Page 1 of 2 [ 18 posts ]  Go to page 1, 2  Next

Polairis
Emu Egg
Emu Egg

User avatar

Joined: 24 Jan 2014
Gender: Male
Posts: 1

29 Jan 2014, 4:25 pm

Hello everyone
This is my first post on the board, so I have a lot of questions.

My diagnoses has vacillated between psychiatrists. My current doctor has diagnosed me with the 296.6 DSM IV code, He tells me that I have schizoaffective disorder and Bipolar II. I'm looking for information on the diagnoses.

I was diagnosed for the first time in 1998. I have been manic and depressive ever since I was 14 years old. I'm now 59. I self-medicated with recreational drugs until I was 19 and on and off until I was diagnosed in 1998.

Here are my symptoms.

I have racing thoughts that are going a billion miles per hour in my head.
My writing gets disjointed because I can't get the words down fast enough and at times I tend to ramble on.
I spend way too much money on random things sometimes to my financial detriment (earlier in life) but that has smoothed out since I've been on medication
I can hyper focus on things that I enjoy sometimes staying awake for as much as three days.
My sexuality goes off the charts. Hyper sexual doesn't even cover it.
I get really irritable with people and paranoid that they are "out to get me".
It's not uncommon for me to get grandiose ideas in my brain (I've started a dozen businesses which have all failed) and feel like I can do anything.

During my depressive times
It's not uncommon for me to stay locked in my house for several days or even weeks without seeing another human
I have very low energy and nothing interests me much
I am very quiet and withdrawn from the world....even a recluse
I don't give a hoot about the world or the people in it
I have suicidal ideation constantly.

One of my questions is, where is the schizophrenic part in all this? Although I do get audible voices in my brain, they don't tell me bad things to do to other people. I have had several psychotic episodes and been hospitalized for a few days (usually because they need to straighten out my meds),. Again, where is the schizoaffective disorder in that?

Anyway, I've had these questions since I became aware of my condition and no doctor has ever answered them.

Thanks for reading.



sunshower
Veteran
Veteran

User avatar

Joined: 17 Aug 2006
Age: 124
Gender: Female
Posts: 3,985

29 Jan 2014, 9:04 pm

schizoaffective would relate to the paranoia, the audible voices in your head, and especially the psychotic episodes. Voices telling you to do bad things is just a stereotypical presentation of schizoaffective/schizophrenia disorders, the voices don't have to be saying bad things and you don't necessarily even need to hear voices at all to still have a schizoaffective disorder; you could instead experience tactile or visual hallucinations, or other things.

Anyway, best way to answer your question is to educate yourself further about schizoaffective disorder.


_________________
Into the dark...


beneficii
Veteran
Veteran

User avatar

Joined: 10 May 2005
Age: 39
Gender: Female
Posts: 7,245

29 Jan 2014, 9:09 pm

I'd ask your doctor why for the specifics.

In general, in schizoaffective disorder you have moments where you're psychotic, but without any significant mood disturbance.

Also, between bipolar disorder and schizoaffective disorder, schizoaffective disorder can be combinatory as well but lacks the jocularity of bipolar disorder. Many aspects of thought disorder in schizoaffective disorder, like fluidity and contamination, are closer to schizophrenia.


_________________
"You have a responsibility to consider all sides of a problem and a responsibility to make a judgment and a responsibility to care for all involved." --Ian Danskin


wcoltd
Veteran
Veteran

User avatar

Joined: 15 Jul 2011
Age: 35
Gender: Male
Posts: 756
Location: The internet

30 Jan 2014, 2:31 pm

sunshower wrote:
schizoaffective would relate to the paranoia, the audible voices in your head, and especially the psychotic episodes. Voices telling you to do bad things is just a stereotypical presentation of schizoaffective/schizophrenia disorders, the voices don't have to be saying bad things and you don't necessarily even need to hear voices at all to still have a schizoaffective disorder; you could instead experience tactile or visual hallucinations, or other things.

Anyway, best way to answer your question is to educate yourself further about schizoaffective disorder.


I have no hallucinations and have been diagnosed with Schizoaffective Bipolar I. For me what got them to change my diagnosis from paranoid schizophrenia (I did experience extreme paranoia in the past) was that I was no longer paranoid, I was convinced that I had unlocked something in my brain to allow me to operate at a much higher potential, and I was trying to spread love and imagination. It was like I was bombarded with epiphanies about everything, I had no fear at all. It was the best feeling I have ever had and it lasted so long. My psychosis lasted for more than 2 weeks. I had disorganized thinking, my delusions didn't cohere to one another. It was soo much fun though.



