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Re: Depression vs. 'negative' psychotic symptoms Tomatheus

Posted by ed_uk2010 on February 15, 2015, at 15:04:00

In reply to Re: Depression vs. 'negative' psychotic symptoms Christ_empowered, posted by Tomatheus on February 14, 2015, at 23:05:17

>I definitely agree with you that schizophrenia and schizoaffective disorder seem to be poorly defined, and I do think that a lot of overlap exists between schizophrenia, schizoaffective disorder, and bipolar I disorder with psychotic features.

It's true. Most psychiatric disorders are quite poorly defined, in fact. Different psychiatrists are likely to have differing opinions about what falls into the schizoaffective category.

>Another thing that I find odd is that the descriptions of the "negative" symptoms all seem to be from the perspective of those who observe patients with psychotic disorders instead of from the perspectives of the patients themselves.

That's very true. I must say this is not necessarily the fault of psychiatry, mainly because those with severe negative symptoms are rarely forthcoming about how they feel. Unfortunately, there is a tendency in psychiatry to give less consideration to the feeling and opinions of those with psychosis than those with other conditions, essentially because such people are considered to 'lack insight'. This approach is understandable in the sense that some people with severe psychotic illness profoundly lack insight and are not able to safely care for themselves. On the other hand, this paternalistic attitude seems to have gone too far - here, at least. I've seen people with psychosis be treated as if their opinions don't matter at all, even when their feelings seems entirely rational. In this sense, a diagnosis of a psychotic disorder can apparently lead to a reduction in the person's ability to be 'taken seriously' by the profession. This is quite sad.

>With other disorders, such as the mood disorders, the symptoms listed describe how the patients feel

I think this is mainly because those with mood disorders are usually more able to describe how they feel, and are more likely to spontaneously and understandably do so. In addition, the abnormal emotions are the prominent feature of the illness. In psychosis, the more severe end of the 'negative syndrome' spectrum often occurs in people with considerably disorganised speech. Not only do such people rarely provide detailed descriptions of how they feel, attempts to find out through questioning may lead to vague or confusing replies.

Mr. Smith, could you tell me how you feel? How is your mood?

Long pause. 'Erm. Erm. Uhm. Not moody, but the internet is coming and Josie is painting the greenhouse'. Silence.

In this situation, there isn't much to go on apart from observation. In those with milder negative symptoms who have more to say, it's not always clear what the cause of the 'negative symptoms' actually is, as in your case. Like C_E said, at least some degree of NS is to be expected in any highly unstimulating environment, regardless of the diagnosis.

>Maybe part of the reason for this is that "negative" symptoms may involve a lack of feeling

That does seem to be part of it.

>I don't take what the "pseudohallucinations" tell me too seriously (it seems like they often try to deceive me, which makes me take them even less seriously)

What might they say? Do you tolerate 7.5mg Abilify? What dose do you find causes further impairment?

I think it's clear that any large changes in your dose would be unhelpful. But I do wonder if some fine tuning could be beneficial, particularly considering the potency of Abilify.

 

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