[Psychotic_Phil]

I can accept if the Bipolar diagnosis were warranted, but when psychosis in the course of the illness has lasted longer than mood symptoms and they occur seemingly seperately, then the Bipolar diagnosis is questionable. Schizoaffective Disorder should be looked into, not brushed aside as a remote fantasy of some sort. Apparently, my doc doesn't seem to understand that. He says that I have "severe" Bipolar I Disorder with the possibility of Schizoaffective. But when all the signs are seemingly pointing to Schizoaffective, then that shouldn't just be a possibility. My course has been like Paranoid Schizophrenia one minute, Bipolar the next. And yet, I'm just Bipolar.

Don't get me wrong, I like my doctor, but his opinions on diagnosis are questionable. Hopefully, we can do more research, but for now, I need to rant.

[Psychotic_Phil]

I suppose no one cares.


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Can I ask you something?

What difference does it make? What difference does it make to your medication? What difference does it make to your treatment?

If you have ideas about medication changes then I'd hope that your doc would be open to that (especially if your current meds aren't working out for you).

What medication are you on?

A mood stabiliser for the bi-pol?

An anti-psychotic?

[withit]

I care, I just can't relate. Labels don't mean anything to me; your aches and pains and inner experiences are of more significance to me than psychiatrists' labels.

Feel free to share how you are feeling, aside from the obvious- that you are p----d by your doc's dx.

Take gentle care,

[SecretGarden]

Hi there Phil....

I read your post but I am a depressive (though unipolar so I understand the cycling) . I do not understand the other diagnosises you speak of because I do not experience them... I do care. I just do not know how to respond. Sometimes things ebb and flow here and I hope someone will respond that might respond better than me.

I recall feeling what I termed psychotic for a period some years ago when I was way way way depressed. So I understand what you mean actually when you speak of the psychosis lasting longer than the mood symptoms so that is concerning. How much longer and has this been going on repeatedly for a while?

I do not know what Schizoaffective Disorder is. What is it and how would your treatment differ if that was confirmed and agreed upon by the person treating you. Would meds differ or treatment or what?

I'm not big into diagnoses... It's a label, really. I believe more in looking at things in terms of a framework-- if the symptoms are there, then of course they exist, and you treat them. I used to obsess over my diagnosis.... I thought it was a definition of myself of some sort... Then I began to look at my symptoms in the way of a framework and characteristics. There is so much overlap in mental health disorders if you end up focusing in so much on your 'diagnosis' you could end up overlooking some pretty important stuff. I used to be obsessed with buying books about borderline personality d/o. I would research it like crazy on the internet, trying to get all of the information I could. But it was so.... surface, I guess. Now I study it through psychoanalysis, looking at my traits through different frameworks.

I can understand why you would want to rant. But rather than emphasizing the label to your pdoc, emphasize your symptoms... and make sure he is doing is best to get them taken care of.

The distinction between bi-polar and schizophrenia was originally intended to capture different courses of illness (for the most part. People with schizophrenia were thought to be chronic such that they couldn't go on to live productive lives whereas the course of bi-polar was thought to be intermittent such that people had episodes of good functioning.

There has been much controversy over whether schizophrenia and bi-polar are different natural kinds or whether there isn't really a great deal of difference between them. The diagnosis of schizoaffective was invented to capture those cases that seemed to fall in the middle. One might be inclined (as Bentall does, for example) to regard there to be a continuum where some people exhibit more of the 'traditionally schizophrenic' symptoms while others exhibit more of the 'traditionally mood' symptoms. Basically... Different people will have their different symptoms.

I was reading something the other day about 3 views of medication. One view is that medication is general. Benzo's were used like that, I think, to basically sedate all the patients (regardless of what their diagnosis or symptoms were). Another view is that medication is symptom specific. So it doesn't matter what your dx is if you have delusions (caused by drugs, endocrine disorder, acquired cerebral injury, in the context of depression, in the context of bi-polar, in the context of a psychotic disorder) then anti-psychotics will help. Another view is that medication is diagnosis specific. I think it was... social anxiety without panic (or something along those lines) that only became acknowledged as a kind of mental disorder by virtue of their having developed a treatment that seemed very affective with a subclass of people with panic disorders. Basically... We don't have very many medications like this. Lithium (when effective) might be one of them (for bi-polar), however. But there are plenty of people with a dx of bi-polar who don't respond well to lithium.

