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Re: Beginning to think I have schizophrenia

Posted by SLS on October 7, 2021, at 15:47:05

In reply to Re: Beginning to think I have schizophrenia SLS, posted by undopaminergic on October 7, 2021, at 12:12:18

Hi, UD.

I think you may be getting somewhere.

> Hi SLS.
> > I'm glad the manual offered you meaningful information that might enhance your ability to differentiate between symptom clusters and better identify treatments with better chances of success.
> >
> From the point of view of treatment, (unipolar) depression would seem to be the most useful diagnosis. With schizophrenia, there's a risk the clinician will overemphasise antipsychotics, and likewise with bipolar and mood stabilisers.
> > Yours is not an easy case to characterize. Have you already discounted schizoaffective disorder, particularly the bipolar subtype?
> >
> Not entirely. But the schizoaffective criteria require that a mood disorder be present for most of the time of the illnesss. A major depressive episode has to include depressed mood, not just anhedonia. I don't suffer much from a depressed mood, and haven't for some years. Moreover, my delusions are not associated in any apparent way with depression, only with mania. And delusions have far outlasted my manias. Taken literally, I might qualify, because I have had (mild) mood symptoms before, and the criteria don't state explicitly that the depression has to be the *cause* of the delusions. I don't think I qualify if we consider the "spirit" of the criteria. What do you think?
> -undopaminergic

1. How do you differentiate between schizophrenia and schizoaffective disorder?

2. How would you describe the difference between bipolar mania and the delusions that persist after the manic episode resolves?

3. What exactly is meant by saying "depressed mood"? I really don't know.

4. Does "depressed mood" differ from "melancholic depression"?

5. Psychotic depression is not often talked about. The TCA, amoxapine (Asendin), emerged in the early 1980s and was touted as being effective in the treatment of psychotic depression. This is not unexpected. Amoxapine (an antidepressant) is an active metabolite of loxapine (the parent molecule that acts as an antipsychotic). Once inside the body, loxapine is metaboized into amoxapine and several other compounds that are inert. Some research clinicians are advocating the use of loxapine rather than amoxapine to treat psychotic depression. Since the metabolism of loxapine yields large amounts of amoxapine, one can argue that using loxapine by itself would serve to introduce amounts of amoxapine sufficient to produce a TCA antidepressant effect.

1. Mixed-state bipolar with psychotic depression?

2. Schizoaffective disorder presenting with a bipolar mixed-state?

3. Schizoaffective disorder presenting as a bipolar mixed-state where the depressive component is that of psychotic depression.

Is there any history of seizures, traumatic brain injury, or multiple concussive injuries?

Lyme Disease? I doubt it, but Lyme infection produces a plethora of strange combinations of psychiatric symptoms.

In treatment resistant psychiatric disorders, some very smart doctors often subscribe to the ancient adage that if you throw enough crap against the wall, some of it is bound to stick.

- Scott


Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.




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