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After the breakthrough symptoms of the Thursday before last through last Sunday, which was marked by significant paranoia, I expected my pdoc to make changes to my meds to help stamp this sort of thing out. But when I talked to her, she talked about learning through therapy to tolerate some level of psychotic symptoms rather than just throwing more meds at the psychosis. To me this kind of seemed like giving up, and after all I want no psychotic symptoms not just to cope with them better. After all, things have not always been this way, having gone years without any psychosis at all in the past; I want to get back to that. And sure, I am on two antipsychotics right now, so maybe she thought I was on a lot of AP in the first place (she is squeamish about multiple APs to begin with), but could she not at least try changing one of the APs to one that is more effective, as the ones I am on right now sure are not proving effective if I have breakthrough symptoms like these? So if my pdoc is not going to change my meds, what can therapy do to help in the first place?

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There are skills you can adapt to recognize and try to discredit delusional thinking, as well as learning how to reality check on a daily basis, but a lot of dealing with psychosis is done through medication. It sounds like your psychiatrist isn't providing the flexibility you need to try and quell your symptoms, even if you are on 2 APs. Have you thought of getting a second opinion?

Edited by Swamp56
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I would get a 2nd opinion, reasons being I think the goal should be to minimize psychosis through medication. I explained to my pdoc that therapy never helped because when I go into psychosis I don't have the mental capacity to utilize coping skills..I am completely unable to reason with. So after failing on multiple AP/AAP my doctor put me on clozapine and I have been on it a great while, my psychosis is.a world of difference. 

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2 minutes ago, Butterflykisses said:

I would get a 2nd opinion, reasons being I think the goal should be to minimize psychosis through medication. I explained to my pdoc that therapy never helped because when I go into psychosis I don't have the mental capacity to utilize coping skills..I am completely unable to reason with. So after failing on multiple AP/AAP my doctor put me on clozapine and I have been on it a great while, my psychosis is.a world of difference. 

I second trying Clozapine if you haven't already. Some therapy can help but ultimately dealing with psychosis requires getting the right medication.

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I don't feel I am ready for clozapine at this point, since I am on the only set of APs that has really failed on me w.r.t. its AP effect - and there is still some room to go up (the cariprazine can be increased to 6 mg, even though the risperidone cannot really be increased due to EPS even with benztropine). I have tried other APs, but they have been discarded for other reasons. And anyways, the bloodwork would be a major hassle.

Therapy might actually work for me, because I retain insight and apparently am quite cognizant even when markedly psychotic. Supposedly I already cope quite well with being psychotic - e.g. I remain outwardly functional enough even at my most delusional - even if it does not always feel that way to me (of course I don't have anything to compare myself against in this regard IRL). This bodes well for therapy working.

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I've been told to try therapy. For my psychosis. Basically just to help deal with command hallucinations. Right now my dx is Schizophrenia NOS. I take Lithium, Zyprexa, and Seroquel. All at the max dose except for lithium. Some psychiatrists want me to deal with the voices and paranoia, others want to heavily medicate me. I've been on I think about between 12-15 antipsychotics. I'm only 23. Sometimes less medicine is better. Either way, I hope you find some peace within your own mind.

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I haven't found therapy to be very effective for psychosis. I'd push your pdoc to try different pharmaceutical interventions. For me zyprexa has really stamped out my psychosis, and I wouldn't want to go back to where I started. Surely there's something more you can try before just accepting constant psychotic symptoms.

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My pdoc has done this sort of thing before - she will not change my AP rx when I have a seemingly isolated short delusional episode after having previously been stable (mind you that to her having limited minor psychotic thoughts and hallucinations is still stable) unless I have further episodes that demonstrate that this was not isolated. In this case was four or five days of marked delusions, preceded and followed by periods of limited delusions (the preceding period was several weeks long. This is probably a product of her having a very conservative mindset as a pdoc.

Personally, I rather she would simply stamp out all the psychosis right off the bat, no matter how much meds and how many med changes it would take. Even occasional episodes of more marked delusions are highly non-ideal. Even a constant low-level background psychosis like I have had since at least last November if not earlier is non-ideal.

Edited by Closure
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I had CBT for my voices and paranoia a couple of years ago. It kinda helped with the voices I suppose but not to a great extent. I don't have a lot of insight into my paranoia when it's bad so the therapy didn't help for that. I'll give the guy points for trying though, he was really thorough and went through everything with me. I think you definitely need to need to quash your symptoms with APs as therapy only had a limited effect (for me).

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I agree with a 2nd opinion.  Or something in your meds might not be working, or maybe needs a med tweak? 

I would hate to have psychosis and have to deal with it with therapy and without med changes or anything.  Personally it would probably bring out more psychosis in me, making things a lot worse.

I have also heard of zyprexa working, like @aura was saying.

But I'd still go with the 2nd opinion.

 

 

 

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My meds seem to be suppressing most of my psychosis - I no longer am markedly psychotic all the time - but not completely enough that I don't have a constant low background level of psychosis or occasional more pronounced breakthrough symptoms. I probably do need a med tweak if all psychosis is to be suppressed completely. I am not confident that simply increasing my current meds will do it, since I don't have much room to go up.

I have thought of trying olanzapine, so if I have more breakthrough symptoms I will mention it to my pdoc. However, I fear the side effects of olanzapine, so another possibility I thought of was asking for an olanzapine prn, so I can suppress breakthrough symptoms effectively without having to take olanzapine every day.

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11 hours ago, Closure said:

another possibility I thought of was asking for an olanzapine prn, so I can suppress breakthrough symptoms effectively without having to take olanzapine every day.

I know of at least one person on this site who uses olanzapine PRN and it works to stop when he is becoming psychotic or heading for a mania.  Sometimes takes it for 2 days, but the when things are calmed down he stops taking it.  Seems to be working for him.

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