> The diagnosis of schizoaffective disorder requires that the patient experience some decline in social functioning for at least a six-month period

> Negative symptoms are the opposite of positive symptoms. They are the absence of thoughts, perceptions, or behaviors that are ordinarily present in people in the general population. These symptoms are often stable throughout much of the patient's life.

Blunted Affect. The expressiveness of the patient's face, voice tone, and gestures is diminished or restricted. However, this does not mean that the person is not reacting to his or her environment or having feelings.

The disorder is usually life-long

_________________________________

Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms , but as many as one-third of people have some residual symptoms.

People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated

Apathy. The patient does not feel motivated to pursue goals and activities. The patient may feel lethargic or sleepy, and have trouble following through on even simple plans. Patients with apathy often have little sense of purpose in their lives and have few interests.

Anhedonia. The patient experiences little or no pleasure from activities that he or she used to enjoy or that others enjoy. For example, the person may not enjoy watching a sunset, going to the movies, or a close relationship with another person.

Poverty of Speech or Content of Speech. The patient says very little, or when he or she talks, it does not amount to much. Sometimes conversing with the patient can be unrewarding.

Inattention. The patient has difficulty attending and is easily distracted. This can interfere with activities such as work, interacting with others, and personal care skills.

__________________________

So... Bi-polar gives you a better prognosis than schizoaffective.

I would say your doc is doing the right thing in not wanting to dx you with schizoaffective until it really does look like you aren't going to be living a very productive life. A dx of schizoaffective is fairly much 'chronic' by definition, you see.

It makes no difference to your treatment.

It is mostly... A difference in prognosis.

[Psychotic_Phil]

The confusing thing is I don't ift the criteria for Bipolar or Schizoaffective. My course is like Paranoid Schizophrenia one minute, Bipolar the next. My doc says wait and see but there should be enough information to say what's going on. Maybe it is JUST psychotic Bipolar.

[sunrise]

Hi Phil, are you seeing a therapist? If so, maybe you can discuss with your therapist why having a definitive diagnosis is so important to you? Does it make a difference in what psychotherapy techniques would be used with you? Does it make a difference in what meds would be prescribed to you? Does it make a difference in what insurance or disability benefits you would receive?

My therapist holds off on diagnosis. I like that. I am a person first, not a definition in a book. We work together on my symptoms, my problems, and navigate toward health. This really works well for me. I feel like he is viewing me as a unique person and not just putting me into the "box" of a particular diagnosis in a manual.

> The confusing thing is I don't ift the criteria for Bipolar or Schizoaffective. My course is like Paranoid Schizophrenia one minute, Bipolar the next. My doc says wait and see but there should be enough information to say what's going on. Maybe it is JUST psychotic Bipolar.

whats going on is... that you are having certain symptoms that are making living your life problematic.

did you know that more people meet diagnostic criteria for the 'not otherwise specified' catch all category than meet criteria for any of the more specific diagnoses?

the first DSM had... three diagnoses, i believe. now the DSM has over 200. want to know the reason why? while the APA would have us conclude that we are getting more and more scientific the real reason is that there is increasing pressure on the APA to convey the appearance of more scientific. the DSM is a MAJOR money earner for the APA and DSM diagnosis is required for health insurance reimbursement in the US.

the reason we have such a weighty tome of classifications is because of political pressure and not because of the scientific evidence.

there is a move to try and get a dimensional rather than a categorical system off the ground. trouble is that the dimensionalists don't really have much of a consensus on what a dimensional system should look like. sigh. a dimensional system would reflect (what seems to be supported by the data) that it is a difference in DEGREE rather than KIND whether someone is mentally disordered or not. It is likewise a difference in DEGREE rather than KIND whether someone has one condition rather than another.

its not like medicine where it matters whether you are diagnosed with a certain pathogen because the treatment for it is specific to the kind of pathogen.

people like the little boxes...

seems to me that what this amounts to is...

whether you are likely to recover or not.

if 99.999% of people with your diagnosis don't recover then who cares so long as you are that 00.001%. trouble is that when people tell you you are unlikely to recover that tends to make it so...

i don't see why it matters what your diagnosis is...

what difference does it make?

how does what name you call it change the symptoms you experience?

