Schizoaffective disorder symptoms look like a mixture of two kinds of major mental illnesses that are usually thought to run in different families, involve different brain mechanisms, develop in different ways, and respond to different treatments: mood (affective) disorders and schizophrenia.
Symptoms of Schizoaffective Disorder:The two major mood disorders are unipolar depression and bipolar or manic-depressive illness.
Feel constantly sad and fatiguedHave lost interest in everyday activitiesAre indecisive and unable to concentrateSleep and eat too little or too muchComplain of various physical symptomsMay have recurrent thoughts of death and suicide
Suffering from sleeplessnessCompulsively talkativeAgitated and distractibleConvinced of their own inflated importanceSusceptible to buying spreesProne to cheerfulness turning to irritabilityIndiscreet sexual advances, and foolish investmentsParanoia, and ragePeople with chronic schizophrenia:
Appear apatheticAre emotionally unresponsiveHave limited speechHave confused thinkingMay suffer from hallucinations and delusionsPerplex others with their strange behaviorAnd inappropriate emotional reactions
Difficulty In Distinguishing IllnessesPeople with:
Affective disorders usually appear normal between episodes of illness and do not become more seriously disabled with time. Schizophrenia rarely seem normal, and their condition tends to deteriorate, at least in the early years of the illness. This distinction is not always as obvious as the description suggests. Emotion and behavior are more fluid and less easy to classify than physical symptoms. Seriously depressed and manic people often have hallucinations and delusions. Mania can be impossible to distinguish from an acute schizophrenic reaction, and psychotic or delusional depression is important enough to rate its own classification by some psychiatrists. Mood changes occur both as symptoms of schizophrenia and as reactions to its devastating effects; for example, depression after a schizophrenic episode (post-psychotic depression) is common and often severe, and it is during this time that a person suffering from schizophrenia is most likely to commit suicide.
Schizophrenic apathy and an incapacity for pleasure can also be mistaken for depression. Often a diagnosis has to be changed from one kind of major mental disorder to the other. In a recent study of more than 936 people with a severe psychiatric disorder who were hospitalized at least four times in a seven-year period, investigators found that about 25% of those originally given other diagnoses (including bipolar disorder) and 33% of those originally given other diagnoses (including bipolar disorder) had a final diagnosis of schizophrenia.
Signs That May Help Define Schizoaffective as the Diagnosis:The illness usually begins in early adulthoodIt is more common in womenA person has difficulty in following a moving object with their eyesA person·s rapid eye movement (dreaming) begins unusually early in the nightHowever, the research is inadequate and the results have been confused by varying definitionsChoice of Therapies:If a person is in a psychotic state, a neuroleptic (antipsychotic) drug is most often used, since antidepressants and lithium (used for bipolar disorder) take several weeks to start working. Antipsychotic drugs may cause tardive dyskinesia, a serious and sometimes irreversible disorder of body movement, so people are asked to take them for long periods only when there is no other alternative. After the psychosis has ended, the mood symptoms may be treated with antidepressants, lithium, anticonvulsants, or electroconvulsive therapy (ECT). Sometimes a neuroleptic is combined with lithium or an
antidepressant and then gradually withdrawn, to be restored if necessary. The few studies on drug treatment of this disorder suggest that antipsychotic drugs are most effective. The greater effectiveness of these new drugs may be partly due to their activity at receptors for the neurotransmitter serotonin, which is not influenced as strongly by standard antipsychotic drugs.
Schizoaffective disorder is a serious mental illness that has features of two different conditions, schizophrenia and an affective (mood) disorder, either major depression or bipolar disorder.
Schizophrenia is a brain disorder that distorts the way a person thinks, acts, expresses emotions, perceives reality and relates to others. Depression is an illness that is marked by feelings of sadness, worthlessness or hopelessness, as well as problems concentrating and remembering details. Bipolar disorder is characterized by cycling mood changes, including severe highs (mania) and lows (depression).
Schizoaffective disorder is a life-long illness that can impact all areas of daily living, including work or school, social contacts and relationships. Most people with this illness have periodic episodes, called relapses, when their symptoms surface. While there is no cure for schizoaffective disorder, symptoms often can be controlled with proper treatment.
What Are the Symptoms of Schizoaffective Disorder?
