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beneficii
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03 Mar 2015, 2:36 pm

According to my new psychiatrist, who was my psychiatrist as a teenager, that looking over my history longitudinally, I was never on the autism spectrum. Instead, I am on the schizophrenia spectrum, which got started early. Some evidence for this, he says, is that though I had a speech delay I did try to compensate for it with body language and other methods of communication, I never really had that much of a problem with body language (except for getting too close to people as a kid), I had a major psychotic episode at age 14, I show signs at times of disorganized speech and unusual thoughts*, and my condition continues to fluctuate in severity.

*Problems with thinking were reported as early as age 5 1/2, while cognitive disorganization and perceptual distortions were commented on as early as age 8.


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slave
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04 Mar 2015, 1:23 am

WOW!! !
do you agree with your Doc?



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04 Mar 2015, 6:51 pm

Interesting.



btbnnyr
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04 Mar 2015, 7:10 pm

It makes sense, given some of your behaviors that you posted about on wp.
It is true that speech-delayed autistic children generally don't compensate with non-verbal cues.
One of the DSM-IV criterion specifically says delay in speech without compensation through gesture or mime.


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05 Mar 2015, 10:06 pm

I haven't noticed any "ideas of reference" in your posts nor delusionary thinking, so I am a bit dubious about this latest diagnosis.

How many different things have you been diagnosed with to date? And who by in each case (eg psychologists, psychiatrists, psychotherapists etc). The rate of misdiagnosis of people on the spectrum as schizophrenic or schizoid seemed to be high in the past, and perhaps still is, despite (hopefully) better understanding.

An episode of psychosis doesn't automatically equate with schizophrenia; psychotic episodes can arise simply from being so extremely overwhelmed that coping mechanisms break down temporarily. This can manifest as "psychotic behaviour" but this can arise from a whole lot of overload thoughts and experiences flooding into consciousness at the same time, like a damn bursting when the pressure of flow gets too great.

Does that make any sense to you B?



beneficii
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06 Mar 2015, 4:01 am

B19,

I was diagnosed with schizotypal PD by the same psychiatrist who was the first to diagnose me with Asperger's syndrome, at age 13.

In the lead up to the psychotic episode, I had stressors, but I started going to a special school again where it was easier and things were more structured. It still didn't prevent it. In retrospect, it appears that I had little mental control prior to age 14, but after the episode I learned to control my mind much much better, leading to major improvement.

In the past year, however, due to a major disappointment, I have begun to lose mental control again and have had to go on disability.

Nevertheless, I do have unusual thinking still, like that strange desire to blind myself in my right eye around New Year's. Thankfully, I no longer have that, perhaps due to the psychiatrist putting me on a max dose of Seroquel. On the Seroquel, I feel in control of my mind.

When I am off Seroquel, I notice that I feel much less steady. My awareness starts to get overrun by all sorts of things that people typically don't notice, like a couple weeks ago when I kept feeling, passively, the blood pumping where my right supraorbital ridge connects to my nose. I wasn't annoyed or anything, only curious why it was happening. I become much more combative online--I was actually banned from a forum a couple weeks ago--and offline.

My condition has fluctuated in severity a lot throughout my life, which points away from the autism spectrum and toward the schizophrenia spectrum, says my psychiatrist. Basically, by adulthood, how you are on the autism spectrum stays that way, whereas on the schizophrenia spectrum you can always move around it and there's always that threat of having a major mental breakdown and loss of control that leads to full-blown schizophrenia.


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Last edited by beneficii on 06 Mar 2015, 4:06 am, edited 1 time in total.

B19
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06 Mar 2015, 4:06 am

Is stress what sets episodes off?



beneficii
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06 Mar 2015, 4:22 am

B19 wrote:
Is stress what sets episodes off?


I've only had one episode and there were stressors then, but not immediately before it. It seems from that one case, the stressor (being put in a regular school nearly a year before the episode) started a sort of breakdown process which took months to work itself out and produce psychosis. Immediately prior to the onset of psychosis, and even during the time I was psychotic--when I was "double bookkeeping"*, knowing not to talk about my delusions (because I believed that everyone else was too stupid to understand that I had special insight into the universe and would mistake me for a "schizo") and trying to go to a normal school--I seemed to be doing better. When the real world and my delusional world collided, however, which was probably inevitable, I engaged in seriously dangerous behavior that led to a 6-month hospitalization. Because of my silence about my delusions--was still thinking that these people were too stupid to understand my special insight--, they weren't sure if I was psychotic. When I tell them what I was thinking now, however, the full story, they're like, "Yeah, you were psychotic."

