[franz kafka]

On my aftercare sheet, for the past two sessions, pdoc has written my diagnoses as "schizophrenia" and "obsessions/compulsion." This seems wrong to me, because I definitely experience depression and I've been hospitalized for mania in the past.

Do you think I should reach out to pdoc? I feel misunderstood.

[still_crazy]

I think...and I"m stealing this idea from the Orthomolecular people...the -core- of Schizophrenia is a disconnect, a mis-perception of the surrounding world. lots of stuff can happen on top of that, or with that, but...yeah. its also worth noting...

I've been diagnosed as Bipolar I, Schizoaffective, Schizophrenic, and once...mildly Schizophrenic, Bipolar I (combined, somehow). different psych people will have a different perception of what ails you. I would warn against a pdoc who jumps to Schizophrenia and then acts dismissively towards you...and I'd honestly suggest that you have a talk with the pdoc about what's going on here, for your own peace of mind and to get an idea of what's going on in -their- mind, as well.

hope this helps.

[USMCBIPOLAR7]

I am Bipolar 1 and sometimes have psychosis with my severe depression or manic episodes . If I was seen during just those times I may appear to have a different diagnosis. They have to look at history to get the best most accurate diagnosis.

[fern46]

I find it interesting that many of the symptoms of these disorders overlap and can present similarly. The DSM lists them as distinct diagnoses, but I'm not so sure that's the case. Bipolar with psychosis can look like schizoaffective for example.

Franz, how long have you seen this pdoc?

My diagnosis has been up in the air for a while. I was given the advice to try not to focus on that as much as whether or not the treatment I am receiving is effective. That helped a little.

[Wild Coyote]

Hi Franz, Glad to read you are feeling a bit better today.

Why not ask the pdoc about any question you may have?

I hope you are getting great care, Franz.

[Blue_Bird]

I have schizoaffective disorder bipolar type

from what I understand sza is on a spectrum with bipolar or depressive type on one end and schizophrenia on the other end and schizoaffective (either type) leans more toward the schizophrenia side of the spectrum. You could ask your doctor if it's concerning you though, hope you're able to get some clarity

[Wild Coyote]

Oh! Forgot to ask you if you are in the US or not. I know you were in Egypt for quite awhile and also know you travel..

Pdocs in other countries often diagnose people differently. If you are seeing a different pdoc and are traveling, this may explain the diagnostic difference.

Either way, please do ask the pdoc. : ).

[Blue_Bird]

It's also possible for the illness to progress or change over time, so as others have said it would be best to check with your pdoc

[franz kafka]

Originally Posted by fern46

Franz, how long have you seen this pdoc?

I've only met him 2-3 times. I go to a teaching clinic and I see a new resident every 6 months. The only constant is the attending, but I don't know what he thinks.

[fern46]

Originally Posted by franz kafka

I've only met him 2-3 times. I go to a teaching clinic and I see a new resident every 6 months. The only constant is the attending, but I don't know what he thinks.

It makes sense then that he might not have a good handle on your diagnosis yet. Hopefully he will get it right in time.

[franz kafka]

Originally Posted by fern46

It makes sense then that he might not have a good handle on your diagnosis yet. Hopefully he will get it right in time.

I guess it doesn't really matter anyway. My only treatment is an antipsychotic. No other class of drugs works for me. So SZ or SZA, same treatment.

[fern46]

Originally Posted by franz kafka

I guess it doesn't really matter anyway. My only treatment is an antipsychotic. No other class of drugs works for me. So SZ or SZA, same treatment.

Thats essentially what my doctor said to me. If it is working, the treatment is the most important part

[BeyondtheRainbow]

Originally Posted by franz kafka

I guess it doesn't really matter anyway. My only treatment is an antipsychotic. No other class of drugs works for me. So SZ or SZA, same treatment.

I wonder if it has to do with the clozapine. It's very rarely used for BP and maybe your doctor feels it is more appropriately used for schizophrenia? I am on it definitely for bipolar but it is supposed to be a last resort for schizophrenia, not bipolar. I just ran out of the other bipolar options and needed this one which is probably fairly rare. Diagnosing based on the treatment that works doesn't seem right but I wonder if this is someone's attempt at that.

[franz kafka]

Tdoc is going to have a conversation with resident pdoc about this. They work in the same department and she is senior to him. She thinks he is way off base and that this might be a good learning moment to get him on track.

[*Beth*]

That's interesting; keep us posted.

[still_crazy]

not to sound too antipsychiatry, but...

ok, i think often...diagnosis says a lot about the person who is in the position to diagnose. and I also think jumping to Schizophrenia might indicate that this particular psych has power issues and/or is quick to invalidate you...

oh, and...just to be clear: Schizophrenia is, even now, a remarkably large, heterogeneous category. its not quite as crazy as in the 50s, when there were multiple kinds of Schizophrenia and "Schizophrenic-reactions," etc., but...

the category still includes people with very different problems and very different reactions to 'standard treatment,' etc. some progressive nations have scrapped use of Schizophrenia in favor of less stigmatizing labels. and...

its also possible to be intelligent, capable, and deal with what many psychiatrists call Schizophrenia. it just happens to also be an extremely stigmatizing label.

my last, last, last thought...maybe a switch to a female psychiatrist? on the one hand, a psych is a psych is a psych, but...i've had better luck with female pdcos than male ones.

[bpcyclist]

Very interesting discussions. Ironically enough, my pdoc just brought up the possibility of adding clozapine because of some of the stubborn symptoms I am dealing with. I am thinking about it. Don't really want to deal with all the clozapine baggage, but I really just can't go on suffering like this. I won't make it.

I am officially bp1. And yet, I have had absolutely massive and devastating psychotic episodes, some lasting for months. I have always wondered what is the difference between a bp1 with pretty marked psychotic features like me and a garden-variety schizoaffective person. I know it doesn't really matter what the name is. To me, what counts is what are we gonna do about it? Still, it seems to me that bipolar disorder and schizophrenia are in some senses almost parts of the same continuum. It isn't surprising, therefore, that there is a lot of medication overlap between the two. Anyhoo, I find this all very interesting.

[BeyondtheRainbow]

Originally Posted by bpcyclist

Very interesting discussions. Ironically enough, my pdoc just brought up the possibility of adding clozapine because of some of the stubborn symptoms I am dealing with. I am thinking about it. Don't really want to deal with all the clozapine baggage, but I really just can't go on suffering like this. I won't make it..

I've been on clozapine for 3.75 years. It is by far the most useful med I've ever taken. My review of it is Clozaril

It's not nearly as bad as I feared when I went on it; the worst side effects are manageable.

I hope you can get away without needing it but if you do it's really not that bad, especially once you are adjusted.d

[Zeroid]

Originally Posted by franz kafka

Tdoc is going to have a conversation with resident pdoc about this. They work in the same department and she is senior to him. She thinks he is way off base and that this might be a good learning moment to get him on track.

I think that is the heart of the issue. They are new, and learning, and without decent oversight they might overreach. I imagine that new pdocs could have a tendency to want to come up with the diagnosis, which is what they spent a lot of time and money training to do. Rubber stamping someone else's opinion would feel like an anti-climax

[bpcyclist]

Originally Posted by BeyondtheRainbow

I've been on clozapine for 3.75 years. It is by far the most useful med I've ever taken. My review of it is Clozaril

It's not nearly as bad as I feared when I went on it; the worst side effects are manageable.

I hope you can get away without needing it but if you do it's really not that bad, especially once you are adjusted.d

Thanks very much for sharing your experience and I will definitely read what you have linked to. Maybe I'm psyching myself out...