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BP1 w/ psychosis in normal mood


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I have brought this up on the schizophrenia/psychoses forum, but one thing I have been wondering is how many of you have been diagnosed as BP1, even though it is clearly acknowledged that one has psychosis in normal mood? This is where I am at right now, which feels weird, since after all does psychosis in normal mood not necessarily rule out bipolar? Of course, for me, my treatment team does not seem to acknowledge that psychosis in bipolar necessarily has to occur in a mood episode. But then, what difference is there between BP1 w/ psychosis in normal mood and SZA bipolar-type? That said, my treatment team does not seem to put much value in labels in the first place. But without labels, I am left with essentially saying that I have mood symptoms and I have psychotic symptoms and leaving it at that, without having a real name for anything.

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I am diagnosed as bipolar 1 with psychosis.  I have psychosis in normal moods.  I think that I am not diagnosed as sza because the baseline psychotic symptoms are fairly mild and do not affect my functioning much, and a fairly new diagnosis of autism spectrum disorder can explain a lot of the negative symptoms.  I have been diagnosed as sza in the past, though. 

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In all the research I've done (and I've actually done a lot of research; I've been diagnosed about a month and a half or so but I started suspecting I might be bipolar because I was doing research on BP for character creation), I've always heard that psychosis outside of a major mood episode indicated schizoaffective disorder. I've also asked a few schizoaffective people and many of them have said the same, so I don't know? If your doctor team isn't satisfying you, maybe you could find a PDF of the DSM and see what they have to say about it. Especially if labels help.

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1 hour ago, Closure said:

But without labels, I am left with essentially saying that I have mood symptoms and I have psychotic symptoms and leaving it at that, without having a real name for anything.

I know what you mean ... I know exactly what you mean by having a label ... having one, it is so much easier to say one word to describe everything to someone ... I have (ie, SZ, SZA, BP, etc) ... than saying all the symptoms.  I mean the treatment might be the same no matter what the label, but labels, IMO, do matter ... at least in terms of explaining what is wrong to someone else.

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I get psychotic symptoms without mood symptoms. In fact, my psychosis was so bad once that I spent over a week in hospital. They diagnosed me with depression w/psychosis because of the content of my delusions, but I wasn't depressed. I've been depressed and that wasn't it for sure. But still my doctors prefer to think of that as "a kind of episode I have" rather than indicative of SZA.

So episodes of psychosis sans depression/mania are some kind of bipolar episode that I have, apparently. I still don't get it and I've given up trying to. My docs seem firmly convinced, so BP1 w/ psychosis it is.

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1 hour ago, jacques said:

In all the research I've done (and I've actually done a lot of research; I've been diagnosed about a month and a half or so but I started suspecting I might be bipolar because I was doing research on BP for character creation), I've always heard that psychosis outside of a major mood episode indicated schizoaffective disorder. I've also asked a few schizoaffective people and many of them have said the same, so I don't know? If your doctor team isn't satisfying you, maybe you could find a PDF of the DSM and see what they have to say about it. Especially if labels help.

No, I'm in the same camp, and you can have some psychosis outside of mood episodes and still be BP 1 with psychotic features rather than SZA. It's a matter of degree, as I understand it. My psychosis gets worse and worse with the passing years, so I really don't know if I'll be diagnosed SZA at some point. I'm not sure it really matters, to be honest. Whether you have SAD, MDD, bipolar 2, bipolar 1, bipolar 1 with psychotic features, SZA, or Schizophrenia, what difference does it really make in the end? Given my progression, I'm pretty sure I'm going to end up SZA at some point. And I have had enough really bad psychosis to put me on the hit list of authorities.

I don't really have words to respond, because it disgusts me that a docile creature like me would be incarcerated because I'm a danger to society. But in the new world order, I'm a threat that needs to be put down, and it scares me shitless. My bad behavior is limited to punching someone when I was a little kid. But now I'm a threat to society and need to be put down, despite decades of exemplary behavior. But I'm on a number of psychiatric medications, so I need to be neutralized. Because we all "know" those medications are the ones that actually make you nuts. 