FireBird
Veteran
Veteran

User avatar

Joined: 12 Feb 2007
Age: 41
Gender: Female
Posts: 2,151
Location: Cow Town

30 Jan 2014, 4:10 pm

I had a manic episode that was beneficial believe it or not. Before this manic episode in 2008 I was terrified of public speaking. But as the manic episode hit i thought i was going to change the world forever. So i joined Toastmasters. I started talking at autism conferences. I also took on huge art projects. I drew a massive picture that normally takes an entire month to finish but i did it in 2 days. I truly thought I was going to make 100's of millions dollars doing this. Of course when I didn't make money, I crashed into a depression. I was also hallucinating. Actually I'm hearing and seeing things right now but not from psychosis its from pain pills and my surgery. Thats all for now cant write much.



beneficii
Veteran
Veteran

User avatar

Joined: 10 May 2005
Age: 39
Gender: Female
Posts: 7,245

30 Jan 2014, 6:55 pm

I want to clarify that hallucinations are not necessary for a diagnosis of schizophrenia or schizoaffective disorder; generally, at least one of the following must be present for such a diagnosis (just one by itself is not sufficient, though): delusions, hallucinations, disorganized speech.

Also, paranoia is very common in bipolar disorder as well as schizophrenia, so your differential diagnosis of bipolar I disorder with psychotic features, schizoaffective disorder bipolar type, and schizophrenia would not turn on the presence or absence of paranoia. In fact, the paranoid subtype of schizophrenia was gotten rid of in the DSM-5 (and the evidence points to its removal in the ICD-11 as well). As well, you never actually needed to be paranoid to qualify for a diagnosis of paranoid schizophrenia: For that you just needed "preoccupation with one or more delusions" or "frequent auditory hallucinations" (DSM-IV TR), in the absence of prominent symptoms of disorganized speech or behavior and in the absence of prominent negative symptoms. The paranoid subtype, a misnomer, was schizophrenia centered around delusions and/or hallucinations and not much else.

wcoltd,

If I had to guess, based on your description, what caused them to change your diagnosis was the presence of mania, a significant mood disturbance, not the absence of paranoia, as paranoia can often also occur as part of mania.


_________________
"You have a responsibility to consider all sides of a problem and a responsibility to make a judgment and a responsibility to care for all involved." --Ian Danskin


Ettina
Veteran
Veteran

User avatar

Joined: 13 Jan 2011
Age: 34
Gender: Female
Posts: 3,971

30 Jan 2014, 7:48 pm

The dividing line between schizoaffective and bipolar is said to be 'mood-incongruent' hallucinations/delusions.

Someone who's just bipolar, they may hallucinate/have delusions when they're in the middle of a severe mood episode, but the hallucinations/delusions match their mood. So if they're manic, they'll be grandiose or paranoid or both (paranoia often involves grandiosity - you'd have to be important for so many people to be out to get you, right?). If they're depressed, they'll have insulting voices or think they're dead or blame themselves to a delusional level ('I caused the Holocaust' sort of thing).

A schizoaffective person has clear manic/hypomanic and depressive episodes, but also has hallucinations/delusions that don't fit this pattern. Either they have some hallucinations/delusions when they aren't manic or depressed, or have hallucinations/delusions that don't match their mood (eg grandiose delusions when depressed). One guy I heard of had three distinct types of episodes - manic, depressed, and paranoid. The paranoid episodes were what got him the schizoaffective diagnosis.



beneficii
Veteran
Veteran

User avatar

Joined: 10 May 2005
Age: 39
Gender: Female
Posts: 7,245

30 Jan 2014, 10:37 pm

Ettina wrote:
The dividing line between schizoaffective and bipolar is said to be 'mood-incongruent' hallucinations/delusions.

Someone who's just bipolar, they may hallucinate/have delusions when they're in the middle of a severe mood episode, but the hallucinations/delusions match their mood. So if they're manic, they'll be grandiose or paranoid or both (paranoia often involves grandiosity - you'd have to be important for so many people to be out to get you, right?). If they're depressed, they'll have insulting voices or think they're dead or blame themselves to a delusional level ('I caused the Holocaust' sort of thing).

A schizoaffective person has clear manic/hypomanic and depressive episodes, but also has hallucinations/delusions that don't fit this pattern. Either they have some hallucinations/delusions when they aren't manic or depressed, or have hallucinations/delusions that don't match their mood (eg grandiose delusions when depressed). One guy I heard of had three distinct types of episodes - manic, depressed, and paranoid. The paranoid episodes were what got him the schizoaffective diagnosis.