A person with schizoaffective disorder has severe changes in mood and some of the psychotic symptoms of schizophrenia, such as hallucinations, delusions and disorganized thinking. Psychotic symptoms reflect the person's inability to tell what is real from what is imagined. Symptoms of schizoaffective disorder may vary greatly from one person to the next and may be mild or severe. Symptoms may include:
Changes in sleeping patterns (sleeping very little or a lot)Agitation (excessive restlessness)Lack of energyLoss of interest in usual activitiesFeelings of worthlessness or hopelessnessGuilt or self-blameInability to think or concentrateThoughts of death or suicide
Increased activity, including work, social and sexual activityIncreased and/or rapid talkingRapid or racing thoughtsLittle need for sleepAgitationInflated self-esteemDistractibilitySelf-destructive or dangerous behavior (such as going on spending sprees, driving recklessly or having unsafe sex)
Delusions (strange beliefs that are not based in reality and that the person refuses to give up, even when presented with factual information)Hallucinations (the perception of sensations that aren't real, such as hearing voices)Disorganized thinkingOdd or unusual behaviorSlow movements or total immobilityLack of emotion in facial expression and speechPoor motivationProblems with speech and communication
While the exact cause of schizoaffective disorder is not known, researchers believe that genetic, biochemical and environmental factors are involved.
Genetics (heredity): A tendency to develop schizoaffective disorder may be passed on from parents to their children.
Brain chemistry: People with schizophrenia and mood disorders may have an imbalance of certain chemicals in the brain. These chemicals, called neurotransmitters, are substances that help nerve cells in the brain send messages to each other. An imbalance in these chemicals can interfere with the transmission of messages, leading to symptoms. Environmental factors: Evidence suggests that certain environmental factors·such as a viral infection, poor social interactions or highly stressful situations·may trigger schizoaffective disorder in people who have inherited a tendency to develop the disorder.
Schizoaffective disorder usually begins in the late teen years or early adulthood, often between the ages of 16 and 30. It seems to occur slightly more often in women than in men and is rare in children.
Because people with schizoaffective disorder have symptoms of two separate mental illnesses, it is often misdiagnosed. Some people may be misdiagnosed as having schizophrenia, and others may be misdiagnosed with a mood disorder. As a result, it is difficult to determine exactly how many people actually are affected by schizoaffective disorder. However, it is believed to be less common than either schizophrenia or affective disorder alone. Estimates suggest that about one in every 200 people (0.5%) develops schizoaffective disorder at some time during his or her life.
How Is Schizoaffective Disorder Diagnosed?
If symptoms are present, the doctor will perform a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose schizoaffective disorder, the doctor may use various tests·such as X-rays or blood tests·to rule out physical illness as the cause of the symptoms.
If the doctor finds no physical reason for the symptoms, he or she may refer the person to a psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a psychotic disorder. A diagnosis of schizoaffective disorder is made if a person has periods of uninterrupted illness and has, at some point, an episode of mania, major depression or mix of both while also having symptoms of schizophrenia. In addition, to diagnose the illness, the person must
display a period of at least two weeks of psychotic symptoms without the mood symptoms.
Treatment typically involves medication to stabilize the mood and treat the psychotic symptoms. In addition, psychotherapy (a type of counseling) and skills training may be useful for improving interpersonal, social and coping skills.
Medication: The choice of medication depends on the mood disorder associated with the illness. The primary medications used to treat the psychotic symptoms associated with schizophrenia, such as delusions, hallucinations and disordered thinking, are called antipsychotics. The mood-related symptoms may be treated with an antidepressant medication or a mood stabilizer such as lithium. These medications may or may not be used in combination with an antipsychotic medication. Psychotherapy: The goal of therapy is to help the patient learn about the illness, establish goals and manage everyday problems related to the disorder. Family therapy can help families deal more effectively with a loved one who has schizoaffective disorder, enabling them to better help their loved one. Skills training: This generally focuses on work and social skills, grooming and hygiene, and other day-to-day activities, including money and home management. Hospitalization: Most people with schizoaffective disorder are treated as outpatients. However, people with particularly severe symptoms, or those in danger of hurting themselves or others may require hospitalization to stabilize their conditions.
What Is the Outlook for People with Schizoaffective Disorder?