How do you argue with people who are so hopelessly brainwashed? Yes, psychiatric medication can cause adverse side effects in rare instances. But so can vaccines. So should we not vaccinate our children?  Just leave everything to chance? Of course not! We know better. But the way our society treats the mentally ill is really sad much of the time. We aren't axe murders; we're people who are suffering from afflictions, the likes of which you do not even understand. We aren't going to kill you. We aren't going to kill your kids. What we want is a little a bit of sympathy and understanding for the raw deck of cards we've been dealt. We will likely die much younger than you because of medical issues. And we don't deserve to be treated like pond scum simply because of your prejudices.  

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8 hours ago, Flash said:

what difference does it really make in the end?

It doesn't, but I do think it makes a difference when explaining things to people.  Instead of saying all the symptoms you're having, a diagnosis is one word.

8 hours ago, Flash said:

And we don't deserve to be treated like pond scum simply because of your prejudices.  

Exactly.

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14 hours ago, Flash said:

No, I'm in the same camp, and you can have some psychosis outside of mood episodes and still be BP 1 with psychotic features rather than SZA. It's a matter of degree, as I understand it. My psychosis gets worse and worse with the passing years, so I really don't know if I'll be diagnosed SZA at some point. I'm not sure it really matters, to be honest. Whether you have SAD, MDD, bipolar 2, bipolar 1, bipolar 1 with psychotic features, SZA, or Schizophrenia, what difference does it really make in the end? Given my progression, I'm pretty sure I'm going to end up SZA at some point. And I have had enough really bad psychosis to put me on the hit list of authorities.

The thing is without labels, I am just a collection of symptoms. And without labels that make sense, I am wondering why I even have that label. And that is where I am now. Taking the literal meaning of the labels in the DSM5, I should be SZA bipolar-type. But both my pdoc and my tdoc agree that I am BP1. So that raises the question of why do they think that, because they must have a reason, else why would they have agreed. But they have not given me a clear reason. The only hint of a reason they have given me is that my tdoc reads SZA as meaning SZ combined with a mood disorder, as if she thinks I am psychotic outside mood episodes but not schizophrenic. But I am not sure what that means.

14 hours ago, Flash said:

I don't really have words to respond, because it disgusts me that a docile creature like me would be incarcerated because I'm a danger to society. But in the new world order, I'm a threat that needs to be put down, and it scares me shitless. My bad behavior is limited to punching someone when I was a little kid. But now I'm a threat to society and need to be put down, despite decades of exemplary behavior. But I'm on a number of psychiatric medications, so I need to be neutralized. Because we all "know" those medications are the ones that actually make you nuts. 

How do you argue with people who are so hopelessly brainwashed? Yes, psychiatric medication can cause adverse side effects in rare instances. But so can vaccines. So should we not vaccinate our children?  Just leave everything to chance? Of course not! We know better. But the way our society treats the mentally ill is really sad much of the time. We aren't axe murders; we're people who are suffering from afflictions, the likes of which you do not even understand. We aren't going to kill you. We aren't going to kill your kids. What we want is a little a bit of sympathy and understanding for the raw deck of cards we've been dealt. We will likely die much younger than you because of medical issues. And we don't deserve to be treated like pond scum simply because of your prejudices.  

I do not have such a view of things; I do not feel threatened by society in any real fashion. While I have been in IP twice, both stays were short and painless, almost too short even, with the only negative sides being the boredom and the inevitable crash following getting out. What I do have is an instinctive need to hide my psychotic symptoms from everyone IRL; I have always had this since I first started having psychotic symptoms. This is to the point that I hide it from my immediate family, and feel very anxious about letting my parents know, even though both my pdoc and my tdoc want me to bring them in so they can talk to them. Yes, my parents knowing would mean I could reality test with them and that, in general, I would not need to keep it all contained in my head around them. But while I am okay with my parents knowing I have a mood disorder, I have a hard time dealing with the idea of my parents knowing I have a psychotic disorder.

