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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by sdjeff on January 5, 2005, at 21:24:49
I was reading over the DSM-IV criteria for Schizoaffective Disorder and it raised some interesting questions.
I seem to fit the criteria fo Schizoaffective Disorder, Depressive type.
These are my main depressive symptoms:
1. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).
2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
3. hypersomnia nearly every day
4. psychomotor retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
5. fatigue or loss of energy every day
6. feelings of worthlessness or excessive or inappropriate guilt nearly every day (not merely self-reproach or guilt about being sick)
7. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
8. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicideHere are my symptoms related to Schizophrenia:
1. hallucinations
2. disorganized speech (e.g., frequent derailment or incoherence)
3. negative symptoms, i.e., affective flattening, alogia, or avolition
4. During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.
5. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.
6. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.Specific Type:
Depressive Type: if the disturbance only includes Major Depressive EpisodesAssociated features:
Learning Problem
Hypoactivity
Depressed Mood
Somatic Dysfunction
Guilt
Odd/Eccentric/Suspicious Personality
Anxious/Fearful/Dependent PersonalityI have auditory and visual hallucenations, mostly auditory. The voices I hear are my own and my dads. They tend to offer a running commentary on how I'm doing, usually not positive.
I tend to be suicidal when I'm not very depressed and when I'm extremely depressed.
I always have a depressed mood. I think I may also suffer from Dysthemia.
I feel flat and adhedonic most of the time.
If I come up with more, I'll post it.
Thanks for reading.
Posted by ghost on January 5, 2005, at 21:31:11
In reply to Schizoaffective disorder? What do you think? long, posted by sdjeff on January 5, 2005, at 21:24:49
> I have auditory and visual hallucenations, mostly auditory. The voices I hear are my own and my dads. They tend to offer a running commentary on how I'm doing, usually not positive.a lot of this hit close to home. this one hit hardest. i can completely relate.
i'm sorry i cant verbalize better. i just wanted to say i understood.
ghost
Posted by sdjeff on January 5, 2005, at 22:15:34
In reply to Re: Schizoaffective disorder? What do you think? long » sdjeff, posted by ghost on January 5, 2005, at 21:31:11
Posted by sdjeff on January 5, 2005, at 22:20:41
In reply to Schizoaffective disorder? What do you think? long, posted by sdjeff on January 5, 2005, at 21:24:49
I just remembered something that I think is important regarding the delusions and voices.
I hear voices but I can rationalize that nobody is there. I can also rationalize most of my delusional thinking except for some of the paranoid stuff.
Posted by justyourlaugh on January 5, 2005, at 23:10:23
In reply to Re: Schizoaffective disorder? More, posted by sdjeff on January 5, 2005, at 22:20:41
jeff,
i can relate ..almost to all..
i can thow in some alcohol..a touch of si..
bingo bango..
borderline.
j
Posted by sdjeff on January 5, 2005, at 23:54:54
In reply to Re: Schizoaffective disorder? More » sdjeff, posted by justyourlaugh on January 5, 2005, at 23:10:23
I can relate to the SI. My Zyprexa helps with that.
Posted by justyourlaugh on January 6, 2005, at 0:05:53
In reply to Re: Schizoaffective disorder? More » justyourlaugh, posted by sdjeff on January 5, 2005, at 23:54:54
fell right off the edge last month..
trying lamical..
thank you for responding to me..
i have been feeling so "whoish".
jyl
Posted by thinkfast on January 6, 2005, at 3:11:18
In reply to Schizoaffective disorder? What do you think? long, posted by sdjeff on January 5, 2005, at 21:24:49
"They tend to offer a running commentary on how I'm doing, usually not positive." I've got that too, but I never figured it to be a psychosis symptom. It's more like me thinking, but it's like I'm talking to myself...not in the usual fasion of just thinking, but like I have no control over it....is this like what u experience? A lot of the stuff seems like stuff a therapist would say to me. Confusing, none the less.
PS...you also have to remember that the more research you do, the more DX's you'll end up giving yourself. My conclusion is that we all have a little of everything....peace
Posted by thinkfast on January 6, 2005, at 3:15:35
In reply to Schizoaffective disorder? What do you think? long, posted by sdjeff on January 5, 2005, at 21:24:49
Jeff, from doing all this reading and whatnot, what exactly are you looking for? The perfect drug or some reason for everything. Just curious....sorry if I'm too nosy...peace
Posted by bimini on January 6, 2005, at 10:30:03
In reply to Schizoaffective disorder? What do you think? long, posted by sdjeff on January 5, 2005, at 21:24:49
I fit somewhat. With the grab-bag type of dxs docs keep adding, I don't take that much credence in the validity. I sometimes wonder if they are necessary just for prescription trials.
