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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by pretty_paints on October 7, 2005, at 10:00:34
Hi guys
For the first time today my doc actually talked *diagnosis*. He asked me if I've watched A Beautiful Mind (yes), and then went on to chat about both Schizophrenia and Schizoaffective Disorder. Now I'm really confused. I didn't ask him any questions because I didn't want to seem attention-seeking. But now I'm home I don't get it. He ended up on the side of Schizoaffective Disorder - I think. But what is this? Isn't this where you get manic? I've never been manic. I have been depressed in the past, sure. But couldn't that be the negetive symptoms of a schizophrenia diagnosis? I don't feel that I'm depressed anymore.
Anyway if anyone has any thoughts, please share them with me :)
Cheers
Kate xx
Posted by Racer on October 7, 2005, at 11:24:09
In reply to schizoaffective - huh?!, posted by pretty_paints on October 7, 2005, at 10:00:34
You should be able to find the criteria for Schizoaffective from the DSM online. My advice is to check them out, and see if you think it fits you. Reading about it might help you figure out whether or not to follow up with him at your next visit.
In general, though, diagnosis is not nearly as important as treatment. If the treatment you're on is working for you, then don't sweat the diagnosis.
Make sense?
Posted by SLS on October 7, 2005, at 11:29:51
In reply to schizoaffective - huh?!, posted by pretty_paints on October 7, 2005, at 10:00:34
I know it is tempting for us here to second guess a doctor's diagnosis. The problem is, we often don't have all of the facts.
Have you ever been described as having episodes of delusions or hallucinations or being out of touch with reality?
- Scott
Posted by SLS on October 7, 2005, at 11:35:26
In reply to Re: schizoaffective - huh?!, posted by Racer on October 7, 2005, at 11:24:09
Posted by DanielJ on October 7, 2005, at 12:10:49
In reply to Re: schizoaffective - huh?! - I like Racer's idea, posted by SLS on October 7, 2005, at 11:35:26
My son was first dxd schizo affective and later schizophrenia. There are tons of symptoms but yes one or more delusions,
visual and or auditory hallucinations, paranoia, flat affect personality, oversensitivity to sound,light etc.
my son has had about all of them except talking nonsense. I don't think your Doc is correct.
Posted by pretty_paints on October 7, 2005, at 12:43:19
In reply to Re: schizoaffective - huh?! - I like Racer's idea, posted by DanielJ on October 7, 2005, at 12:10:49
I don't have issues with the psychotic slant. I've been on 6 antipsychotics and am now on Clozapine after two hospitalisations for psychotic breaks. I am fairly good now, have not been in the past. The issue was with the "schizoaffective" bit. I have never been manic and do not know why I have this diagnosis, rather than just plain schizophrenia.
Thanks for your posts xx
Posted by ed_uk on October 7, 2005, at 14:45:56
In reply to schizoaffective - huh?!, posted by pretty_paints on October 7, 2005, at 10:00:34
Hi Katie,
Nice to see you! How are you coping with the side effects of clozapine?
~Ed xxxxx
Posted by Phillipa on October 7, 2005, at 18:26:33
In reply to Re: schizoaffective - huh?! » pretty_paints, posted by ed_uk on October 7, 2005, at 14:45:56
Hi Kate, nice to hear from you. Are you currently at home? And do you still have the same pdoc and therapist? Fondly, Phillipa
Posted by Sebastian on October 8, 2005, at 16:50:59
In reply to schizoaffective - huh?!, posted by pretty_paints on October 7, 2005, at 10:00:34
I have the same diagnosis. Schizoaffective is half between schizophrinia and manic depressive. Or it is major depresion with psychotic features. In other words it is a vage diagnoisis which is new in popularity that is vage in its discription.
Posted by Dr. Bob on October 9, 2005, at 11:22:15
In reply to schizoaffective - huh?!, posted by pretty_paints on October 7, 2005, at 10:00:34
> He asked me if I've watched A Beautiful Mind
I'd just like to plug the double double quotes feature at this site:
http://www.dr-bob.org/babble/faq.html#amazon
The first time anyone refers to a book, movie, or music without using this option, I post this to try to make sure he or she at least knows about it. It's just an option, though, and doesn't *have* to be used. If people *choose* not to use it, I'd be interested why not, but I'd like that redirected to Psycho-Babble Administration:
http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
Thanks!
