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Re: Schizoaffective disorder-judy, sebestian

Posted by PsychoSage on March 18, 2004, at 21:37:22

In reply to Re: Schizoaffective disorder » Sebastian, posted by judy1 on March 16, 2004, at 11:14:19

> that's a tricky dx, the key is to still have some symptoms that last beyond the standard manic or depressive episode. honestly, I think most people with bp 1 fall into this category, maybe they save it for people who experience more psychotic symptoms. I got stuck in the hospital last week and had a depot injection of haldol- a standard for schizophrenics, and I am most definitely BP 1. what caused your pdoc to change? your diagnosis?
> take care, judy

Judy, I was wondering why they gave you haldol, and I found this, so it makes more sense to me now.

Acute Phase

During the acute phase, treatment is aimed at decreasing symptomatology as well as safety concerns. Several reports and commissions have concluded that coercive treatment should be used only as a last resort, with at least one concluding that restraint and seclusion are not treatments, but instead are traumatic and should be used very rarely.[7-9] The Center for Medicare and Medicaid Services defines chemical restraint as a medication that is not given as part of a patient's usual treatment and is used to control movement.....

n another project, 50 experts were provided with a case scenario that varied in the degree of presenting symptoms.[11] Half of the respondents said they would use coercive treatment at the point where an uncooperative patient had both irritable and intimidating behavior. All agreed that restraints would be appropriate if the patient was directly threatening or assaultive. Most said it was not appropriate to restrain patients who simply refused to cooperate, stared intensely, had motor restlessness, purposeless movements, affective lability, or loud speech. Rather, they agreed that attempts should be made to manage patients verbally and with oral medications. Benzodiazepines, either alone or in combination with a conventional neuroleptic, were considered the treatments of choice for an unknown patient who presents a behavioral emergency. However, if it is known that the patient was treated with antipsychotics in the past, antipsychotics would be more appropriate to use as a first-line agent. If parenteral medication is necessary and there is some confidence that bipolar mania is the diagnosis, then a combination of benzodiazepines and conventional neuroleptics, usually haloperidol, would be used. For mania, the first-line choice would be a combination of haloperidol 5 mg and lorazepam 2 mg. The second choice would be lorazepam alone. If repeated doses are needed, there is little additional benefit from total doses above 7.5 mg of haloperidol.

http://www.medscape.com/viewarticle/460892_2

I've just learned that psychotic symptoms and mania go hand in hand, and there is a dopamine related hypothesis regarding mania. THe dopamine model is the main model for schizophrenia.

I hope you do NOT get hung up on your diagnosis, sebestian. As many learn, bipolar and schizo overlap considerably. I definitely try not to keep social connotations and laypeople's opinions about mental illness in my head when I consider diagnoses. I also try not to sell myself short when I realize I have many symptoms but I am short of a full blown disorder. If one has a full blow disorder or falls short, one has to deal with symptoms regardless.

On the flip side I thought I really needed to have a big AXIS 1 {bipolar, major depressive, or schizophrenic, etc} serious diagnosis in my head, so i could have a framework about what I thought I was, and that turned out to be ineffective. It was a great way to be self-conscious and beat myself up.

I have symptoms that relate to anxiety, depression, inattention, hypomania, mania and psychosis. The diagnoses of schizoaffective or amphetamine-induced psychosis helped me understand to what extent i may have them, but saying I have BP1 as opposed to schizophrenia or just schizoaffective as opposed to schizophrenia doesn't make me less vulerable to anything a full blown schizo experiences. It also doesn't make me a full blown schizo.

This dimensional concept that I guess i am inadequately trying to explain is discussed below.

"The perspective of disease works by categories and asks " what the patient has." .The perspective of dimensions works by the logic of gradation and quantification and asks "what the patient is." The perspective of behavior works by the logic of teleology and goals and asks "what the patient is doing." The perspectives of the life story works by the logic of narrative and asks "what the patient has encountered.""

http://www.hopkinsmedicine.org/press/2001/august/McHugh.htm

The problem with the DSM IV is that it is not strong from a dimensional perspective.

Good luck, all!


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