[Psychotic_Phil]

I don't know. Right now I'm fed up with it all. Fitting no criteria is frustrating because I want to know what I can expect. If I have say a Schizophrenic illness, I can just expect nothing from my life. If I'm Bipolar, then that's not really serious. Just mood states deemed unacceptable in my environment. I find it unlikely that I have ANYTHING serious (meaning my shrinks "temporary diagnosis" is probably solid) I'll just do nothing in my life and be nothing. What difference does it make? What do I matter? So I wrote a few essays above 7th grade level. Big %#@&#! deal. So either way i'm in a Catch 22. If I'm Schizophrenic I may as well undo my existance. If I'm Bipolar, no need to. Life will do it for me. Either way I fail and am nothing that I set out to be. I wanted to originally pursue a mathematics career, like John Nash. I read the biography on him and when I got to the section dealing with his Schizophrenia I just tuned out and knew I'd never be that, because I am nothing. Never have been and never will be.

[Psychotic_Phil]

Just like last time, no one cares.



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</font><blockquote><div id="quote"><font class="small">Quote:</font>
Psychotic_Phil said:
If I have say a Schizophrenic illness, I can just expect nothing from my life. If I'm Bipolar, then that's not really serious. I'm Schizophrenic I may as well undo my existance. If I'm Bipolar, no need to.

</div></font></blockquote><font class="post">

I work in vocational rehabilitation.... a lot of people who have schizophrenia do very well for themselves.... and can make out quite nicely at work. There are some who have been diagnosed with bipolar who have not been so lucky. It really depends on the level of functioning. You cannot say that if you have schizophrenia life is over, if you have bipolar, then it's not, because that's not really serious. Both disorders are to be taken seriously.

[Psychotic_Phil]

Well, Schizophrenia is a very disabling condition adn if I were ever diagnosed with it or a related disorder, I'd deny it. Bipolar is just mood swings with some psychosis, high levels of functioning etc. Can expect nothing to go wrong with that, so no need to take meds. Because nothing will happen to me. I don't care anymore. As far as I know i fit parts of both criteria. I don't care anymore. And yes, Schizophrenia diables people to the point of homelessness and drug abuse. SSimple as that.

[Direction]

Phil - I struggle with this needing a DX.

I think it is from my black and white thinking...reading through this post, it sounds you may have the same style of thinking as I do? It's got to be black or it's got to be white.

I hear what the others are saying that it is more grey and that it doesn't matter; however, if you are like me - there is not much they can say to actually internalizing the grey. I hear it, but...

Phil, try to hang in there. What you've got going for you at thirteen that so many of us didn't, is that you are being treated for "whatever" Dx you have.

That the struggles that you have are being heard.

That is huge. Had I been treated at your age...wow. My life would have been so different.

I know it sucks, I really do, but try not to get hung up on the labels. I know people who suffer from both dx's and both are highly functional.

If you don't think your psychiatrist is diagnosing you properly, is there anyway you could switch to get a second opinion?

Good luck, Phil

Keep us posted.

[Psychotic_Phil]

What does that mean Black or White thinking Direction? What diagnosis is that? Proabably Bipolar. So now I can quit my meds. Thanks.

Black and white thinking is not a disorder-- it's a coping mechanism, a defense if you will... Tends to fit within the framework of borderline personality, but it's not indicative of the disorder...bascially it refers to looking at things and having feelings in terms of two extremes-- black and white--no middle ground, no gray area. I do it alllll the time. And why would you quit your meds?

[Direction]

It's more of a style of thinking.

It like saying that I love a person or I hate a person. No choice in the middle. That you can love a person, but not be particularly happy with something they did. Black and White leaves no room for grey.

As for quiting meds...please don't read that what I posted had anything to do with medication. Having said that do you see the black in white in your last post. Either take the meds or don't take them. Nothing in the middle about adjusting them.

Hopefully this makes some kind of since for you...

> Schizophrenia is a very disabling condition adn if I were ever diagnosed with it or a related disorder, I'd deny it.

then why are you trying to persuade your p-doc to dx you with schizoaffective?

> Bipolar is just mood swings with some psychosis, high levels of functioning etc. Can expect nothing to go wrong with that, so no need to take meds. Because nothing will happen to me.

i don't see how any of that follows.

> And yes, Schizophrenia diables people to the point of homelessness and drug abuse. SSimple as that.

i'm afraid it isn't simple as that and i think you should be sensitive to the feelings of people with schizophrenia.

one third of people in developed western nations recover from schizophrenia.

two thirds of people in developing western nations recover from schizophrenia.

(check out the WHO studies for the precise stats).

PS... if people don't respond to your post within the hour it is of course possible that they aren't online. people don't just sit in front of their computer waiting for you to post so they can reply quick smart to posts from you before you accuse them of not caring.

