[Numbers]

Hi

Well I been in and out of therapy and probably never been totally honest, but finally they sent me to an actually good one, and I decided to be straight with him. And well he seems to think I'm psychotic (actually he seems very sure of it) and he says that I'm probably going to need medication because there's only so much he can do, and it's not even his exact field of psychology.

I don't want to have to go to a new one though and I'm actually pretty scared about the whole med thing. I'm terrified if the meds take all my imagination away, it's not like it's all bad, and I'm scared of all the side effects. I'm also scared what the docs are going to do to me. Like how am I going to be tested?

Is it possible to get better without meds?

Hope somebody has some answers

Numbers who's very confused

[pegasus]

Hello Numbers, I disagree when your T says there is only so much that can be done with therapy. Therapy, particularly CBT can be very helpful.

You may need meds though, that doesn't mean forever but are very useful in times of severe distress. The meds can calm things down.

Take care.

[spiritual_emergency]

Numbers: ...he seems to think I'm psychotic (actually he seems very sure of it) and he says that I'm probably going to need medication because there's only so much he can do, and it's not even his exact field of psychology.

Hello Numbers,
It's my understanding that psychosis tends to be glaringly obvious but I suppose there are shades and nuances of degree. Meanwhile, if an individual is talking with a therapist they're usually talking about something that has occurred in the past however, there is also a present taking place as they sit on their chair in their therapist's office. A diagnosis of psychosis can only be made as based upon behavioral responses so do you know if it was your past behavior (what you were talking about) or your present behavior (what you were doing in that moment) that has nudged your therapist towards a diagnosis of psychosis?

Is it possible to get better without meds?

Yes. Although not always and in this culture where meds are considered a first line of defense in treatment, it can be downright impossible to find a doc who won't treat with meds if he/she suspects psychosis. There are various reasons for why that's so but for now, suffice to say that your psychologist is likely legally mandated to refer you to a psychiatrist and prescribing medication is, essentially, what psychiatrists do these days. Many people see both a psychiatrist and a psychologist although those decisions might be guided by your health insurance.

Overall, meds are a tool -- they are one of many tools. Some people identify them as exceptionally helpful, some people don't. Depending on what's happening for you, you might be able to talk (and work) the situation through with your psychologist but that's going to depend on the level of distress you might be experiencing and how well you are functioning, i.e. can you still tend to your studies and daily needs? It's also going to depend on your therapist's comfort levels.

Something I recommend you do now while you still have the chance, is to review any information as related to any mental health laws in your location. You can probably find such information through your favorite search engine. Your profile says you're 18 and in some areas, that's considered a legal adult -- in other jurisdictions, it's not. As an adult you're usually allowed to make your own treatment decisions (unless you have presented as a threat to yourself or another) but it's possible you live in an area where adulthood is not legally recognized until you're a year or two older. If that's the case, your parents or guardians would likely make treatment decisions on your behalf. Do they know how you feel about medication and treatment options? If not, now would be the time to let them know.

Anti-psychotic medication is frequently the norm if psychosis is suspected but anti-depressants, anti-anxiety agents, mood stabilizers and other medications may also be prescribed. Ideally, you (and possibly, your parents/guardians) would know the risks and benefits of those drugs beforehand so you can make your best, informed decisions.

To sum up, these are the things you should review...

- The rationale for the diagnosis of psychosis

- Whether or not you're considered a legal adult and therefore, permitted to make your own treatment decisions.

- If your health insurance will allow you to see both a psychologist and a psychiatrist if necessary.

- What forms of treatment your health insurance will pay for, e.g., they might pay for a psychiatrist but refuse to pay for a therapy such as CBT.

- Whether or not you possess the necessary information to help you (or your parents/guardians) make the best treatment decisions.

As a final consideration, if you are taking or experimenting with recreational drugs -- certainly not an unusual pastime among people in your age group -- it would probably be best to let your caregivers know you have done so and to set the practice aside. There does seem to be a strong link between cannabis and psychosis in particular, although I've known of other "street" drugs that can trigger psychotic states of consciousness.

~ Namaste

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[ScaredSad]

Thank you for your post SE. I love it that you reminded the poster of their rights to control their treatment. I think that's so important. I just wanted to add something to the legally mandated to refer part...