There is no cure for schizoaffective disorder, but treatment has been shown to be effective in minimizing the symptoms, and in helping the person better cope with the disorder and improve social functioning.
Can Schizoaffective Disorder Be Prevented?
There is no known way to prevent schizoaffective disorder. However, early diagnosis and treatment can help avoid or reduce frequent relapses and hospitalizations, and help decrease the disruption to the person's life, family and friendships.
Schizoaffective disorder is a psychiatric diagnosis. It describes an illness that is defined by recurring episodes of mood disorder and psychosis. The disorder usually begins in early adulthood and is rarely diagnosed in childhood (prior to age 13). Despite the greater variety of symptoms, the illness course is more episodic and has an overall more favorable outcome (prognosis) than schizophrenia.
The American Psychiatric Association classifies schizoaffective disorder into two types: bipolar and depressive. The ICD classifies it into five types: manic, depressive, mixed (manic and depressive), other and unspecified. Generally, using the ICD classification, the mixed type has a better prognosis than the depressive type. The mainstay of treatment is pharmacotherapy with an antipsychotic and an antidepressant and/or mood stabilizer. Psychotherapy, vocational and social rehabilitation are also important for recovery. A specific type of psychosocial rehabilitation known as psychiatric rehabilitation may improve the individual's chances at recovery. Some individuals diagnosed with schizoaffective disorder may be diagnosed with comorbid conditions, including substance abuse.
The diagnosis was introduced in 1933.
1 Signs and symptoms2 Diagnosis2.1 DSM-IV-TR criteria2.2 Subtypes2.3 Bipolar type2.4 Depressive type3 Etiology and pathogenesis3.1 Drug abuse4 Epidemiology5 Treatment6 Prognosis7 Complications8 History9 References9.1 Cited texts
Late adolescence and early adulthood are the peak years for the onset of schizoaffective disorder, although it has been diagnosed (very rarely) in childhood. These are critical periods in a person's social and vocational development which can be severely disrupted by disease onset.
Schizoaffective disorder is a mental illness characterized by recurring episodes of mood disorder and psychosis. Psychosis is defined by paranoia, delusions and/or hallucinations. Mood disorders are defined as discrete periods of clinical depression, mixed and/or manic episodes. Individuals with the disorder may experience psychotic symptoms before, during or (commonly) after their depressive, mixed and/or manic episodes.
The illness tends to be difficult to diagnose since the symptoms are similar to other disorders with prominent psychotic symptoms like bipolar disorder with psychotic features, major depressive disorder with psychotic features and schizophrenia.
The main similarity between schizoaffective disorder, bipolar disorder with psychotic features, and major depressive disorder with psychotic features, is that in all three disorders psychosis occurs during mood episodes. By contrast, in schizoaffective disorder, psychosis must also occur during periods without mood symptoms. In schizophrenia, mood episodes tend be absent or much less prominent than schizoaffective disorder. Since these distinctions can be difficult to detect, a firm diagnosis of schizoaffective disorder may thus require an extended period of observation and treatment.
Untreated, the individual with schizoaffective disorder may experience delusions. It should be noted that delusions in schizoaffective disorder are acute manifestations of an active psychosis and are not personality traits; that is, they go away when the psychosis subsides. Manifestations of delusions include the individual being convinced that he or she is Jesus or the Antichrist, has some special purpose or destiny (such as to save the world), or is being monitored, watched or persecuted by something (commonly governmental agencies), when in reality they are not. Individuals may also feel extremely paranoid. Other delusions may include the belief that an external force is controlling the individual's thought processes. (See thought insertion.)
Hallucinations involving all five senses can also occur in untreated schizoaffective disorder. That is, the individual may see, hear, smell, feel or taste things that aren't there. For example, the individual may see overt visual hallucinations such as monsters, the devil or more subtle ones such as shadowy apparitions. Individuals may hear voices or, in some cases, music. Things may look or sound different. Individuals may also experience strange sensations. These hallucinations may worsen when the individual is intoxicated.
The untreated individual may quickly change their mind about their romantic partner, friends or family if they hear something negative being said about them; as a result they may attack or, conversely, isolate themself from the person or group until they regain normal thoughts, which usually takes treatment and time.