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32 minutes ago, Closure said:

But both my pdoc and my tdoc agree that I am BP1. So that raises the question of why do they think that, because they must have a reason, else why would they have agreed. But they have not given me a clear reason. The only hint of a reason they have given me is that my tdoc reads SZA as meaning SZ combined with a mood disorder, as if she thinks I am psychotic outside mood episodes but not schizophrenic. But I am not sure what that means.

(bold) Have you asked both of them why they diagnosed you as they did, and ask them to give you a clear reason of why?

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1 minute ago, melissaw72 said:

(bold) Have you asked both of them why they diagnosed you as they did, and ask them to give you a clear reason of why?

I mostly had a conversation about it with my tdoc, and while I tried hard to get clear answers out of my tdoc, I was not particularly successful. From the conversation I had with my pdoc over the phone (I needed a dx to give to my gdoc), she also basically said that dxes are for the insurance company and do not really matter.

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7 minutes ago, Closure said:

I mostly had a conversation about it with my tdoc, and while I tried hard to get clear answers out of my tdoc, I was not particularly successful. From the conversation I had with my pdoc over the phone (I needed a dx to give to my gdoc), she also basically said that dxes are for the insurance company and do not really matter.

I would press your tdoc about how she diagnosed you.  If she doesn't answer you to your understanding, keep on asking. You have a right to.  You're paying them to help you.

(I'm just this way at rare times) ... if it were me, and if tdoc doesn't give you a clear answer, then don't talk ... except for this topic.  Go in with one question, and/or more specific questions you'd like an answer to.  That is what I'd do anyway. 

I hate not getting clear answers, especially after asking over and over with no success.  Makes me wonder if they (in general) actually know what they are talking about.

I think diagnoses do matter more than for insurance companies ... in the sense that when explaining your MI to someone, you don't have to explain a bunch of symptoms; a word is easier to describe.  I mean treatment will be the same, but IMO a diagnosis helps for other reasons too.

Edited by melissaw72
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I do not think my pdoc or tdoc even really want me to think in terms of dxes. For what label to have, if I need to have a label, they both say bipolar I, or in my pdoc's case she prefers just bipolar (that is what she told me to tell my gdoc), even though they obviously have not put too much thought into whether that actually fits - I do not think they care whether it fits - and they have gone out of their way to emphasize that that is just a label, nothing more. But the thing is I do kind of want a label for what I have that actually means something.

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2 hours ago, Closure said:

The thing is without labels, I am just a collection of symptoms. And without labels that make sense, I am wondering why I even have that label. And that is where I am now. Taking the literal meaning of the labels in the DSM5, I should be SZA bipolar-type. But both my pdoc and my tdoc agree that I am BP1. So that raises the question of why do they think that, because they must have a reason, else why would they have agreed. But they have not given me a clear reason. The only hint of a reason they have given me is that my tdoc reads SZA as meaning SZ combined with a mood disorder, as if she thinks I am psychotic outside mood episodes but not schizophrenic. But I am not sure what that means.

I do not have such a view of things; I do not feel threatened by society in any real fashion. While I have been in IP twice, both stays were short and painless, almost too short even, with the only negative sides being the boredom and the inevitable crash following getting out. What I do have is an instinctive need to hide my psychotic symptoms from everyone IRL; I have always had this since I first started having psychotic symptoms. This is to the point that I hide it from my immediate family, and feel very anxious about letting my parents know, even though both my pdoc and my tdoc want me to bring them in so they can talk to them. Yes, my parents knowing would mean I could reality test with them and that, in general, I would not need to keep it all contained in my head around them. But while I am okay with my parents knowing I have a mood disorder, I have a hard time dealing with the idea of my parents knowing I have a psychotic disorder.

