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I've had two previous major psychotic episodes while off my medication for long periods. These episodes put me into a manic frenzy that caused legal problems. Once where I isolated and resisted arrest on foot and the other where I resisted / eluded by motor vehicle across 3 counties. One occurred during a heat wave in mid-July and the next during frigid temperatures in mid-January, thus extreme temperatures are one of my triggers.

Thankfully there was little damage and no one was hurt either time.

My lifestyle pattern involves me taking anti-psychotic medication by court order (usually by injection) for 1 to 2 years for probation before going off and feeling consistently better from the lack of adverse side effects (akathisia, drowsiness, suicide ideation, anxiety, panic attacks, anhedonia, hopelessness, severe weight gain, etc).

I do well for about 7 to 8 months but then begin to isolate in my apartment and decompensate and become delusional and manic, thinking I possess special abilities and evolutionary traits and can communicate with a higher power. There is some paranoia involved as well. Sometimes I hallucinate. Then I relapse and become frenetic.

There is however, little to no depression when I'm off the anti-psychotics. When I take them I'm severely depressed.

I have seen a number of psychiatrists since I developed this illness in 2011 at age 22 and been labeled Paranoid Schizophrenic, Schizoaffective, and Bipolar 1 With Mania. None of them are completely synonymous and my current psych can't make up his mind.

I'm very sensitive to anti-psychotics. Only 1.25mg of Zyprexa zapped my delusional thinking and hallucinations in a few hours and Invega Sustenna 39mg (what I'm currently taking) is more than enough for treating my symptoms as well. The same thing with 2mg of Abilify. I'm just saying this because I've heard that some individuals need moderate to higher dosages for the medications to be effective. I'm not one of them.

Anyway, I came across one psychiatrist who was part of the justice system (in the beginning of my term) who refused to place me on an anti-psychotic claiming I was too focused during my occurrences with the police for him to diagnose me Schizoaffective. He said that I still retained some sanity based on what he was told and wasn't trying to murder anyone or hurt myself.

He refuted Schizoaffective Disorder and labeled me Bipolar 1 With Mania And Temporary Psychosis and said I had one of the most extreme cases of Mania he had ever seen. He recommended a heavy mood-stabilizer instead of an anti-psychotic. He said there may be some delusional thinking but I will remain baseline and wont act upon them. Unfortunately, I was extradited within a few weeks and placed out of his care and the next psych I came across was an AP dispenser and convinced me to take it so probation would accept me.

The only mood-stabilizer I've tried is Nuerontin or Gabapentin and I wasn't on it long enough to know if it treated my symptoms effectively.

I come off probation in December and don't want to get in trouble with the law once again, but at the same time I despise what these anti-psychotics are currently doing to me. Some things I wouldn't wish upon my worst enemy. Being on the anti-psychotic leads to depression, anxiety, suicidal thoughts, akathisia, hating every aspect of life, and weight gain and coming off completely means thinking I have 38 girlfriends and can stop missiles in their tracks. Could a mood-stabilizer be the appropriate balance to end this nightmare? Can someone have Bipolar Mania so severe they develop Psychosis but not actually be Schizoaffective?

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Bipolar can have psychosis, but it has to be during a mania and cannot happen outside of it. I would say that the hallmark of schizoaffective is psychosis outside of having any mood swings, which is why I was re-diagnosed schizoaffective after an original diagnosis of bipolar 1. I still take a mood stabilizer on top of the antipsychotic though (2 actually).

Not all antipsychotics are this devastating side effect-wise, often it can mean you simply have a bad fit or too high of a dosage for you. How many have you tried besides the three you mentioned?

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1 hour ago, saintalto said:

Bipolar can have psychosis, but it has to be during a mania and cannot happen outside of it. I would say that the hallmark of schizoaffective is psychosis outside of having any mood swings, which is why I was re-diagnosed schizoaffective after an original diagnosis of bipolar 1. I still take a mood stabilizer on top of the antipsychotic though (2 actually).