Comorbid or co-occurring anxiety disorders may also play a role in the subjective experience of schizoaffective disorder and thus may shape the individual's delusional thought content. For example, the individual may feel anxious, have trouble swallowing, and then believe that outside forces are controlling their throat functions. They may also suffer from various phobias which may also manifest as delusions.
There may be a decline in work or school functioning during episodes of illness. As stated above, individuals with schizoaffective disorder may withdraw socially and become isolated.
The untreated individual may sleep too much, or (more often) be unable to sleep.
Difficulties with thinking known as "cognitive deficits" may also be a problem for individuals with schizoaffective disorder. This may include difficulties with concentration, attention, logical reasoning and impulse control.
Without treatment, the individual with schizoaffective disorder may further worsen in their delusional thought processes and become further alienated from people and society.
With comprehensive treatment, many individuals with schizoaffective disorder may recover much, most or even all of their functionality.
Diagnosis is based on the self-reported experiences of the person as well as abnormalities in behavior reported by family members, friends or co-workers to a psychiatrist, psychiatric nurse, social worker or clinical psychologist in a clinical assessment. There is a list of criteria that must be met for someone to be so diagnosed. These depend on both the presence and duration of certain signs and symptoms.
As discussed above, there are several psychiatric illnesses which may present with a similar range of psychotic symptoms; these include bipolar disorder with psychotic features, major depression with psychotic features, schizophrenia, drug intoxication, brief drug-induced psychosis, and schizophreniform disorder. These disorders need to be ruled
out before a firm diagnosis of schizoaffective disorder can be made.
An initial assessment includes a comprehensive history and physical examination by a physician. Although there are no biological tests which confirm schizoaffective disorder, tests are carried out to exclude medical illnesses which rarely may be associated with psychotic symptoms. These include blood tests measuring TSH to exclude hypo- or hyperthyroidism, basic electrolytes and serum calcium to rule out a metabolic disturbance, full blood count including ESR to rule out a systemic infection or chronic disease, and serology to exclude syphilis or HIV infection; two commonly ordered investigations are EEG to exclude epilepsy, and a CT scan of the head to exclude brain lesions. It is important to rule out a delirium which can be distinguished by visual hallucinations, acute onset and fluctuating level of consciousness and indicates an underlying medical illness.
Investigations are not generally repeated for relapse unless there is a specific medical indication. These may include serum BSL if olanzapine has previously been prescribed, thyroid function if lithium has previously been taken to rule out hypothyroidism, liver function tests if chlorpromazine has been prescribed, and CPK levels to exclude neuroleptic malignant syndrome. Assessment and treatment are usually done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to self or others.
The most widely-used criteria for diagnosing schizoaffective disorder are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, the current version being DSM-IV-TR:
The following are the revised criteria for a diagnosis of schizoaffective disorder from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR):
A. Two (or more) of the following symptoms are present for the majority of a one-month period (or a shorter period of time if symptoms got better with treatment):
delusionshallucinationsdisorganized speech (e.g., frequent derailment or incoherence) which is a manifestation of formal thought disordergrossly disorganized behavior (e.g. dressing inappropriately, crying frequently) or
catatonic behaviornegative symptoms·e.g., affective flattening (lack or decline in emotional response), alogia (lack or decline in speech), avolition (lack or decline in motivation), anhedonia (lack or decline in ability to experience pleasure), social withdrawal (sometimes called social anhedonia). It should be noted that negative symptoms are different from symptoms of depression. If the delusions are judged to be bizarre, or hallucinations consist of hearing one voice participating in a running commentary of the patient's actions or of hearing two or more voices conversing with each other, only that symptom is required to meet criterion A above. The speech disorganization criterion is only met if it is severe enough to substantially impair communication. AND at some time during the illness there is either one, two or all three of the following:
major depressive episodemanic episodemixed episodeB. During the same period of illness, there have been delusions or hallucinations for at least two weeks in the absence of prominent mood symptoms.
C. 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.
D. 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.
Two subtypes of Schizoaffective Disorder exist and may be noted in a diagnosis based on the mood component of the disorder:
a manic episodea mixed episodeMajor depressive episodes usually, but not always, also occur in the bipolar subtype, however they are not required for DSM IV diagnosis.
The depressive type is noted when the disturbance includes major depressive episodes exclusively.