Yeah, the psychosis is what will make people stare at you funny more than anything else. Imagine trying to explain to people that your homicidal command hallucinations are not a threat to them. BTDT.  I once got a scary look from a neighbor that said 'stay the fuck away from me and my kids' when I complained about the beeping noise coming from her house that was driving me batshit. It was the carbon monoxide detector in her basement going off because the battery was low. She couldn't even hear it in her own house, but my senses were so heightened that I heard EVERYTING, even all the way up the hill on the far end up my house. 

When I'm in a mood episode, I often get very sensitive to light and sound. Just the clanging of dishes when loading or unloading the dishwasher can completely send me over the edge. My blinds have been drawn for over 6 months now, because I can't stand the light. And when you can't sleep on top of it, it is just so much worse. I finally understand my father. I'd be alone in the kitchen with both doors closed, eating my peas, and he would scream at me from the living room, "Stop making so much god-damn noise!" It's a running joke with my friends, because "peas are loud." My dad had MS too, which certainly didn't help matters. I haven't been tested for it in a very long time, and frankly, I don't want to know if I do. It would just be one more "fuck you" from my crappy genetic pool. 

I just want a fairly normal, simple life. I have no grand designs to change the world. It would be nice if I could simply make it to my concerts without my head fucking with me. Being paralyzed and home-bound is not my definition of fun. But if someone calls you and wants you to meet them someplace, how do you even respond? I'm like, "No, I can't go anywhere right now. I'm sorry." And when they ask you to explain why, you don't even know what to say. And so more and more friendships die, and you find yourself more and more alone. 

And if one more person tells me that I just need to "snap out of it," or " take more vitamins" or whatever, I'm gonna completely lose my shit. People don't understand when you're brain is trying to kill you, especially if it has just previously made you into a outgoing chatterbox hypersexual nutcase from hell. They don't understand when the police are trying to break through your bedroom window and arrest you. They don't understand when bombs or wrecking balls are demolishing your apartment. They don't understand why bobcats are jumping out of shopping carts trying to kill you. It just doesn't compute. 

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17 hours ago, Flash said:

No, I'm in the same camp, and you can have some psychosis outside of mood episodes and still be BP 1 with psychotic features rather than SZA. It's a matter of degree, as I understand it. My psychosis gets worse and worse with the passing years, so I really don't know if I'll be diagnosed SZA at some point. I'm not sure it really matters, to be honest. Whether you have SAD, MDD, bipolar 2, bipolar 1, bipolar 1 with psychotic features, SZA, or Schizophrenia, what difference does it really make in the end? Given my progression, I'm pretty sure I'm going to end up SZA at some point. And I have had enough really bad psychosis to put me on the hit list of authorities.

I don't really have words to respond, because it disgusts me that a docile creature like me would be incarcerated because I'm a danger to society. But in the new world order, I'm a threat that needs to be put down, and it scares me shitless. My bad behavior is limited to punching someone when I was a little kid. But now I'm a threat to society and need to be put down, despite decades of exemplary behavior. But I'm on a number of psychiatric medications, so I need to be neutralized. Because we all "know" those medications are the ones that actually make you nuts. 

How do you argue with people who are so hopelessly brainwashed? Yes, psychiatric medication can cause adverse side effects in rare instances. But so can vaccines. So should we not vaccinate our children?  Just leave everything to chance? Of course not! We know better. But the way our society treats the mentally ill is really sad much of the time. We aren't axe murders; we're people who are suffering from afflictions, the likes of which you do not even understand. We aren't going to kill you. We aren't going to kill your kids. What we want is a little a bit of sympathy and understanding for the raw deck of cards we've been dealt. We will likely die much younger than you because of medical issues. And we don't deserve to be treated like pond scum simply because of your prejudices.  