Actually, mood-incongruent delusions and hallucinations can occur in bipolar disorder:

http://ajp.psychiatryonline.org/article ... leid=97857

Also, paranoia can occur in bipolar mania:

http://bipolar.about.com/cs/psychoticfe ... ranoia.htm

http://www.ncbi.nlm.nih.gov/pubmed/9858078

This, too:

Quote:
Schizophrenia and bipolar disorder patients demonstrated significantly more Positive symptoms, Thought Disturbance and Paranoia than unipolar depressed patients.


The abstract did not say, however, that there was a difference in paranoia between schizophrenia and bipolar disorder.

http://www.ncbi.nlm.nih.gov/pubmed/23006239


_________________
"You have a responsibility to consider all sides of a problem and a responsibility to make a judgment and a responsibility to care for all involved." --Ian Danskin


wcoltd
Veteran
Veteran

User avatar

Joined: 15 Jul 2011
Age: 35
Gender: Male
Posts: 756
Location: The internet

31 Jan 2014, 10:36 am

beneficii wrote:
I want to clarify that hallucinations are not necessary for a diagnosis of schizophrenia or schizoaffective disorder; generally, at least one of the following must be present for such a diagnosis (just one by itself is not sufficient, though): delusions, hallucinations, disorganized speech.

Also, paranoia is very common in bipolar disorder as well as schizophrenia, so your differential diagnosis of bipolar I disorder with psychotic features, schizoaffective disorder bipolar type, and schizophrenia would not turn on the presence or absence of paranoia. In fact, the paranoid subtype of schizophrenia was gotten rid of in the DSM-5 (and the evidence points to its removal in the ICD-11 as well). As well, you never actually needed to be paranoid to qualify for a diagnosis of paranoid schizophrenia: For that you just needed "preoccupation with one or more delusions" or "frequent auditory hallucinations" (DSM-IV TR), in the absence of prominent symptoms of disorganized speech or behavior and in the absence of prominent negative symptoms. The paranoid subtype, a misnomer, was schizophrenia centered around delusions and/or hallucinations and not much else.

wcoltd,

If I had to guess, based on your description, what caused them to change your diagnosis was the presence of mania, a significant mood disturbance, not the absence of paranoia, as paranoia can often also occur as part of mania.


Oh, I'd reckon you are probably right about that. Also I have an older brother who was diagnosed with schizoaffective.

The reason I thought it was absence of paranoia was because of some wrong impression I developed while I was in the mental hospital. I basically put 2 and 2 together and got something that's not a number.

If schizoaffective disorder is its own animal so to speak, what seperates it from bipolar? And what separates it from schizophrenia?



beneficii
Veteran
Veteran

User avatar

Joined: 10 May 2005
Age: 39
Gender: Female
Posts: 7,245

31 Jan 2014, 12:03 pm

wcoltd wrote:
beneficii wrote:
I want to clarify that hallucinations are not necessary for a diagnosis of schizophrenia or schizoaffective disorder; generally, at least one of the following must be present for such a diagnosis (just one by itself is not sufficient, though): delusions, hallucinations, disorganized speech.

Also, paranoia is very common in bipolar disorder as well as schizophrenia, so your differential diagnosis of bipolar I disorder with psychotic features, schizoaffective disorder bipolar type, and schizophrenia would not turn on the presence or absence of paranoia. In fact, the paranoid subtype of schizophrenia was gotten rid of in the DSM-5 (and the evidence points to its removal in the ICD-11 as well). As well, you never actually needed to be paranoid to qualify for a diagnosis of paranoid schizophrenia: For that you just needed "preoccupation with one or more delusions" or "frequent auditory hallucinations" (DSM-IV TR), in the absence of prominent symptoms of disorganized speech or behavior and in the absence of prominent negative symptoms. The paranoid subtype, a misnomer, was schizophrenia centered around delusions and/or hallucinations and not much else.

wcoltd,

If I had to guess, based on your description, what caused them to change your diagnosis was the presence of mania, a significant mood disturbance, not the absence of paranoia, as paranoia can often also occur as part of mania.


Oh, I'd reckon you are probably right about that. Also I have an older brother who was diagnosed with schizoaffective.

The reason I thought it was absence of paranoia was because of some wrong impression I developed while I was in the mental hospital. I basically put 2 and 2 together and got something that's not a number.

If schizoaffective disorder is its own animal so to speak, what seperates it from bipolar? And what separates it from schizophrenia?


In the DSM-IV and DSM-5, what separates it from bipolar disorder/major depressive disorder is a period, lasting at least 2 weeks, in which you are psychotic outside of a major mood episode. In the DSM-IV, what separates it from schizophrenia is that mood episodes occur during psychotic episodes more than "briefly"; in the DSM-5, what separates it from schizophrenia is that mood episodes occur during psychotic episodes at least half the total time of the psychotic episodes.

