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Psychotic symptoms gaining independence from mood


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I notice a lot of people around here with SZA dxes, and I know of some people here with BP1 dxes with psychosis outside of mood episodes, so I am wondering how common is it for you to have started out with what appeared to be an ordinary mood disorder, with psychosis only occurring within mood episodes, but where the psychotic symptoms eventually gained independence from the mood symptoms, so that they now can occur at any time? Bonus points if one has also developed negative symptoms and/or cognitive symptoms separate from depression after having originally developed a mood disorder.

(That is what seems to have happened with me; my early psychotic symptoms were all tied to mania, but now seem to be completely independent of mood, and I now seem to have negative symptoms in any mood, when avolition for me was originally tied specifically to depression.)

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Closure, I always had sza as a rule out. It is hard for me to tell. They tell me I was manic when I had my first psychotic break, but later the psychosis continued while my mood had stabilized.

I am not trying to be obtuse. I just think for me, the nature of psychosis, that you usually don't know until it's over that you were having symptoms, makes it hard for me to determine what my mood had been like.

My dx definitely progressed: social anxiety (before break) , psychosis nos, bipolar 1, sza bipolar type

I am going to say that my sense is that the dx more honed in on the symptoms than that the symptoms changed. And, I just think this is the best box for the moment, but I may be labeled something else in the future.

 

I guess I didn't really reply to the right question. I just have doubts about my symptoms, too. Did I have a really long psychotic episode with periods of lucidity or did i have numerous breaks?

Edited by confused
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There are some things that I am not sure about; e.g. even in high school I had trouble with motivation, outside depression (I only had very light depressions at most in high school), and it kind of leaked in over the years, unnoticed and unchecked, long before I started having psychotic episodes outside of a mood episode; it's just that in early years I had far less motivation while depressed such that there was a very clear difference in motivation between when I was and when I was not depressed. Likewise, I always functioned poorly when living on my own; it just is unclear, now that I think of it, how much was depression and how much was something else, because in college I functioned non-ideally regardless of whether I was depressed or not, even though I did function worse when depressed - however, it was years later when I really started functioning poorly outside a mood episode.

Edited by Closure
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My current diagnosis is up in the air. 

Two pdocs have said in the past though that my cognition difficulties are likely due to the mood and psychosis. 

The rest idk. Idk at what point retreating socially and lacking interest and motivation and the ability to take care of myself would go from anxiety and laziness/depression to negative symptoms. 

I know I have holes in my clothes and that I don't wash my hair but if people want me to show up to work they'll have to put up with that. 

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I've definitely noticed a change from psychosis only associated with mania to frequent bouts of delusions or hallucinations. Depending on the content of the delusion, my docs might call me manic or depressed, even when I personally think I'm somewhere near the middle. 

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Wow. My pdoc thinks I am manic - even though even she acknowledges that I have outwardly normal mood and that the only symptoms I have that could possibly be construed as manic are psychosis, anxiety, and hyperacuity (I really have no other symptoms that could  be construed as manic at all, and she acknowledged this) - and of course anxiety and hyperacuity can be just as easily linked to psychosis by itself. It's... like she really does not want to admit that I might be SZA or something.

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11 minutes ago, Closure said:

Wow. My pdoc thinks I am manic - even though even she acknowledges that I have outwardly normal mood and that the only symptoms I have that could possibly be construed as manic are psychosis, anxiety, and hyperacuity (I really have no other symptoms that could  be construed as manic at all, and she acknowledged this) - and of course anxiety and hyperacuity can be just as easily linked to psychosis by itself. It's... like she really does not want to admit that I might be SZA or something.

That's really bizarre. At least in my experience, doctors really like to cling to their diagnoses, even when presented with contrary evidence. Your doc sounds a lot like mine in some ways. 