Bob
Posted by xjs7 on October 10, 2005, at 0:11:50
In reply to schizoaffective - huh?!, posted by pretty_paints on October 7, 2005, at 10:00:34
I hate to say this but mental health diagnoses are worthless without a thorough medical examination. You could indeed have schizophrenia but you might also have a brain tumor--or you could have both. I was diagnosed with schizophrenia but was determined to have a brain tumor and multiple hormone deficiencies. It takes years to sort out. Don't resign yourself to a certain diagnosis, at least not until several years have passed.
For what it is worth, you do not talk like a schizophrenic would. I don't think they would use smiley faces. They are very apathetic and flat. They rarely smile.
Posted by med_empowered on October 10, 2005, at 9:31:16
In reply to Re: schizoaffective - huh?!, posted by xjs7 on October 10, 2005, at 0:11:50
hey! Schizoaffective disorder has been used now and then as a diagnosis since the 30s, I think. What happened in psychiatry is that at some point, psychosis was split up: there was manic-depressive psychosis, and there was schizophrenic psychosis. Obviously, diagnoses like these are good and well in the abstract, but real people are much, much more complicated. Certain people just don't fit the mold--people with psychotic depression, schizophrenia with lots of mood symptoms, etc. So..schizoaffective disorder kind of arose as a "half-way" diagnoses between bipolar and schizophrenia (there's a lot of overlap between the two). I don't know how diagnosis works in the UK, but here in the US schizoaffective basically means there's pronounced depression (depressive-type) or bipolar-ish symptoms (bipolar-type)...in addition, there needs to be a period of at least 2 weeks when there are prominent psychotic symptoms without the presence of any major mood symptoms. So...basically, the diagnosis is supposed to bridge the gap between "affective" (mood) disorders (which can have psychotic symptoms secondary to the mood problems) and "psychotic" disorders, which are primarily based upon psychotic symptoms with mood problems at most being secondary. In the US, schizoaffective is a relatively rare diagnosis--about 1/200 people get the DX at some time, so its about 1/2 as frequent as Bipolar I or schizophrenia--but it seems to be becoming more popular. I think this is because psychiatry is finally revisiting something patients have known for a long time: when psychosis is part of the picture, there can also be very real mood disorders that are just as problematic and severe as the psychosis. Hence you'll hear cases of "classic schizophrenia" (lots of psychosis, no apparent mood disturbances) and "moody schizophrenia" (baffling mix of mood and psychotic issues)...there's also "bipolar I with psychotic features," which is just a psychosis-heavy form of Bipolar I. Its a tricky diagnosis; some shrinks don't use it at all, and there's disagreement over what exactly it means--some consider it primarily a form of schizophrenia, some a disorder all its own, and some place it more on the bipolar spectrum of things. To complicate matters, patients with bipolar disorder (and I think severe, psychotic depression) sometimes have "schizoaffective episodes" in which psychosis pops up w/o really prononced mood problems; sometimes this results in a change of diagnosis, and sometimes it doesn't. In terms of treatment...schizoaffective disorder is usually treated with an antipsychotic, with other stuff added as deemed necessary (lithium, depakote, benzos, antidepressants, etc.). However...some patients, particularly those who lean more towards the bipolar end of the spectrum, can be maintained pretty well on conventional mood-stabilizers such as depakote (its worth noting that mood-stabilizers can be used to control psychosis in bipolar disorders, and some people diagnosed as schizophrenic can do fine with a mood-stabilizer and no long-term neuroleptic treatment...others require a neuroleptic along with a mood-stabilizer). You seem confused as to why exactly you've been labelled "schizoaffective". Both schizophrenia and schizoaffective are kind of mushy diagnoses--when you look at the patients given those diagnoses, there's a whole lot of variation among them in terms of symptoms and outcome. Plus, the criteria by which schizophrenia and schizoaffective are diagnosed have changed with pretty much every edition of the DSM (the psychiatric "bible")...lots of patients diagnosed with "schizophrenia" by one doc will be diagnosed as bipolar by another or given a label of some other sort of mood-disorder. I wholeheartedly agree with the poster who suggested getting a very thorough checkup to make sure there's nothing wrong physically. Also, if mood symptoms are a big part of the picture and you have any doubts about your need for neuroleptics and/or neuroleptics dont work well for you, or they cause lots of problems, you might want to try a more bipolar-type medication schedule based on a mood-stabilizer instead of a neuroleptic. I myself was mis-diagnosed with schizophrenia by an incompetent shrink; turns out, I just have an "unusually complicated" mood-disorder. Some articles I've read have quoted docs recommending that patients initially diangosed with schizophrenia or schizoaffective go through thorough trials with different mood-stabilizers before resorting to long-term neuroleptic treatment. I think that's a reasonable recommendation. Good luck!