This subtype applies if major depressive episodes only (and no manic or mixed episodes) are part of the presentation.
Although the causes of schizoaffective disorder are unknown, it is suspected that this diagnosis represents a heterogeneous group of individuals, some with aberrant forms of schizophrenia and some with very serious forms of mood disorders. There is little evidence that schizoaffective disorder is a distinct variety of psychotic illness. Consequently, the disorder appears to be comorbid or (co-occurring) schizophrenia and mood disorder. Schizoaffective disorder thus appears to exist on a continuum in-between schizophrenia and severe bipolar disorder and severe recurrent unipolar depression. It follows then that the etiology is probably more similar to that of schizophrenia in some cases and more similar to severe mood disorders in other cases.
Many different genes may be contributing to the genetic risk of acquiring this illness. In addition, many different biological and environmental factors are believed to interact with the person's genes in ways which can increase or decrease the person's risk for developing schizoaffective disorder. Schizophrenia spectrum disorders (of which schizoaffective disorder is a part) have been marginally linked to advanced paternal age at the time of conception, a common cause of mutations.
The physiology of patients diagnosed with schizoaffective disorder appears to be similar but not identical to that of those diagnosed with schizophrenia and severe bipolar disorder.
See also: Dual diagnosisA clear causal connection between drug use and psychotic spectrum disorders, including schizoaffective disorder, has been difficult to prove. The two most often used explanations
for this are "substance use causes schizoaffective disorder" and "substance use is a consequence of schizoaffective disorder", and they both may be correct. A 2007 meta-analysis estimated that cannabis use is statistically associated with a dose-dependent increase in risk of development of psychotic disorders, including schizoaffecive disorder. There is little evidence to suggest that other drugs including alcohol cause schizoaffective disorder, or that psychotic individuals choose specific drugs to self-medicate; there is some support for the theory that they use drugs to cope with unpleasant states such as depression, anxiety, boredom and loneliness. However, regarding psychosis itself, it is well understood that methamphetamine and cocaine use can result in methamphetamine or cocaine induced psychosis which presents very similar symptomatology and may persist even when users remain abstinent.
Estimates of the prevalence of schizoaffective disorder vary widely, but schizoaffective manic patients appear to comprise 3-5% of psychiatric admissions to typical clinical centers. At one point it was widely believed that schizoaffective disorder was associated with increased risk of mood disorders in relatives. This may have been because of the number of patients with psychotic mood disorders who were included in schizoaffective study populations.
The current diagnostic criteria define a group of individuals with a mixed genetic picture. They are more likely to have schizophrenic relatives than individuals with mood disorders but more likely to have relatives with mood disorders than individuals with schizophrenia.
Treatment for schizoaffective disorder consists of a combination of medicine, psychotherapy and psychosocial rehabilitation focused on recovery. Not all treatment services focus on recovery, however, so a recovery-oriented program may need to be sought out.
A licensed psychiatrist will prescribe (usually combinations of) medicine for the individual. Each person responds differently to medication. Common medicines used to treat schizoaffective disorder are listed below.
For psychotic symptoms, one or more neuroleptic medications are usually prescribed.
Examples of neuroleptic medications include the following:
Olanzapine (Zyprexa)Risperidone (Risperdal)Quetiapine (Seroquel)Aripiprazole (Abilify)Ziprasidone (Geodon)For manic symptoms, mood stabilizer medications may be prescribed along with a neuroleptic. Examples are:
Lithium salt (Lithium)Valproate semisodium (Depakote ER)Carbamazepine (Tegretol)For depression, antidepressant medications may be prescribed along with a neuroleptic. Examples are:
Prozac (or other SSRI antidepressants)Lamictal (a mood stabilizer with antidepressant properties)In schizoaffective individuals with manic symptoms, combining lithium, carbamazepine, or valproate with a neuroleptic has been shown to be superior to neuroleptics alone. Lithium-neuroleptic combinations, however, may produce severe extrapyramidal reactions or confusion in some patients.