Anyway, this must be really frustrating for you. Sorry :-/

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18 minutes ago, Closure said:

Wow. My pdoc thinks I am manic - even though even she acknowledges that I have outwardly normal mood and that the only symptoms I have that could possibly be construed as manic are psychosis, anxiety, and hyperacuity (I really have no other symptoms that could  be construed as manic at all, and she acknowledged this) - and of course anxiety and hyperacuity can be just as easily linked to psychosis by itself. It's... like she really does not want to admit that I might be SZA or something.

My old pdoc hated the term SZA. Even though the one before her plus numerous IP pdocs diagnosed me with it. To her, that diagnosis didn't really exist. My current pdoc actually persuaded ME that I really do have SZA, I was so caught up in all the invalidating situations with old pdoc who didn't care about my persistent psychosis that I was manipulated. Needless to say, current pdoc is extremely helpful and feels 100% that I am SZA. 

I experience psychosis almost daily without any mood fluctuations. Sometimes I will feel depleted but that is from the psychosis.

My mood is stable.

I would present the facts to your pdoc. If you continue to feel invalidated maybe its time to find a new pdoc, one who listens and is not stuck in their ways...

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4 minutes ago, aura said:

That's really bizarre. At least in my experience, doctors really like to cling to their diagnoses, even when presented with contrary evidence. Your doc sounds a lot like mine in some ways. 

Anyway, this must be really frustrating for you. Sorry :-/

And get this - her suggested med change to deal with my being psychotic? Not adding more cariprazine, but rather switching out carbamazepine for valproate of all things. (She thinks that since I have been on carbamazepine for so long it has induced the risperidone I am on to the point of being ineffective.) She will see about any more changes next week. Frankly I am scared the valproate will not be interchangeable with the carbamazepine and who knows what will happen. Well, if she's right, then I should get less psychotic. If she's wrong, I will stay just as psychotic as I am now. And either way, who knows what will happen to my mood.

Why couldn't she just throw more AP at things?

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2 minutes ago, Closure said:

And get this - her suggested med change to deal with my being psychotic? Not adding more cariprazine, but rather switching out carbamazepine for valproate of all things. (She thinks that since I have been on carbamazepine for so long it has induced the risperidone I am on to the point of being ineffective.) She will see about any more changes next week. Frankly I am scared the valproate will not be interchangeable with the carbamazepine and who knows what will happen. Well, if she's right, then I should get less psychotic. If she's wrong, I will stay just as psychotic as I am now. And either way, who knows what will happen to my mood.

Why couldn't she just throw more AP at things?

I am so sorry. I don't understand why she would not add more Vraylar, that seems like it would be a good solution

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7 minutes ago, Butterflykisses said:

I am so sorry. I don't understand why she would not add more Vraylar, that seems like it would be a good solution

Because, at the end of the day, she doesn't like AAPs, and especially multiple AAPs. She would rather fuck with liver enzymes to make the AAPs prescribed already more effective than to prescribe more.

(She is kind of like my third pdoc, who prescribed me a typical, fluphenazine, before trying any AAPs... and only tried an AAP, risperidone, when fluphenazine turned out to be a catastrophe.)

Edited by Closure
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I had a doc like you who gave me Thorazine and then when that didn't work perphenazine...went up so high my next doc was appalled...then he added two more(!) aaps to that. I feel like once you've tried several you should definitely look at clozaril. But for now I guess see how the Depakote goes...but I agree weird choice 

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48 minutes ago, Iceberg said:

I had a "non-AP" doc once...it just didn't work. What's your cariprazine dose at? Is the risperdal high? Cuz if it's SZA you might need someone with more comfort with antipsychotics 

My risperidone is at 6 mg and my cariprazine is at 1.5 mg.

Note that part of my pdoc's replacing carbamazepine with valproate was that the interaction between carbamazepine and cariprazine had not been adequately studied (and presumably how she'd dose the cariprazine would depend on the nature of said interaction).

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15 minutes ago, Iceberg said:

Ok...that's logical I guess. Carbamazepine does have a lot of annoying interactions. I guess it depends on how long she's going to wait using the valproate before bringing some more AP action to the party 

She is going to see how I am next Monday, and go from there. I presume that means she will likely add more AP then if I still am having psychotic symptoms.

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