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Q: Still Dissociates & Compartmentalizes
I came into my doctor in a psychotic depression having dissociation
panic attacks given the diagnosis PTSD and bipolar later changed to
schizoaffective. I have discontinued my risperadal and have felt fine no hallucinations but I compartmentalize and dissociate still. I also have bouts
of anger and irritability which seem to be getting worse. I am on 100mg Lamictal
and 4 mg xanax daily. It was suggested I may have incongruent mood disorder and
bipolar instead of schizo affective. My concern is the anger. Is the mood
stabilizer enough or should I approach my psych with new suggestions? I have
depersonalization issues as well with occasional suicidal ideation which has
almost cleared with two counselors on board. If I can't handle a situation then
I automatically compartmentalize and retreat into a sort of fantasy world. I am
better now than I was just concerned I might need a change in
meds
Krista
Dear Krista --
While I cannot tell you specifically what to do with your medications, the
following bit of information might be useful to you.
Schizoaffective disorder is a term that gets pulled out when a patient has
psychotic symptoms in the absence of mood symptoms (yet at other times, clearly
has mood symptoms as well). There is even a "schizoaffective disorder, bipolar
type", which is supposed to mean that the overall presentation of this illness
is closer to bipolar disorder than it is in "schizoaffective disorder,
schizophrenic type".
Secondly, it is also very important to know that
bipolar disorder itself can cause psychotic symptoms. Lots of doctors seem to
forget this and haul out the term "schizophrenia" when they see psychosis (e.g.
hearing voices, having delusions). A crucial fact emerges from this one: it is
possible to treat psychosis without an anti-psychotic. Mood stabilizers such as
lithium and valproate (Depakote) can make psychosis go away and keep it from
returning. In case you need to cite an example, here is a classic paper by
McElroy, Keck and colleagues.
Emerging from this confusion is a simple message, although many doctors seem to
find it counterintuitive: patients with symptoms like yours can manage without
an antipsychotic. However, your situation is probably much more complicated,
with dissociative episodes on top of other symptoms. I can easily imagine that
some dissociative symptoms may have been mistaken for psychosis in your case
(even if at other times you had classic psychotic symptoms as well). that
exactly what role each of your medications will play in keeping certain sets of
symptoms under control can often take years to work out. Good luck with that
process.
Dr. Phelps
Published April, 2008
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