I am in a permanent fog. My thinking is of the Swiss cheese variety. It works, then doesn't. Prolonged focusing results in increased agitation. If I can manage to budget the necessity to concentrate I optimize level of functioning.
This is perceived as avoidance and characterized as agoraphobia.Spacing out to retard motorcontrol, missing time, quitting sentences midway, inability to react, balance issues are perceived as panic reaction causing phobias.
Halluzinations produced by chemical fireworks, inability to destinguish close from far, seperating left from front, object non-recognition due to closure problems, integrating movement/stationary delay, seperation of concept and form- consequently got interpreted as dopamine abundance.
bimini
Posted by DanielJ on January 6, 2005, at 11:38:52
In reply to Re: Schizoaffective disorder? What do you think? long, posted by bimini on January 6, 2005, at 10:30:03
Hi Jeff,
My 17 year old son is Schizoaffective. His meds are. 15 mg Zyprexa and 75 mg Zoloft daily taken about 7 pm. They work very well. He has had most of the symptoms you listed. After starting Zyprexa his delusions gradually subsided along with auditory hallucinations. He claims he sees words in script but has learned to ignore them. Over about 6 months he went from very severe to nearly normal in functionality due to proper and consistent medication. He gets straight A's in H.S. (he would not study at all for the last 3 years) He had a bad episode, was hospitalized for one day and a month later spent 2 weeks in a crisis center where after that most of the correct meds were given him but dosages needed adjustment. He enjoys his life now. It took some experimentation of Zoloft dosage to bring back his sense of humor. I would say about 3 to 4 months of not missing meds got him back from the "flat affect world".
He would watch comedy movies without ever smiling or laughing. Improvement was slight from one day to the next, it took patience to get him where he is now but he is better and it was worth the effort. THe correct treatment can bring most patients back from the edge and a little will power can keep them there.
Posted by banga on January 6, 2005, at 13:13:03
In reply to Re: Schizoaffective disorder? What do you think? long, posted by DanielJ on January 6, 2005, at 11:38:52
If we're strictly speaking whether the diagnosis fits, the key is having hallucinations and problems at times without feeling depressed.
Keep in mind, "pure" (whatever that means)major depression can have psychotic features. Supposedly indiagnosing, you try to distinguish whether the hallucinations and delusions are from schizophrenia (or schizoaffective, which is an alternation of depression and schizophrenia) versus depression by asking whether the hallucinations and delusions fit the mood (that is, are all the hallucinations and delusions in sync with depresson--negative, degrading messages, etc., versus believing you are God or something similar--which at least I'd think means positive feeling about yourself--thus doesnt fit with your depressed mood. And also do you have psychotic symptoms at times without being depressed.I am not saying this to say I agree or diagree with the classification, or what your diagnosis could be. I just mean it is difficult to pick all this apart---people with "pure" Major Depressive disorder can experience mixed up thinking and hallucinations when really low, and people with schizophrenia are very frequently extremely depressed. Schizoaffective disorder is a (by the way, highly criticized) diagnosis designation the people who seem to truly have both diagnoses that intermingle in a very specific way.
All in all, it doesnt really matter in my mind, these lines between the diagnoses are fairly arbitrary. My paper on schizoaffective disorder in grad school--looking at the genetics--could not find supportive evidence that it is a disorder distinct from depression and schizophrenia, or that it is related to one and not the other, at least biologically speaking. And even then Im not saying it doesnt exist--just giving info.
I have major depression, and in one period I was very close to being delusional. My mom had depression, and she did become highly delusional at least once.
Posted by sdjeff on January 6, 2005, at 19:34:58
In reply to Re: Schizoaffective disorder? What do you think? long, posted by banga on January 6, 2005, at 13:13:03
Thanks everyone for your responses. I guess that I'm just looking for answers. I am very frustrated by my problems. I was reading up on various disorders and said, "Gee that sounds like me."
As far as delusions and hallucenations, they are more intense when I'm depressed but I do have these problems, particularily auditory hallucenations, when I'm not. In fact my last hospitalization was for suicidal ideation but I wasn't all that depressed. I did feel pretty agitated.
I take 15 mg Zyprexa and 60 mg Cymbalta. This combo keeps a lot of this in check, but not well enough for me to work.