When lithium is not effective or well tolerated in manic individuals with schizoaffective disorder, Tegretol or Depakote are frequently used. Granulocytopenia can occur during the first few weeks of carbamazepine treatment, and neuroleptic blood levels may be decreased substantially due to hepatic enzyme induction. Valproate can, in rare cases, cause liver toxicity and platelet dysfunction. Calcium channel blockers such as verapamil may also be an effective treatment for manic symptoms but are seldom prescribed for that purpose. The degree of benefit for an individual patient should be considered carefully, as each of these medications carries its own risks.
Benzodiazepines such as Ativan and Klonopin are effective adjunctive treatment agents for acute manic symptoms, but long-term use may result in dependency.
In schizoaffective individuals with depressive symptoms, an antidepressant (usually Prozac or other SSRIs) will be prescribed with a neuroleptic. The SNRI antidepressants and Wellbutrin tend not to be prescribed in schizoaffective disorder because they may cause mixed episode symptoms and induce psychosis, respectively. The anticonvulsant Lamictal is also used in treating depressed schizoaffective individuals.
Often a sleeping pill will be prescribed initially to allow the individual rest from his or her anxiety, delusions or hallucinations. Long-term use of sleeping medications can, however, cause dependence and can also cause delusions and hallucinations thereby exacerbating psychosis.
Nutritional supplements and lifestyle changes are both being studied to augment existing treatments as well. Frequently co-occurring conditions such as mitochondrial dysfunctions, adrenal fatigue, sleep disorders, and diabetes are the targets of nutritional and lifestyle changes. Omega-3 fatty acid supplementation is used as a nutritional aid for many mental disorders including schizoaffective disorder. Some depressed schizoaffective individuals use 5-HTP, an amino acid and precursor to serotonin, in place of SSRI antidepressants to avoid side associated side effects. Other supplements with antidepressant properties, St John's Wort and SAM-e, however, may cause adverse reactions of mixed-state symptoms or psychosis in depressed schizoaffective individuals.
People with schizoaffective disorder generally have a better outlook than those with schizophrenia, and about the same or worse outlook (depressive subtype having the least favorable outlook) as those with bipolar disorder. It is important to note that individual outcomes may be more favorable than those cited above since these prognoses are based on statistical averages of large groups of patients.
As with any chronic illness, compliance with medication is important, especially since more than one medication is often prescribed. Psychiatric rehabilitation plays an important part in maximizing the individual's chances at recovery, which may result in a better prognosis.
Complications are similar to those for schizophrenia and major mood disorders. These include:
Problems following medical treatment and therapyUse of unsanctioned drugs in an attempt to self-medicateShort-term side effects and problems arising from long-term use of prescribed medications, including drug interactions.
Problems resulting from manic behavior (for example, spending sprees, sexual indiscretion)Suicidal behavior due to depressive or psychotic symptoms
The term schizoaffective psychosis was coined by the American psychiatrist John Kasanin in 1933 to describe a more episodic psychotic illness with predominant affective symptoms, that was termed a good-prognosis schizophrenia.
Schizoaffective disorder was included as a subtype of schizophrenia in DSM I and DSM II, though research showed a schizophrenic cluster of symptoms in individuals with a family history of mood disorders whose illness course, other symptoms and treatment outcome were otherwise more akin to the manic phase of a bipolar disorder. DSM III placed schizoaffective disorder in psychotic disorders Not Otherwise Specified before being formally recognized in DSM III-R.
Some have disputed that the term "schizoaffective disorder" refers to a well defined condition, and have recommended that the term be removed from or amended in future versions of the DSM.
Is this article going to be about psychotic persons?
No! There are no psychotic persons, no psychotic killers, no psychotic rapists. The word "psychotic" isn't supposed to describe a human being.
Psychosis is a temporary mental state. A person experiences a psychotic state for a while, then they come out of it. No one is born psychotic. Psychosis is not a personality trait.
One or more of the following six things usually characterizes a psychotic episode:
1. an underlying chemical imbalance which makes the person vulnerable.
2. a trigger: something the person perceives as very stressful.
3. a history. We all have histories, of course.
4. a distinct change in the thought process. Your thinking is just fine -- until the psychotic episode begins. Episodes usually begin pretty quickly. They tend to taper off gradually.
5. pain. There is no happy psychotic episode. There is no neutral psychotic episode. Enduring a psychotic episode hurts like hell. We're talking about raw fear here.