[Psychotic_Phil]

> Schizophrenia is a very disabling condition adn if I were ever diagnosed with it or a related disorder, I'd deny it.

then why are you trying to persuade your p-doc to dx you with schizoaffective?

I changed that and I am most likely Bipolar. I may be wrong, but I don't think so. Sorry about the Schizophrenia thing OK? I was talking about Schizophrenia SPECIFICALLY, not Schizoaffective.

I don't see why you hate me alexandra. What did I do to you? Nothing. So what?

[Rapunzel]

Phil,

I don't think that anyone hates you. But it really does rub everyone the wrong way when they get accused of not caring because they haven't responded to you yet and it's been less than an hour since you posted. I know that doesn't make me want to respond. I would be happy to help you if you asked nicely though. I do know that anxiety rises if you don't get answers right away. When I post something that I really need feedback on (that's pretty much anything that is personal), it's hard not to keep checking every minute or so to see if anyone has said anything yet, and it is disappointing when they haven't. But all of us go through that. Sometimes there just isn't anyone online right then who has a good answer for you. It's best to find something else to do for a while, and check back later.

You sound very angry, and you want answers right now. I also sense that you are looking for an excuse not to do anything productive with your life. Well, mental health professionals are there to help you make the most out of your life, regardless of which disorder you meet criteria for. Especially when you are still young, they will be reluctant to give you a diagnosis that might limit you. You are still developing, and you still have the chance to learn to manage your symptoms, and be able to do the things in life that are important to you. Professionals want to give you the best chance you can get. One thing that might help would be for you to meet (and also read about) people who have those more serious diagnoses and have accomplished great things, like John Nash. There is no reason that you can't be one of those people, but it would be so much easier if you have a therapist, or a mentor, or someone who can teach you how to manage your symptoms and encourage you to try things and find your best place in life.

I don't know if you have read about my brother. He had schizophrenia, and he died last month (it was suicide). I read some of his journals, and I was so sad because his was a wasted life. People thought that he was just lazy, or that he was too sick to do things. But he could have done the things that he wanted to do, and he did want to do things. He wanted to get an education (he was always intelligent but dropped out of high school due to his illness), and he wanted to work. He was interested in languages and art and graphic design and genealogy, and he had a lot of talent in those areas. There was no reason that he couldn't have done something meaningful with that. But when he said that he wanted to try, they increased his medication until he didn't feel like it anymore. I am so mad that they did that to him, I could spit nails. It cost him his life. He felt worthless, and he even started to believe that he was lazy, and maybe he acted the part. People tend to live up to negative expectations. I guess it's easier than reaching beyond them and doing what you are really capable of.

It's late and it's dark here, and I can't turn on the light right now, but the last psychologist who evaluated my brother made some recommendations, and when I read them I thought that would have been very helpful if someone had started back when he was 13 or so. I'll post those for you, but it might be tomorrow night before I can. I have to go to work early in the morning, and it will be a long day. We'll see, and I'll try to work it in earlier if I can.

What I hope that you get from this is that it would be tragic if you used your diagnosis (whatever it is) as an excuse not to live your life to the fullest extent that you can. I hope that you will make goals (they can be small for now) about things that you would like to do with your life, and don't let anything stop you. That matters so much more than your diagnosis does. Take your medicine and get therapy and work hard at it, but pay more attention to what you can do than what you think you can't or might not be able to do. Do what you can, and push yourself, and be great at something that means something to you.

Rap

[Psychotic_Phil]

That was a very touching message Rapunzel. Thank you. I'm sorry about your brother. That really meant something to me.

[MissCharlotte]

Hi Phl,

One of the reasons that pdocs are not quick to diagnose with schizoaffective or schizophrenia is just what you articulated, that it is a diagnosis that will change how the world looks at a person. It is not something to be taken lightly and frankly is a diagnosis that evolves over time. You are too young to be given such a diagnosis. Like Pinksoil said, both bipolar and shcizophrenia are serious illnesses and should not be taken lightly. However, most important is how YOU look at you. Never mind the label--that is important for the pdoc so he can prescribe the right meds. What's important for you is to decide how you can manage your symptoms best so you can have a life despite the illness. My son has been diagnosed with "psychosis -nos" (NOS means not otherwise specified). He probably has some sort of schizophrenia, but we are not eager for this label and neither is he. He is working hard at getting his life together and finding a job. He is smart, a college graduate and I won't give up on him and pray he won't give up on himself. The point is Phil, a label doesnt mean you have to give up and generalizations about an illness are just that--generalizaions. They are not meant to describe any one individual.

Good luck to you, and keep trying!