflykisses said:

coming to terms that you have more of.a psychotic disorder than a mood disorder is scary...

I can empathize.  When I was diagnosed with SZA, I did not accept it.  I scheduled a 2nd opinion.  Never went to the 2nd opinion DR (reasons).  The diagnosis just took a lot of time to accept, and I finally did when things started getting better with the meds.  I had a very hard time with it though.

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15 minutes ago, Closure said:

Properly, all schizoaffective disorder bipolar-type means vis-a-vis bipolar I disorder with psychotic features is that you get psychotic symptoms in normal mood; plain old bipolar I disorder with psychotic features is just as psychotic, it just means that psychosis only occurs in the context of a mood episode. Of course I assume you already know this. The main implication of this is that psychotic symptoms need to be treated as themselves rather than just through treating mood symptoms. But if one is already on a mood stabilizer, an antipsychotic, and an antidepressant I do not see what would necessarily change. So then it comes down to just one feels about the dx itself, and I do not know what to say there. All in all, it is better to have a dx that more closely fits one's symptoms because then one's symptoms are more likely to be treated effectively (e.g. by trying to treat psychosis rather than just mood), which is my thought on the subject.

Thanks for your feedback! Yes, I do know the diagnostic differences and know the psychosis is just as bad in both conditions. I guess what I was meaning was the stigma around having a psychotic disorder....

 

But I agree, it is better to have a closely accurate dx, I am sure remission relies greatly upon being on the correct treatment.

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3 minutes ago, melissaw72 said:

I can empathize.  When I was diagnosed with SZA, I did not accept it.  I scheduled a 2nd opinion.  Never went to the 2nd opinion DR (reasons).  The diagnosis just took a lot of time to accept, and I finally did when things started getting better with the meds.  I had a very hard time with it though.

Thanks for your reply. I guess I don't feel the need for a 2nd opinion because every time I am hospitalized I get dx with SZA...so I guess it is just now validated with my new pdoc being on board. Oh and I didn't even suggest any diagnosis to her, because I wanted to see what she would see accurately fit.

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Just now, Butterflykisses said:

Thanks for your reply. I guess I don't feel the need for a 2nd opinion because every time I am hospitalized I get dx with SZA...so I guess it is just now validated with my new pdoc being on board. Oh and I didn't even suggest any diagnosis to her, because I wanted to see what she would see accurately fit.

I think that because you have a new pdoc who you didn't suggest any diagnosis with ... that is kind of a 2nd opinion in itself.  Plus with the IP diagnoses, it seems to me like the diagnosis is an accurate one. (My opinion anyway).

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Depending on the setting sometimes I just say bipolar instead of schizoaffective.

I understand what you are saying. For me, it was a relief to get the dx because it made more sense for me. It had always been there as something to rule out.

If I do say schizoaffective, I describe it as a thought and mood disorder.

Like you were mentioning, for me, the psychotic element is more prominent than mood.

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yeah.. i was actually relieved whenever i first got my diagnosis of paranoid sz because i was like "wow! there's a name and now a treatment for what has been going on with me.  now there is a way to make sense of all of this insane shit that has been happening inside of my head."  it made me feel less alone.

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It sad to know you have a psychotic disorder, ugh, I felt sad when I was given the diagnosis, but at the same time everthing made sense and I got the appropriate treatment. When I was said I had a Personality disorder NOS they never helped me, or when I was said I was autistic... unhelpful...

 

Anyway, if you had just bipolar before and now SZA, but you were already taking mood stabilizer+antipsychotic the treatment won't change, it only would for people who move from bipolar to SZA who weren't on an antipsychotic.

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7 hours ago, dazed and confused said:

True, but some MI's are more stigmatised than others.

Good point.

 

7 hours ago, confused said:

Depending on the setting sometimes I just say bipolar instead of schizoaffective.

I understand what you are saying. For me, it was a relief to get the dx because it made more sense for me. It had always been there as something to rule out.

If I do say schizoaffective, I describe it as a thought and mood disorder.

Like you were mentioning, for me, the psychotic element is more prominent than mood.

It depends for me also ... but in most cases I'll say SZ instead of SZA because it sounds similar.  I have more of the psychotic element than I do mood.

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5 hours ago, strange eyes said:

yeah.. i was actually relieved whenever i first got my diagnosis of paranoid sz because i was like "wow! there's a name and now a treatment for what has been going on with me.  now there is a way to make sense of all of this insane shit that has been happening inside of my head."  it made me feel less alone.

And so much easier to explain to others what is going on.  Now it is only one word and not a bunch of symptoms.