Posted by HappyGirl on January 7, 2005, at 0:22:15
In reply to Re: Schizoaffective disorder? What do you think? long, posted by sdjeff on January 6, 2005, at 19:34:58
Hi Jeff:
In my personal opinion through the experience, ... if you'd feel better with your current med. combo., then try to stick with it.I truly understand your frustration not being well enough to work, ... but it often takes quite awhile for med. combo. getting into your system completely, particularly if your condition is moderate to severe form. In my case, it took almost three to four years the med. combo. REALLY started to kick in. It was such a discouraging to see this, however it's VERY true.
Besides this above, everyone takes different ractions on various med. combo. along with different recovery/stability process. We are all 'unique' in this regard. However, as long as staying on the meds., you'd get better sooner or later.
H.G.
Posted by DanielJ on January 7, 2005, at 7:23:36
In reply to Re: Schizoaffective disorder? What do you think? long, posted by HappyGirl on January 7, 2005, at 0:22:15
Your meds very similar to my son's. He continues to improve (going on 2 years now). Have patience as others have said. My son's pdoc does not worry about a super definitive dx, he just treats the symptoms until they are eliminated.
Posted by ramsea on January 7, 2005, at 9:05:48
In reply to Re: Schizoaffective disorder? What do you think? long, posted by HappyGirl on January 7, 2005, at 0:22:15
Hope you are well. I was once dx schizoaffective but---------here is a list of labels I have been saddled with in my life. Social Phobia, School Phobia, General Anxiety Disorder, Unspecific Possible Personality Disorder, Developmental Disorder (from birth), "Fine, she's Just Artistic", Alcoholic, Chronic Schizophrenia, Major Depression with Psychotic Features, Bipolar Disorder (lifelong lithium prescribed), Acute Psychotic Break, Schizoaffective Disorder, Bipolar 1, and, my favorite------"You Know What?? You are A Waste of Time, Just Go To A 12-Step Group and Get Off Your Alcoholic Butt, We Have Real Patient's to Treat."
I am very grateful to that clinic, because their frightening response (he was not joking at all and I was in a very sorry state), made me even more vulnerable to serious, life-threatening/career/family and friend destroying episodes of Manic, Mixed,Depressed and Ultra Rapid Cycling bipolar.
I was most often left untreated because when I drank to help bring myself out of manic mixed spisodes, I was only seen as a drunk--and treated with great and killing derision by some psychiatric workers until a very good psychiatrist helped everyone to see what was really happening. Which meant--in some sense---that there was more biology at work in me than psychology. Positive affirmations, a zillion self-help manual to set me straight in a zillionmillion ways---plus a lifetime sentence to smokey confessions in the magic circle of tee-total rulers--- was not enough to keep me ticking on the earth plane.
You mentioned agitation. That is one bigger than big, ugly, viscious sour pickle.
I am also subject at times to life threatening, intolerable agitation--mania without the feel-good factor. I have had that too, a brilliant euphoria--but especially as I have got older I am more often subject to a terrible, highly energized agitation, at times with psychotic-like features.
I was told that many bipolars are in disguise due to these less stereotypical bipolar episodes and so are not treated properly. It has not been rare that ADs can have a side effect of weirdly powerful agitation which understandably can cause suicidal and SI incidents in sufferers.
It happened to me. Obviously I can't offer insight for you, only you and your health team will know what to do, but-----do review your ADs objectively, ensure that your agitation isn't inspired by Zoloft.
ADs were a danger ***for wacky ole me--- until a mood stabilzer was added. Lithium has helped my depressive side and calmed the agitation and manicky side too. I have been fortunate for a little while. Take care. It can get better and usually does.
Posted by Camille Dumont on January 7, 2005, at 15:28:34
In reply to Schizoaffective disorder? What do you think? long, posted by sdjeff on January 5, 2005, at 21:24:49
For me this test was a godsend. You can't cheat, you can't really fake or misrepresent yourself (there are validity scales and what not) and frankly, for me at least, it was scary how accurately it came back.
Thats how I found out I was mainly schizoid in a depression rather than depressive with psychotic symptoms.
Its always difficult and a tad bit dangerous to diagnose yourself ... you may end up like first year med students who start to feel the symptoms of all the disease they read about. A sort of self-induced hypocondria ... I guess just like when you watch a movie about say, mosquito, your skin may start to itch and what not.
Posted by sdjeff on January 8, 2005, at 0:43:31
In reply to Re: Schizoaffective disorder? long reply » HappyGirl, posted by ramsea on January 7, 2005, at 9:05:48
Thanks for your responses. All of you helped me realize that I should be concerned with the symptoms, not the diagnosis. It would be convenient if I could pin my problems to a particular diagnosis but I guess that really doesn't matter.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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