Not all antipsychotics are this devastating side effect-wise, often it can mean you simply have a bad fit or too high of a dosage for you. How many have you tried besides the three you mentioned?

To be honest, I'm 95% certain that I've only had psychosis during mania. I was also taking Zoloft without a mood-stabilizer at the time of the 2nd episode. It was making me so high and excited at all times. I've never had depression while psychotic.

I understand that there can be a comfortable balance with anti-psychotics but they are among the worst drug type on earth for me and many others, bar none. To me they're almost like a tranquilizer that's how sensitive I am.

Oral anti-psychotics I've taken at their lowest dosages are Zyprexa 2.5mg (best experience), Abilify 2mg, Risperdal, and Geodon. I was prescribed Risperdal and Geodon as a 13 year old for ADHD so I don't recall the dosage for those. Taking Risperdal caused me to develop Gynecomastia which I'm going to need surgery to correct.

Monthly injections at their lowest doses have been Haldol 50mg, Abilify Maintena 300mg (caused severe anxiety / panic), Aristada 441mg (nearly as bad as Abilify), and now Invega Sustenna 39mg (best experience for injection so far, but still have most side effects, just less acute, and Invega is proven to have likeness to Risperdal and therefore worsening Gynecomastia). All I need.

The only mood-stabilizer I've tried is Neurontin and I've never taken a mood-stabizlizer concurrent with an anti-psychotic. My psych claims that "anti-psychotics are the best mood-stabilizers" and doesn't emphasize that prescribing one at this time with the AP may be of benefit. I told him that I disagree, all heyhe APs do is make me severely depressed in terms of mood.

That 1.25mg of Zyprexa that I took was only to be weened on and I didn't have any truly adverse side effects or akathisia so a minuscule dosage AP + heavy mood-stabilizer may be the solution here.

Still, do I really need the anti-psychotic with the mood-stabilizer? I've never had a chance to just take a mood-stabilizer by itself.

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I don't know the answer to that because you really need to talk to a doctor when it comes to wanting a med change of any kind. If you don't trust the one you are currently with, then try another. We can give you our experiences or opinions, but advice as to directly go on a med or not go on one, that's in the realm of psychiatry not forums.

You have tried a lot of APs, but I do not think you should be making sweeping judgments on antipsychotics for other people. I for one can thank my lucky stars I'm alive because of them. They have their downsides, sure, but I'm alive. 

 

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On 9/12/2017 at 6:19 PM, saintalto said:

I don't know the answer to that because you really need to talk to a doctor when it comes to wanting a med change of any kind. If you don't trust the one you are currently with, then try another. We can give you our experiences or opinions, but advice as to directly go on a med or not go on one, that's in the realm of psychiatry not forums.

You have tried a lot of APs, but I do not think you should be making sweeping judgments on antipsychotics for other people. I for one can thank my lucky stars I'm alive because of them. They have their downsides, sure, but I'm alive. 

 

I'm not just making judgements based on my own experience. Anti-psychotics are disabling for most people. They take away certain symptoms and create many others. From interactions and conversations with several individuals in the mental health system including psychiatric wards and outpatient facilities, I am not the only person who has had these severely disabling side-effects. To be honest, while taking anti-psychotics, I could honestly care less whether I died or not, that is how poor my quality of life is while taking them. And that wasn't meant to offend you by any means. I'm just tired of these overdosed, overpowered, disabling drug types of massive proportions that are harming me more than they're helping me.

Edited by tsteele
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18 hours ago, straightjacket said:

I have a diagnosis of Schizoaffective Disorder, before that it was Bipolar with psychotic features, what really swing the change was that I still remained psychotic when my mood stabilised. I'm on Invega Sustenna 50 mg monthly injection.

What is it like still being psychotic while your mood is stabilized or "baseline"? Is it tolerable?

Edited by tsteele
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