Every person over the age of 18 years old who is maintaining power of attorney over their individual rights (meaning no one has taken them to court to declare them incompetent) has the right to refuse medication for all disorders at any time, for any reason in the United States. (only speaking to US, of course, and what has been held up in national precendent -- I have NO experience in international health so I don't want to give anyone false info about what those clinicians face)

As such, referrals for pharmalogical or medical follow-up are no more than fancy suggestions unless they are court ordered... and those are usually when a patient has received inpatient treatment/incarceration and the judge orders continued care as a condition of their release.

The only legally mandated referrals would be ones in states with laws that require for duty to warn such as if a client explicity states intent to harm self or others or if it falls under neglect/abuse laws for children/elderly/incapacitated adults.

If the therapist refers a patient for psychosis simply as a suggestion for medication, there's nothing guiding that clinician other than his/her interpretation of best practice.

So, that's all, I just wanted to say that referrals to a psychiatrist are not typically legally regulated unless it's part of a court ordered discharge agreement or there's abuse/neglect/danger... If the therapist said anything to the contrary, I'd definitely request clarification to see why he is required to refer his clients out... could be agency policy, could be some jacked-up collusion with the drug companies, etc.

To the original poster: I think everything you are experiencing is 100% normal from someone facing similar challenges. I would worry too that I'd lose the good with the bad.

I think it's helpful to generalize it to other situations. Any time we make a decision, there's risk involved. I'm trying to decide whether to prioritize career, family, or friends right now and with every plus involved... I lose something as well.

I've got input from family who want me to choose them... friends who want me to choose them... and from my banks/creditors/landlord who want me to choose them and go where the money is best. All of those things are helpful but in the end, I'm going to have to trust my gut, I guess, as to what is best for me.

If you feel that you are no longer able to make the best decision for you, then you need to find someone you trust and ask them to help you with that decision process. Committing to pharmacological treatment of a disorder is a big step whether it's chemotherapy for an autoimmune disease or atypical antipsychotics for a psychotic disorder.

As far as the tests, first, you will have to fill out a ton of paperwork. It will likely include at least one survey type assessment. The questions will be varied and will ask you about your usual behaviors or what you are feeling right then at that time. If you aren't able to focus on something until you finish, I'd suggest you bring someone with you to help finish the paperwork.

Depending on the clinician, he will either ask you for your version of events or he will go into his exam mode. Some clinicians do strict testing where you will sit with a pencil and fill in circles or write short answers. Some clinicians do old-style movie-type assessments such as perception tests where you look @ a picture and report your response. Some clinicians do a free flowing interview where they use your responses to gather as much information as they can gather. Some clinicians will use the same interview for every client for the first session. Some clinicians won't ask you any questions, will write you a prescription, and send you out the door (be wary of these...) Some clinicians won't even see you that first day...and will reschedule you for later.

You probably won't leave that day with any firm answers. Proper assessment and diagnosis is continuing/ongoing... it's not final. You can't just do it once and it never changes. As people change, so do the disorders they face. Some heal, some worsen, some new ones pop up, and it's possible that some clear out entirely. If you do get a name for your problems that day, use it as a tool and not as the model to build your life around... if you do, you might miss out on opportunities to change and grow because of that self-imposed ceiling.

You write very well and very clearly so I don't doubt that you aren't very intelligent. As the other poster said, use that in your favor to educate yourself about the possibilities/alternatives for your challenges. Did you know that a lot of times anxiety disorders are misdiagnosed as psychotic disorders? Disturbing intrusive thoughts that are unimaginable for most of us (sex with demons, murdering babies, etc) were always treated as psychosis until recently. Now, lots of clinicians/researchers are viewing them as obsessive compulsive behaviors/thoughts... no different than washing your hands 100 times. It turns out they respond to the SAME treatments as OCD (often non-medicated).

There are tons of answers out there and that's great but it's too much for one person to ever learn... so it's helpful if you share things with your therapist/psychiatrist. Ask questions, stay aware, and communicate your true symptoms... It's my personal belief that the more empowered people are over their own care, the more well managed their symptoms will be for a lifetime.

Good luck and thanks for sharing. Please keep us posted.

[Numbers]

Thank you for all the replies, it's been very helpful.

Age is no problem, I am fully of age to make my own descisions and I don't live at home with my parents so there's no problem there.

The reason psychosis didn't seem so obvious was that I haven't been totally honest with my psychologist.

I was referred to a psychologist by my the student counselor at my old school, because he had been getting reports from my teachers that I was acting "wierd". At that time I was under age and living with my parents, and I had actually been refered to a psychologist twice before at other schools, but always managed to get out of having to tell my parents. I had an interview with a school psychologist who recomended a psych and she hinted that I might have a psychosis. It freaked me out but I went to the psychologist for about a year, but never really had the guts to tell just how real the thoughts I was having were. Then she went on maternity leave and I stopped going.