* This article goes into the subject. I was amazed by how similar this description is to my experience:

Quote:
As described above, self-disorders entail a weakening of the natural attitude associated with the emergence of a solipsistic perspective, which usually culminates in psychosis as a profound and rigid alteration of the sense of reality and existence: “[the] patients cannot take things to be the case in the usual way, as the [very] sense of ′is′ and ′is not′ has changed.”28 In our view, many psychotic patients adopt, what might be called, a double ontological orientation, designated by Bleuler29 as “double bookkeeping,” which refers to the predicament (and ability) of simultaneously living in two different worlds, namely the shared-social world (ie, the natural ontological attitude) and a private, psychotic world (ie, a solipsistic ontological attitude). The patients experience both worlds as relevant and in that sense real. They also generally seem to experience them as two different, incommensurable, and thus not conflicting realities, thereby typically allowing them to coexist in an idiosyncratic-personal amalgam and, in the advanced/consolidated stages of the illness, only occasionally to collide (the beginning or exacerbation of psychosis may be, however, associated with a sense of perplexity). Daniel Paul Schreber30 describes in his memoirs a remarkable world of “nerves,” “rays,” and deities, providing us with an unusually lucid, first-person account of double bookkeeping. He claims that God has “entered into exclusive nerve-contact” with him by which he has “gained deeper insight than all other humans beings.” Schreber explains that this “nerve-contact” has made him the centre and constitutor of the world, whose existence now seems to depend entirely on him. Rather than confusing his psychotic experiences with those of real objects, Schreber seems for the most part to have been able to differentiate the two “worlds”: “I could even say with Jesus Christ: ‘My Kingdom is not of this world’; my so-called delusions are concerned solely with God and the beyond… The certainty of my knowledge of God and divine matters is so great and unshakeable that it is completely immaterial to me what other people think of the truth or probability of my ideas.”30 More recently, Professor Elyn Saks, the author of the book, The Center Cannot Hold: My Journey Through Madness, sketched the rationale behind her long-lasting denial of suffering from schizophrenia: “I completely recognized that the things I was saying and doing and feeling would be thought to amount to a diagnosis of schizophrenia; but I thought that it was not true—I didn’t really have the illness… I looked like I had schizophrenia… but if we knew enough, we would see that I really did not… All of my so-called symptoms were things I simply chose to think or do. I was choosing, eg, to hold certain beliefs even though the evidence was not what would classically constitute ‘good’ evidence—I had a special premium on the truth [italics added].”31 Saks seems here to say that she too experienced having a special access to or insight into the real nature of things, a deeper level of reality, which is not readily accessible to others. As Schneider concluded on the issue of delusional conviction: “the significance [of experience] is of a special kind; it always carries a great import, is urgent and personal, a sign or message from another world.”32


http://schizophreniabulletin.oxfordjour ... bt087.full

There's also the self-disorders, which I heavily identify with (from the same article):

Quote:
This basic self-world structure is disturbed in schizophrenia spectrum disorders, ie, it is constantly challenged, unstable, and oscillating, resulting in alarming and alienating anomalous self-experiences (also termed “self-disorders”), typically occurring already in childhood or early adolescence.24 The patients feel ephemeral, lacking core identity, profoundly, yet often ineffably different from others (Anderssein) and alienated from the social world. There is a diminished sense of existing as a bodily subject, distortions of the first-person perspective with a failing sense of “mineness” of the field of awareness (eg, “it feels as if the thoughts aren’t really mine”), and a deficient sense of privacy of the inner world. There is a significant lack of attunement and immersion in the world, inadequate prereflective grasp of self-evident meanings (perplexity), and hyper-reflectivity (eg, “I only live in my head” and “I always observe myself”). Although patients often suffer from self-disorders, the latter are usually lived in an ego-syntonic way, as modes rather than as objects, of the patients’ experience, ie, often affecting more the “how” than the “what” of experience. What is important to emphasize at this point is that the self-disorders, reflecting the unstable basic self-world structure, destabilize the natural ontological attitude and may throw the patient into a new ontological-existential perspective, an often solipsistic framework, no longer ruled by the “natural” certitudes concerning space, time, causality, and noncontradiction. Unconstrained by these certitudes, the world may appear as only apparent or staged, ontologically mind-dependent, prone to noncausal relations, and the patient may experience a unique access to deeper layers of reality, which are inaccessible to others. Often, these experiences evoke a specific sense of grandiosity, leaving others to be seen as oblivious to the true nature of reality and only concerned with everyday trivialities.