Posted by SLS on October 11, 2005, at 10:42:40
In reply to Schizoaffective disorder, posted by med_empowered on October 10, 2005, at 9:31:16
Schizoaffective disorder is considered by many to be biologically distinct from either bipolar disorder or schizophrenia. I'm not sure what to think, but I lean in the direction that it is a separate illness rather than a comorbid presentation of bipolar disorder and schizophrenia.
I have seen someone with this disorder enter a hypomanic state that then led into a schizoid psychosis. In the hypomanic state, there was a reduced need for sleep (3 hours), racing thoughts, and a tendency towards religiosity. This state could last for days, weeks, or months without the appearance of any schizoid thinking. When it did appear subsequently, the psychosis was pronounced and included both auditory and visual hallucinations. I have not been able to follow her beyond this point because she, by this time, would have received treatment with antipsycotics. I never saw her at the point of incoherency, spewing out word-salads with totally disorganized thinking. She responded very well to a combination of Risperdal, Neurontin, and Xanax. I don't know if the Neurontin played any therapeutic roll. It seemed incapable of preventing affective instability. Key in this regimen was the Xanax. It would prevent the build up of anxiety and attendent insomnia that triggered the hypomania. Without the mania, there was no schizoid episode nor subsequent depression.
I think the DSM might have been a little lazy in its description of schizoaffective disorder. In its description, defines the three disease states by referring to other disorders and reciting the diagnostic criteria it uses for them. This is misleading in that it gives one the impression that schizoaffective disorder is somehow a comorbid presentation or an amalgam of two different disorders.
- Scott
Posted by SLS on October 12, 2005, at 17:16:04
In reply to Re: Schizoaffective disorder, posted by SLS on October 11, 2005, at 10:42:40
> Schizoaffective disorder is considered by many to be biologically distinct from either bipolar disorder or schizophrenia. I'm not sure what to think, but I lean in the direction that it is a separate illness rather than a comorbid presentation of bipolar disorder and schizophrenia.
> I have seen someone with this disorder enter a hypomanic state that then led into a schizoid psychosis. In the hypomanic state, there was a reduced need for sleep (3 hours), racing thoughts, and a tendency towards religiosity. This state could last for days, weeks, or months without the appearance of any schizoid thinking. When it did appear subsequently, the psychosis was pronounced and included both auditory and visual hallucinations.
What I forgot to mention is that as the schizoid symptoms appeared, her sleep normalized, her thoughts were no longer racing, and religiosity became less of an issue as she found it increasingly difficult to maintain focus on a single thought. These things are important to note because they represent the appearance of a schizoid episode without manic features. This is necessary condition for a diagnosis of schizoaffective disorder.
- Scott
Posted by chand2407 on October 16, 2005, at 18:23:37
In reply to Schizoaffective disorder, posted by med_empowered on October 10, 2005, at 9:31:16
i went to mhmr for another evaluation and i was diagnosed with borderline personality disorder in which i disagree. so what meds are out there for this. i have typed previous notes so please read thanks
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