I just pulled myself together to go back there, and I actually got a really good psychologist, and he's very easy to talk to. And so last time I decided to tell him straight out.

(I don't have a drug problem)

Up until now I've been paying for psychologists myself because I've been afraid of going to the doctor because I've been unsure of what they will do to me (in my country we all have insurance). My psychologist has told me that they'll send me to a psychiatrist for assesment and probably give me some meds (assesment is free, but meds cost a little). Right now I have money to keep seeing a psychologist.

I do well academically (I study math), and basically that's the only area of my life where I do well. I'm scared that taking meds will take that away from me, because the reason I'm good is my imagination.

I do have good days, where I can actually function around other people but they seem to be getting further apart. I'm scared of losing complete touch with reality but I don't want to lose the only thing in my life that actually works either.

Are you sure the assesment will only be questions, there won't be any scannings or other medical tests?

Numbers

[spiritual_emergency]

Hello Numbers,
Just a bit of a standard disclaimer before I respond further...

To the best of my knowledge, no one here is a professional. That means that no one is in any kind of position to make a diagnosis as based on whatever symptoms you might present with and even if they were, I wouldn't invest much faith in a diagnosis delivered over the internet. From what I understand, the individuals who participate in this topic are either people who have personal experience with psychosis or perhaps are interested in the matter for some reason -- maybe they're a student, maybe they have a friend or family member with the diagnosis. In my own case, I speak from the position of having undergone the experience known as psychosis in this culture. I wanted to be clear on that because what I say next is based on my own opinion which you can take or leave as you see fit.

I do well academically (I study math), and basically that's the only area of my life where I do well. I'm scared that taking meds will take that away from me, because the reason I'm good is my imagination.

When and if you choose to see a psychiatrist, I suggest you discuss your concerns regarding medication with him/her then. If possible, find out what medications they would recommend in your situation as well as why they would choose those specific medications in your case. Then ask for some time to research them before you commit to a trial of treatment. You are an adult so you do have the right to make your own treatment decisions and as far as I can determine (as based on your posts thus far), you're not presenting as a harm to yourself or others.

Two good resources for researching medication are rxlist.com and askapatient.com. The first link offers a medically oriented perspective while the second is based on consumer reports from individuals who have taken that specific medication. Utilizing both will help provide you with a more thorough perspective. You may want to search the sites by both trade and generic name.

I do have good days, where I can actually function around other people but they seem to be getting further apart. I'm scared of losing complete touch with reality but I don't want to lose the only thing in my life that actually works either.

There are a a number of factors that might affect how well you function around other people, psychosis is only one possiblity. Other conditions that can be mistaken for psychosis include complicated grief, trauma reactions, dissociation, anxiety disorders, etc. For that reason, it might be worth going over your psychologist's concerns in more depth so you have a thorough understanding of why he/she is leaning towards that specific diagnosis. This link might be able to offer you some additional insights into the numerous causes associated with psychosis.

Are you sure the assesment will only be questions, there won't be any scannings or other medical tests?

There are no medical tests (i.e. blood tests, brain scans) that can detect psychosis and/or schizophrenia. Diagnosis is made as based on the observations of your doctors and other reports, such as the history you provide or your psychologist's referral. However, some tests may be ordered to rule out any underlying physiological cause. For example, a brain tumor could cause psychosis (rare, but possible). In such a case, surgery would likely be the preferred course of action as opposed to long-term treatment with anti-psychotic medication.

I hope you're able to get the help that you need Numbers. Whatever information you can gather beforehand will likely be very much to your benefit.

~ Namaste

.

[spiritual_emergency]

ScaredSad: I just wanted to say that referrals to a psychiatrist are not typically legally regulated unless it's part of a court ordered discharge agreement or there's abuse/neglect/danger... If the therapist said anything to the contrary, I'd definitely request clarification to see why he is required to refer his clients out... could be agency policy, could be some jacked-up collusion with the drug companies, etc.

Hello ScaredSad,
As I understand it -- and I may well be wrong -- a professional is legally and ethically mandated to refer if they feel the client's/patient's difficulties are beyond the scope of their skill and expertise. Most psychologists do not have the ability to prescribe medications and medications are considered by many to be "thee" essential component of treatment for psychosis. As a result, if a psychologist is working with a client and they suspect psychosis, they will refer as based on their inability to prescribe medication. Too, this decision may be coupled with their lack of faith in their own profession's ability to offer effective treatment. Traditionally, talk therapies have not been promoted as an effective form of treatment although CBT does seem to be making some inroads. Numbers' opening post suggests to me that this is precisely what happened...