Basically, the general idea is that in bipolar disorder/major depressive disorder with psychotic features, you never have psychosis, except induring a major mood disorder, so mood is the primary problem; in schizoaffective disorder, there is much less correlation between mood and psychosis and major mood episodes and psychosis are about equally prominent; in schizophrenia, psychosis is the primary problem, with major mood episodes only occuring sometimes.

Nevertheless, there are questions as to the validity of schizoaffective disorder relative to major mood disorders and schizophrenia. Some researchers think that schizoaffective disorder is just schizophrenia or schizophreniform disorder with a lot more mood symptoms than is average.
Here's one article about it from a psychiatrist with bipolar disorder:

http://www.mcmanweb.com/schizoaffective.html


_________________
"You have a responsibility to consider all sides of a problem and a responsibility to make a judgment and a responsibility to care for all involved." --Ian Danskin


OddDuckNash99
Veteran
Veteran

User avatar

Joined: 15 Nov 2006
Gender: Female
Posts: 2,562

31 Jan 2014, 8:21 pm

It's basically impossible to have schizoaffective disorder and bipolar-II. First of all, schizoaffective disorder is the only diagnosis needed. Saying you're "schizoaffective AND bipolar" is redundant.

Secondly, there are two types of schizoaffective disorder: depressive and bipolar. The fact that schizoaffective disorder requires some form of psychosis means that it is undoubtedly more severe than bipolar-II, which only has hypomanic episodes. And hypomanic episodes, by definition, are not psychotic. Those with bipolar-type schizoaffective disorder are, by default, put into bipolar-I-type symptoms.

On a severity scale, bipolar-I with psychotic features < schizoaffective, bipolar type < schizoaffective, depressive type < schizophrenia. Even though schizoaffective disorder is a mood disorder mixed with schizophrenia, for some as-of-yet-unknown reason, mood symptoms (particularly mania) seem to be protective in some way when it comes to overall functioning. I'm a firm believer that schizoaffective disorder IS a real diagnosis. There have been multiple studies looking at the breakdown of symptoms and profiles, and when diagnosed correctly, it IS its own entity. One of my close friends has schizoaffective disorder (bipolar type), and she has her own unique problems, not those of a bipolar patient and not those of a schizophrenic patient.

Another as-of-yet-unknown thing that fascinates me (and I'd love to study it someday) is the innate differences in affective psychosis and schizophrenia-type psychosis. You don't see first-rank Schneiderian symptoms in a purely affective psychosis, which usually takes on a mood-congruent pattern. Anyway, this is one of my biggest special interests, so there's a short ramble, and I'm more than happy to answer any other questions the OP has.


_________________
Helinger: Now, what do you see, John?
Nash: Recognition...
Helinger: Well, try seeing accomplishment!
Nash: Is there a difference?


Raziel
Veteran
Veteran

User avatar

Joined: 25 Oct 2011
Age: 40
Gender: Male
Posts: 2,612
Location: Europe

01 Feb 2014, 12:57 am

OddDuckNash99 wrote:
On a severity scale, bipolar-I with psychotic features < schizoaffective, bipolar type < schizoaffective, depressive type < schizophrenia. Even though schizoaffective disorder is a mood disorder mixed with schizophrenia, for some as-of-yet-unknown reason, mood symptoms (particularly mania) seem to be protective in some way when it comes to overall functioning. I'm a firm believer that schizoaffective disorder IS a real diagnosis. There have been multiple studies looking at the breakdown of symptoms and profiles, and when diagnosed correctly, it IS its own entity. One of my close friends has schizoaffective disorder (bipolar type), and she has her own unique problems, not those of a bipolar patient and not those of a schizophrenic patient.


This is by a lot of disorders like that actually. For example OCD in ppl with Tourettes, the OCD symptoms differ from OCD only. OCD connected to hygene is typicaly more seen in OCD, but not in Tourettes-OCD. In Tourettes-OCD you have more as motivation the feeling that something has to feel right and also self harm connected to Tourettes-OCD are common. But the self harm is totally different in Tourettes-OCD than seen in ppl with Borderline. It has to do with "have to" and also hitting their head against something or their hand is common. The "comorbidt" OCD-symptoms seen in ppl with Tourettes is strongly connected to Tourettes. Also the ADHD symptoms seen in ppl in Tourettes gives them an own unice profil and differs from normal ADHD. Most ppl with Tourettes have at least some OCD and ADHD symptoms.
Also in McDD (multiple complex developmental disorder) where sysmptoms of schizophrenia and ASD are connected since early childhood differs from typical ASD or childhood schizophrenia. The ASD symptoms are usually "just" ASD traits and also the schizophrenic symptoms are more like schizotypal or seen in schizoaffective and not that severe like in schizophrenia.
I could go on like that, but my personal opinion is that we don't know enough about psychiatry at the moment to explain why many psychiatric disorders differ, when they go along with another psychiatric disorder. Maybe they are very unice entities and not just comorbidities, maybe they are not.


