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Hello Katie! » pretty_paints

Posted by ed_uk on February 7, 2005, at 10:39:58

In reply to Re: The Honest Truth, posted by pretty_paints on February 7, 2005, at 2:07:14

Hi Katie!

Thank you for the babblemail- hope you received my reply! You ARE wonderful!

>BUT you can attribute quite a lot of "weird things" to it, which otherwise you would have had to accept responsibility for in a therapy-type way. For example, all the stuff about the rape and my mum etc. I was trying to wade through all that difficult stuff in therapy. None of it made any sense to me.

You can attribute your delusion about being raped to your psychotic disorder. Why would you need to accept personal responsibility for something that you now know was a delusion?

>but now knowing it is a delusion, I can just let it go.

You see, you are finding the answer to your own problem! Whether you end up being diagnosed with schizophrenia or not doesn't matter, you already *know* that you were psychotic. You *know* that you were ill and can attribute your delusions to your illness. It doesn't make any difference which 'specific' psychotic disorder you end up getting diagnosed with- a delusion is a delusion!! Many people want a diagnosis, it makes them realise that they are not the only one to experience a particular set of symptoms. To be honest though, psychotic disorders are much more common than most people realise- you are not alone :-) 0.5-1.5 % of the population suffers from a schizophrenic illness and many more people suffer from other forms of psychosis. As I said before, there is significant overlap between the so-called 'specific' psychotic disorders. In many ways, it would be easier to simply think of yourself as having a psychotic disorder rather than thinking of yourself as being schizophrenic. You can attribute "weird things" to your psychotic disorder, you do not need to call it schizophrenia or psychotic depression or schizoaffective disorder to make real- you already know that it was a real illness. There is 0% probability that you pdoc will think that you were never really ill just because you told a few lies :-)

>He was always feeling angry. But I don't think this is was thought withdrawal or thought insertion or thought broadcasting.

It doesn't have to be :-) If you *truly believed* that your toy cat had real feelings, this would be an example of a bizarre delusion because it's impossible for a toy to have feelings. Bizarre delusions are suggestive of schizophrenia or schizoaffective disorder, they are not typical of psychotic depression.

>Also, when I was back at Uni I thought all the tutors could see into my room and KNOW what I was up to.

How did you think that they could see into your room? Did you suspect hidden cameras or did you believe that they 'just knew' what you had been doing? Did you believe that they had supernatural powers which allowed them to know what you were doing?

To quote from the ICD......

In schizophrenia, 'the most intimate thoughts, feelings, and acts (of the patient) are often felt to be known to or shared by others, and explanatory delusions may develop' eg. that your tutors had special vision that allowed them to see through your bedroom walls.


>every thing I read about depression said it slowed everything down, "depressed" all the body systems. It said your thoughts would become slow and difficult to form, and that everything would kinda move in slow motion. They said everything would be grey and dreary, that there would be no sensations and everything would be bleak. Unless of course it is an agitated depression, which is different.

Depression is a very personal and individual experience. It is rarely, if ever, like you would expect it to be! Different people can have very different symptoms and experiences. Also, people can have very different types of depression at different times in their life.

>Colours, sights were vivid. Noises sounded suspicious and edgy.

These symptoms are suggestive of schizophrenia or schizoaffective disorder. They are not typical of psychotic depression.

The ICD say that.........

In schizophrenia 'perception is frequently disturbed in other ways: colours or sounds may seem unduly vivid or altered in quality.'

>EVERYTHING was on high-speed. My THOUGHTS were crazy, on fastforward all the time, shoo shoo shoo. SO therefore, I thought I was manic. But it turns out that I was psychotic.

Yes, these symptoms can occur in schizophrenia, schizoaffective disorder and manic-depression (bipolar disorder).
Considering the nature of your delusions, a diagnosis of bipolar disorder would be extremely unlikely. You are much more likely to be diagnosed with schizophrenia, schizoaffective disorder or possibly psychotic depression. The mixed affective episode-like symptoms that you just described are particularly suggestive of schizoaffective disorder.

NB. A mixed affective episode is an episode of illness in which depressive and manic symptoms are both prominent at the same time. It can be difficult (and sometimes impossible) for a pdoc to distinguish between an agitated depressive illness and a mixed episode.

As defined in the ICD, schizoaffective disorder is a term used to refer to 'episodic disorders in which both affective (eg. depressive, manic, mixed) and schizophrenic symptoms (eg. bizarre delusions, hallucinations) are prominent within the same episode of illness, preferably simultaneously, but at least within a few days of each other.'

>Does the person have to be psychotic for 6 months?? What if they are treated with antipsychotics? Surely then this would help the psychosis. Would a doc really insist on seeing 6 months of pure psychosis, without doing anything to put a stop to the delusions etc?