Immediately prior to the onset of psychosis, things seemed different, changed, strange in some way. It felt like I was in a video game where the plot was just about to start. Everyone else was just NPCs (non-player characters) while I was the main character. I then saw a sign and my delusions came into being and solidified, and were unchanging. As I said before, I was silent on the delusions because I thought everyone else was too stupid to understand the truth like I had.


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B19
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06 Mar 2015, 4:28 am

"Immediately prior to the onset of psychosis, things seemed different, changed, strange in some way. It felt like I was in a video game where the plot was just about to start".

That sounds rather like dissociation in the form called "derealization". One of the precursors to that experience of things not seeming real is PTSD in the past (before the onset of the derealization experiences).



beneficii
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06 Mar 2015, 4:41 am

B19 wrote:
"Immediately prior to the onset of psychosis, things seemed different, changed, strange in some way. It felt like I was in a video game where the plot was just about to start".

That sounds rather like dissociation in the form called "derealization". One of the precursors to that experience of things not seeming real is PTSD in the past (before the onset of the derealization experiences).


I do not have and have never met the criteria for PTSD.

Derealization is also common in so-called delusional atmosphere, from which delusions generate. If you look at the sentence following, however, ("Everyone else was just NPCs (non-player characters) while I was the main character,") you will see that there is something different from normal derealization: a sense of centrality (i.e. I was the player character, the real human being with insight, which everyone else, being non-player characters, lacked). (EDIT: A sense of centrality is also a part of delusional atmosphere.)

I remember from my reading that the additional presence of a sense of centrality distinguishes the schizophrenia spectrum from "normal" dissociation. This article goes into comparing depersonalization and schizophrenia, but this analysis would likely be similar for derealization, and the quote here does mention a "sense that things are unreal," and depersonalization disorder is now called in the DSM-5 depersonalization-derealization disorder:

Quote:
Depersonalized patients may well feel that something is gravely wrong or altered in their perception of themselves and the world; certainly they can have feelings of great insight or of intellectual change and the sense that things are unreal. What they do not show are tendencies to entertain grandiose ideas of controlling or creating the world, or solipsistic experiences of being the center or source of all that exists.


https://www.sussex.ac.uk/webteam/gatewa ... df&site=42

The schizophrenia spectrum has, but not depersonalization disorder, "a dislocation of first-person perspective such that self and other or self and world may seem to be non-distinguishable, or in which the individual self or field of consciousness takes on an inordinate significance in relation to the objective or intersubjective world."


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Last edited by beneficii on 06 Mar 2015, 5:01 am, edited 2 times in total.

beneficii
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06 Mar 2015, 4:47 am

Also, in this article, the presence of derealization in an at-risk mental state (for psychosis) is found to be associated with psychosis:

http://schizophreniabulletin.oxfordjour ... 5/1/5.full

Look at Table 1 ("Cognitive and Perceptual Basic Symptoms Associated With Psychosis and Prototypic Self-observations by Patients"):

Quote:
Derealization, ie, a decreased emotional and gestalt connection with the environment (“Sometimes, I feel disconnected from the world around me, like I'm under a glass cover.”)


http://schizophreniabulletin.oxfordjour ... nsion.html


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06 Mar 2015, 5:13 am

Interesting.

There is another overlap condition (which you may know of) called Multiple Complex Developmental Disorder:

http://europepmc.org/abstract/med/12629541

If you are interested, google will bring up links.



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08 Mar 2015, 8:56 pm

Interesting. There is a certain amount of overlap between the autism spectrum and the schizophrenia spectrum. Essentially, pretty much all of the 'negative' symptoms of schizophrenia are also seen in autism. But it sounds like you have positive symptoms as well, so that makes sense with what your psych says.



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08 Mar 2015, 8:59 pm

I have a close long-time friend and she's dx'd schizophrenic. Beyond the DSM gobbledigook we're really quite similar. I encourage you not to sweat the small stuff...


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beneficii
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10 Mar 2015, 11:27 pm

B19 wrote:
Interesting.

There is another overlap condition (which you may know of) called Multiple Complex Developmental Disorder:

http://europepmc.org/abstract/med/12629541

If you are interested, google will bring up links.


I've heard of that and it's actually quite interesting. MCDD may more accurately have described my childhood behavior than simple autism spectrum or simple schizophrenia spectrum. I looked at the criteria and compared it to my childhood notes and it seemed to fit. The problems socializing; the problems with anxious, confused, and disruptive behavior (repeatedly noted); the difficulties of organizing my thoughts at times in a coherent manner (i.e. cognitive disorganization, which was specifically mentioned in a psychological report at age 8); and the perceptual distortions (noted in the same report) all suggested MCDD.

Thank you for sharing that link.

Also, I have heard about a study that the majority of people with MCDD develop a psychotic episode by age 18.


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