_________________
"I'm astounded by people who want to 'know' the universe when it's hard enough to find your way around Chinatown." - Woody Allen


Lethea
Tufted Titmouse
Tufted Titmouse

User avatar

Joined: 14 Feb 2014
Age: 27
Gender: Female
Posts: 31

15 Feb 2014, 6:32 am

I'm diagnosed bipolar I ("with psychotic features" is kind of redundant, isn't it - if you're bipolar without psychotic features, aren't you bipolar II, or am I missing something?), but am currently in hospital pending assessment for schizoaffective disorder. My most persistent psychotic features are delusions, paranoia, and tactile hallucinations. I am supposedly taking risperidone to control these things, but I find that it makes me dysphoric and causes me to binge-eat. I'm currently unmedicated.

There's a strange trade-off in my symptoms in that, when I am not experiencing mania, depression, or a mixed state, I have dissociative symptoms, such as memory loss and depersonalization/derealization. When the bipolar-form symptoms hit again, however, they protect against the dissociation. I have done research into this little quirk, but can't find anything relating to it.


_________________
When your time's on the door, and it drips to the floor, and you feel you can touch all the noises too much, and the seeds that are sown are no longer your own...


OddDuckNash99
Veteran
Veteran

User avatar

Joined: 15 Nov 2006
Gender: Female
Posts: 2,562

16 Feb 2014, 9:49 pm

Lethea wrote:
I'm diagnosed bipolar I ("with psychotic features" is kind of redundant, isn't it - if you're bipolar without psychotic features, aren't you bipolar II, or am I missing something

Nope. Not all bipolar-I people have mania that is severe enough to become psychosis. But yes, all bipolar-IIs, by definition, cannot have psychosis.


_________________
Helinger: Now, what do you see, John?
Nash: Recognition...
Helinger: Well, try seeing accomplishment!
Nash: Is there a difference?


beneficii
Veteran
Veteran

User avatar

Joined: 10 May 2005
Age: 39
Gender: Female
Posts: 7,245

16 Feb 2014, 11:13 pm

OddDuckNash99 wrote:
Lethea wrote:
I'm diagnosed bipolar I ("with psychotic features" is kind of redundant, isn't it - if you're bipolar without psychotic features, aren't you bipolar II, or am I missing something

Nope. Not all bipolar-I people have mania that is severe enough to become psychosis. But yes, all bipolar-IIs, by definition, cannot have psychosis.


Actually, people with bipolar II can still have psychotic depression.


_________________
"You have a responsibility to consider all sides of a problem and a responsibility to make a judgment and a responsibility to care for all involved." --Ian Danskin


beneficii
Veteran
Veteran

User avatar

Joined: 10 May 2005
Age: 39
Gender: Female
Posts: 7,245

16 Feb 2014, 11:19 pm

OddDuckNash99 wrote:
Another as-of-yet-unknown thing that fascinates me (and I'd love to study it someday) is the innate differences in affective psychosis and schizophrenia-type psychosis. You don't see first-rank Schneiderian symptoms in a purely affective psychosis, which usually takes on a mood-congruent pattern. Anyway, this is one of my biggest special interests, so there's a short ramble, and I'm more than happy to answer any other questions the OP has.


Actually, it looks like first rank symptoms will be de-emphasized in future diagnostic manuals, as recommended by reviewers such as this:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2632385/

They were in fact taken out of the DSM-5, which no longer permits you to be diagnosed with schizophrenia, schizophreniform disorder, or schizoaffective disorder with just one system. I hear they are likely to be taken out of the ICD-11, as well.

Now, if you look more closely at the source, you find there is still some validity to the concept of first rank symptoms as specific to schizophrenia, but only when a "a radical qualitative change in the thought processes" (quoted at the link) has occurred, in that context. Unfortunately, clinicians usually did not interview patients long enough to get whether indeed such "a radical qualitative change" had occurred, so lots of misdiagnoses and inconsistency in research occurred.


_________________
"You have a responsibility to consider all sides of a problem and a responsibility to make a judgment and a responsibility to care for all involved." --Ian Danskin