The '6 month rule' is from the DSM- the diagnostic manual written by the American Psychiatric Association.

The person must have suffered clear psychotic (ie. delusions, hallucinations) symptoms for at least 1 month. Milder schizophrenic symptoms must have been present for at least 6 months (eg. paranoia, odd beliefs, unusual perceptual experiences such as seeing vivid colours, social withdrawal etc.) If the patient receives treatment with an antipsychotic and recovers, psychotic disorder NOS or schizophreniform disorder may be diagnosed. Several years later, if it becomes clear that the patient's illness is long-term, the diagnosis can be changed to schizophrenia.

NB. Schizophreniform disorder is when somebody has a short episode (less that 6 months) of a schizophrenia-like ilness. Schizophreniform disorder is most commonly diagnosed when the patient was ill for less than 6 months and has remained symptom-free ever since without long-term medication. In your case, it cannot be known whether you would have recovered in less than 6 months without medication. As a result, psychotic disorder NOS was diagnosed. If you become psychotic again, and it becomes clear that your illness is long term, schizophrenia may be diagnosed. If it becomes clear that depressive, manic or mixed episodes are a major feature of your illness, in addition to schizophrenia-like symptoms, schizoaffective disorder is a likely diagnosis. If, in the long run, you recover completely, schizophreniform disorder may be diagnosed. If you suffer future episodes of severe depression accompanied by mood congruent delusions, your pdoc may diagnose sever depression with psychotic features ie. psychotic depression. Psychotic depression will not be diagnosed if you experience persistent mood-incongruent delusions. Bizarre (ie. 'impossible') delusions are never considered to be mood-congruent. Persecutary delusions are only considered to be mood-congruent if they are directly related to depressive themes eg. 'I was raped as a punishment for my evil.' Otherwise, persecutory delusions are considered to be mood-incongruent.

The '6 month rule' does not exist in the ICD. Schizophrenia can be diagnosed after *definate* symptoms have been present for only 1 month. The diagnosis of schizophreniform disorder does not exist in the ICD. The ICD classifies transient psychotic disorders in a different way. In the ICD, short-term psychotic disorders are divided into 6 categories. Here is a list of the acute and transient psychotic disorders listed in the ICD.....

1. Acute polymorphic psychotic disorder without symptoms of schizophrenia
2. Acute polymorphic psychotic disorder with symptoms of schizophrenia
3. Acute schizophrenia­-like psychotic disorder
4. Other acute predominantly delusional psychotic disorder
5. Other acute and transient psychotic disorders
6. Acute and transient psychotic disorder, unspecified

I hope you can see that there is actually substantial overlap between the various diagnostic categories that are often thought of as being specific. Schizophrenia, delusional disorder, schizoaffective disorder and psychotic depression are not discreet conditions- psychotic disorders occur on a spectrum. Apart from psyhotic disorders causes by drugs or medical conditions such as MS, no discreet form of psychotic disorder has yet been identified. The DSM frequently disagrees with the ICD. Psychiatrists frequently disagree with each other! Some people think that even attempting to put people's individual psychiatric symptoms into diagnostic categories is bound to fail! In psychiatry, diagnosis is very controversial. People's illnesses are very real but the way that they are classified is somewhat contrived and artificial. Many people's symptoms *never* fit the criteria for any of the 'specific' psychotic syndromes- psychotic disorder NOS will be a long-term diagnosis for these people. Frequently, psychiatrists diagnose psychotic disorder NOS when they don't have enough information to diagnose any of the 'specific' psychotic disorders such as schizophrenia. Several years later, when more information is available, a 'specific' diagnosis can often be made.

Here is a list of the psychotic disorders defined in the DSM............

Brief Psychotic Disorder
Delusional Disorder
Schizoaffective Disorder
Schizophrenia
Schizophreniform Disorder
Shared Psychotic Disorder
Psychotic Disorder Due to a general medical condition
Substance-Induced Psychotic Disorder
Psychotic Disorder NOS (Not Otherwise Specified)

>Anyway Mr Ed, how are you dude?? I hope you are doing alright.

Yes, I'm in my second week of lectures now. So far, the lectures have been ok. Thank you for asking.

>You said you are studying pharmacy, how many years have you been doing this? Do you find it interesting?

I'm in the second year. Sadly, the course is quite boring. I'm not in love with my university by any means!! I wish I enjoyed in more :-( As least the lectures this semester aren't as boring as they were last semester! I missed my January exams... I was so bored I couldn't be bothered to get out of bed. I'm supposed to be doing them in August with the people doing resits.

Ed xxxxxxxxxxxxx



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poster:ed_uk thread:452494
URL: http://www.dr-bob.org/babble/20050207/msgs/454288.html