...he seems to think I'm psychotic (actually he seems very sure of it) and he says that I'm probably going to need medication because there's only so much he can do, and it's not even his exact field of psychology.

That doesn't mean Numbers can no longer talk with his psychologist. I'm hopeful he can continue, especially since he's found it to be so helpful. However, that may depend on his psychologist's comfort levels.

My own explorations have suggested that psychotherapy can be highly effective in the hands of a skilled clinician, but finding such a clinician can be very difficult. John Weir Perry, Jaakko Seikkula, Loren Mosher, Bertram Karon -- these are all examples of Western-based psychiatrists or psychologists who relied on forms of talk therapy as coupled with reduced or no medication. Unfortunately, at least two of those individuals are dead, a third is in Finland/Norway. That leaves Dr. Karon but I've no idea if he's still practicing. If individuals wish to pursue talk therapies as treatment, it's always possible they'll be able to find professionals who practice in a similar vein. The odds of doing so appear to be somewhat better in Northern Europe.

.
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[Numbers]

Thank you Spiritual Emergency

At least now I know what to ask the psychologist for next time, and thanks a lot for the links

The psychologist can't perscribe meds as you said, that's why he's referring me to a normal doctor, who he says will probably send me to a psychiatrist.

And just so you know I'm a girl, but that's ok, lots of people confuse me with a boy

I know I shouldn't put faith in what in internet diagnosis, but never been diagnosed on the internet, did I give you that impression? English is not my mother tongue so I might write rubbish sometimes. I apolgise for any misunderstandings.

Thank you for the great advice, it's very helpful at least now I can do something.

Numbers

[spiritual_emergency]

Numbers: And just so you know I'm a girl, but that's ok, lots of people confuse me with a boy.

Thanks for the clarification.

I know I shouldn't put faith in what in internet diagnosis, but never been diagnosed on the internet, did I give you that impression?

Not at all. I just wanted to be certain you understood I wasn't a professional before I started throwing any official looking links, studies, etc. in your direction. Some people have assumed I'm a student at minimum and I'm not. And even if I was you shouldn't trust a diagnosis made over the internet. A true diagnosis requires an indepth knowledge of your personal circumstances, test results, etc.

English is not my mother tongue so I might write rubbish sometimes. I apolgise for any misunderstandings.

Hopefully, that means you're from Northern Europe where your odds of working with a somewhat different medical paradigm might be greater than they would be if English was your first language.

Best of luck to you Numbers.

~ Namaste

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[cajun]

Originally Posted by Numbers

Thank you for all the replies, it's been very helpful.

Age is no problem, I am fully of age to make my own descisions and I don't live at home with my parents so there's no problem there.

The reason psychosis didn't seem so obvious was that I haven't been totally honest with my psychologist.

I was referred to a psychologist by my the student counselor at my old school, because he had been getting reports from my teachers that I was acting "wierd". At that time I was under age and living with my parents, and I had actually been refered to a psychologist twice before at other schools, but always managed to get out of having to tell my parents. I had an interview with a school psychologist who recomended a psych and she hinted that I might have a psychosis. It freaked me out but I went to the psychologist for about a year, but never really had the guts to tell just how real the thoughts I was having were. Then she went on maternity leave and I stopped going.

I just pulled myself together to go back there, and I actually got a really good psychologist, and he's very easy to talk to. And so last time I decided to tell him straight out.

(I don't have a drug problem)

Up until now I've been paying for psychologists myself because I've been afraid of going to the doctor because I've been unsure of what they will do to me (in my country we all have insurance). My psychologist has told me that they'll send me to a psychiatrist for assesment and probably give me some meds (assesment is free, but meds cost a little). Right now I have money to keep seeing a psychologist.

I do well academically (I study math), and basically that's the only area of my life where I do well. I'm scared that taking meds will take that away from me, because the reason I'm good is my imagination.

I do have good days, where I can actually function around other people but they seem to be getting further apart. I'm scared of losing complete touch with reality but I don't want to lose the only thing in my life that actually works either.

Are you sure the assesment will only be questions, there won't be any scannings or other medical tests?

Numbers

You know I'm always here for you. E-mail me or leave a PM if you need to talk..........Cajun