I had never heard it put that way, but it makes a lot of sense. The way mental health stuff is categorized can be so overwhelming and confusing sometimes that it's pitifully easy to get lost in everything. It's always nice to get new thoughts and information from people, so thank you.

And society... society is hard. I'm not SZA nor does my intermittent psychotic symptoms (almost exclusively when manic) bring me anywhere close. I agree that the way society handles mental health is pitifully awful, and I'm really sorry you feel so in danger by the system. I get overwhelmed thinking about these things when I do, so I could only imagine how you feel and I'd like to lend you a hug-over-message-boards.

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2 hours ago, Flash said:

Yeah, the psychosis is what will make people stare at you funny more than anything else. Imagine trying to explain to people that your homicidal command hallucinations are not a threat to them. BTDT.  I once got a scary look from a neighbor that said 'stay the fuck away from me and my kids' when I complained about the beeping noise coming from her house that was driving me batshit. It was the carbon monoxide detector in her basement going off because the battery was low. She couldn't even hear it in her own house, but my senses were so heightened that I heard EVERYTING, even all the way up the hill on the far end up my house. 

When I'm in a mood episode, I often get very sensitive to light and sound. Just the clanging of dishes when loading or unloading the dishwasher can completely send me over the edge. My blinds have been drawn for over 6 months now, because I can't stand the light. And when you can't sleep on top of it, it is just so much worse. I finally understand my father. I'd be alone in the kitchen with both doors closed, eating my peas, and he would scream at me from the living room, "Stop making so much god-damn noise!" It's a running joke with my friends, because "peas are loud." My dad had MS too, which certainly didn't help matters. I haven't been tested for it in a very long time, and frankly, I don't want to know if I do. It would just be one more "fuck you" from my crappy genetic pool.

I tend to believe that does not apply to me; after all, my positive symptoms tend towards the innocuous and invisible - except when I am looking around for people watching me - these days, mostly minor hallucinations combined with some paranoia and like, and my most salient psychotic symptoms that everyone sees are negative ones. I am not particularly afraid of scaring anyone. I can see how people would be scared by some of my past positive symptoms, namely thoughts that I am being watched and followed by unmarked police cars and that I am being hunted down by the police for crimes unknown to myself... even though those probably scare - read, terrify - me more than they scare other people. The thing is I just do not feel comfortable letting this stuff out of my head with anyone I know IRL, even if it does not scare them one bit.

2 hours ago, Flash said:

I just want a fairly normal, simple life. I have no grand designs to change the world. It would be nice if I could simply make it to my concerts without my head fucking with me. Being paralyzed and home-bound is not my definition of fun. But if someone calls you and wants you to meet them someplace, how do you even respond? I'm like, "No, I can't go anywhere right now. I'm sorry." And when they ask you to explain why, you don't even know what to say. And so more and more friendships die, and you find yourself more and more alone. 

And if one more person tells me that I just need to "snap out of it," or " take more vitamins" or whatever, I'm gonna completely lose my shit. People don't understand when you're brain is trying to kill you, especially if it has just previously made you into a outgoing chatterbox hypersexual nutcase from hell. They don't understand when the police are trying to break through your bedroom window and arrest you. They don't understand when bombs or wrecking balls are demolishing your apartment. They don't understand why bobcats are jumping out of shopping carts trying to kill you. It just doesn't compute. 

I manage to have a fairly normal, simple life. My problem is simple absence of doing things, of any sort. Even then I manage to get out, to work and to sit in a coffee shop with my cup of coffee, such that most people aside from my parents and my daughter probably have no idea of how I actually am. To most I probably am a fairly boring person, rather than a crazy one. Still, the people at the coffee shop wonder out loud when I tell them I am fine or okay when they ask me how I am doing. But that's the thing, the part I cannot hide from other people is the mood disorder, but that is the part I am generally okay enough with people seeing. No one sees the fact that I constantly hallucinate, or that I currently view Facebook as as malevolent force personally threatening me.

Edited by Closure
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