 

 

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One thing I have found, though, is a mood disorder with psychosis in normal mood is not always diagnosed as schizoaffective. This is where I am right now; my treatment team is very well aware of my having psychosis in normal mood, yet I have been given a diagnosis of bipolar I nonetheless. Of course it does not really matter; my tdoc e.g. specifically emphasized that dxes were only for insurance companies and did not actually mean anything. But even then, I feel better having a name to things that makes sense, and while I now have name to things, it does not make sense exactly to me. My assumption is that it is that I still have a more pronounced mood disorder than psychotic one... but even then my tdoc seems to think that my psychosis is worse than I think it is.

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46 minutes ago, Closure said:

One thing I have found, though, is a mood disorder with psychosis in normal mood is not always diagnosed as schizoaffective. This is where I am right now; my treatment team is very well aware of my having psychosis in normal mood, yet I have been given a diagnosis of bipolar I nonetheless. Of course it does not really matter; my tdoc e.g. specifically emphasized that dxes were only for insurance companies and did not actually mean anything. But even then, I feel better having a name to things that makes sense, and while I now have name to things, it does not make sense exactly to me. My assumption is that it is that I still have a more pronounced mood disorder than psychotic one... but even then my tdoc seems to think that my psychosis is worse than I think it is.

My pdoc feels that because I have had days upon weeks of auditory hallucinations, paranoia, disorganized thoughts/speech, with the absence of mood episodes, its a clear indicator that I have schizoaffective disorder. Especially since I am on mood stabilizing drugs and with a stable mood experience very distressing psychosis. However, I have experience mania and depression both were considered severe. I have had psychosis while in a mood episode as well...BUT: I experience psychosis most days whilst having a normal-balanced mood. Psychosis meets the criteria for Schizophrenia, but because I have experience the POLES of mania and depression, I 100% have Schizoaffective Disorder- Bipolar Type. 

 

I find a diagnosis helps me understand myself better and helps me to explain it to others. 

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1 hour ago, Butterflykisses said:

My pdoc feels that because I have had days upon weeks of auditory hallucinations, paranoia, disorganized thoughts/speech, with the absence of mood episodes, its a clear indicator that I have schizoaffective disorder. Especially since I am on mood stabilizing drugs and with a stable mood experience very distressing psychosis. However, I have experience mania and depression both were considered severe. I have had psychosis while in a mood episode as well...BUT: I experience psychosis most days whilst having a normal-balanced mood. Psychosis meets the criteria for Schizophrenia, but because I have experience the POLES of mania and depression, I 100% have Schizoaffective Disorder- Bipolar Type. 

 

I find a diagnosis helps me understand myself better and helps me to explain it to others. 

Whereas all I can really think about it is that I have mood symptoms and I have psychotic symptoms. My tdoc explained my dx by that bipolar disorder can have psychotic symptoms... which she did not state were necessarily linked to any mood episode. It is like no distinction is being made between BP1 and SZA, and that just does not fit with my understanding of the two.

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On 25/01/2017 at 7:54 AM, Closure said:

Whereas all I can really think about it is that I have mood symptoms and I have psychotic symptoms. My tdoc explained my dx by that bipolar disorder can have psychotic symptoms... which she did not state were necessarily linked to any mood episode. It is like no distinction is being made between BP1 and SZA, and that just does not fit with my understanding of the two.

There's a difference between having bipolar with psychosis and having schizoaffective. Bipolar with psychosis you are only psychotic when severely manic or severely depressed. When your mood is stable there is no psychosis. With schizoaffective the psychosis is occurring even when the mood is stable i.e. not manic or depressed. To be diagnosed as schizoaffective you have to have been psychotic for at least 2 weeks after a manic or depressive episode. So once the episode stops and the psychosis continues then they usually diagnose schizoaffective. If the psychosis goes when the mania/depression does then they say bipolar with psychotic features. 

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8 hours ago, dazed and confused said:

There's a difference between having bipolar with psychosis and having schizoaffective. Bipolar with psychosis you are only psychotic when severely manic or severely depressed. When your mood is stable there is no psychosis. With schizoaffective the psychosis is occurring even when the mood is stable i.e. not manic or depressed. To be diagnosed as schizoaffective you have to have been psychotic for at least 2 weeks after a manic or depressive episode. So once the episode stops and the psychosis continues then they usually diagnose schizoaffective. If the psychosis goes when the mania/depression does then they say bipolar with psychotic features. 

No, the thing is I have psychosis in any mood... and yet have a bipolar dx.

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11 minutes ago, Closure said:

No, the thing is I have psychosis in any mood... and yet have a bipolar dx.

Ah ok, sorry I misunderstood what you were trying to say. That seems very unusual. It's frustrating when several doctors have different opinions on what disorder it can be. For me they can't decide if I have bipolar or schizoaffective or schizophrenia. You'd think that if the symptoms were clear cut then it would be easy to make a diagnosis. I guess there's probably other things that they look for to determine the right diagnosis. Who knows?

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