Think back to the last time you were really afraid. Either your mind was busy trying to find a way out of the situation or it was trying to make you feel better, as in, "This dental work will be over soon." When you are experiencing psychosis, you are afraid, and your mind is what is creating the fear. Your mind just makes the terror worse, telling you that you are such a bad person that you actually deserve this horrible pain. If your mind does try to make you feel better, it does it in a misguided way, by creating delusions of grandeur.
6. lack of understanding of the real world. I have trouble with the phrase "out of touch with reality". You are quite aware of what's going on around you. In fact, you are hypersensitive, able to detect the slightest change in people's expressions.
A typical psychotic episode manifests itself in one or more of the three following ways:
1. Hallucinations: believing something is there that actually is not there. Hearing something strange and knowing that it is strange is not a hallucination. The hallucinator perceives the voice; their brain says, "That's Dad calling me," with no doubt at all. The non-hallucinator hears the voice and says, "Could that possibly be Dad calling me? But he moved out a year ago." If you are not sure what you heard or even if you wonder if it is a hallucination, it is not a hallucination. A hallucinator is absolutely positive (though they may have their doubts later on). So, during a psychotic episode, you usually "hear voices."
2. Delusions: believing something is true that couldn't possibly be true. I'm not talking
about believing that Bill Clinton never had sex with Monica Lewinsky. I'm talking about physical impossibilities or grandiose ideas such as believing that you were born on Mars or that you are Jesus Christ come back to life.
The most common delusion is paranoia: fear that gets way out of hand. You may be constantly afraid that bad things will happen to you or that people will hurt or betray you. You may pick up your gun every time you answer the door.
Probably the most common thing that happens during a psychotic episode is that you have a lot of trouble talking straight. Your words and sentences get garbled -- all mixed up like a "word salad." Each individual phrase or sentence makes sense, but they are out of order and you never quite get to the point.
Be careful not to confuse the people who endure psychotic episodes with their symptoms. The symptoms are devastating. The people are good people struggling to keep living and loving through it all.
Q. Are hallucinations, delusions, and "word-salad speech" symptoms of psychotic episodes, of mental illness, or both?
A. They're symptoms of psychotic episodes only. Not all persons diagnosed with mental illness have psychotic episodes. So not every mentally ill person experiences hallucinations, delusions, or severe difficulty talking.
Q. Can you look at people (or yourself) and see symptoms of mental illness? of psychosis?
A. Mental illness? No chance. There is no way of walking, no way of talking that tells you definitely that somebody is mentally ill, unless, maybe, you are a psychiatrist. The rest of us will just have to trust psychiatrists' judgment on who is and is not mentally ill.
Psychosis? That can sometimes be easy to spot. If a person trapped in a psychotic episode comes out and tells you about his or her hallucinations or delusions, it can become pretty clear that they have psychiatric problems. A good rule of thumb is: Don't try to diagnose anyone unless it is necessary for survival.
A long time ago, on a bus late at night, I saw a woman several seats behind me who was
clearly coping with a psychotic episode. I was afraid of her and got off the bus as fast as I could. Now I know that she was much more afraid than I was. Just because she was talking in a garbled way to no one I could see did not mean she would or could ever hurt me. The primary emotion in any psychotic episode is fear.
Q. Are you saying that, even if a person kills during psychosis, they never experience any emotion but fear?
A. Not at all. I'm saying that emotions are very complicated during psychosis.
In order for you, a person who is not undergoing psychosis (assuming you are not a hit person!), to get to where you kill somebody, you need to (1) be very angry, (2) decide to get revenge, and (3) kill the person. A severely mentally ill person who kills goes through exactly the same stages, unless the stress involved happens to trigger a psychotic episode.
Psychosis throws out all the rules. Under psychotic conditions, the anger can be repressed, converted to fear, glee, or any other emotion, exaggerated into an overarching hatred for the whole universe, or you name it. In psychosis, your anger melds with what the trigger person did to you to initiate disorganized thinking. Then that thinking may or may not compel you to kill.
If you do kill, you may well kill someone other than the trigger person. You probably won't kill at all. Thousands of people have undergone psychotic episodes. Only a tiny percentage of these people have killed anyone, and the vast majority of these latter killed themselves.
During a psychotic episode, you are just as good and just as smart as you ever were. But you are trapped in a frighteningly chaotic brain that is turning against its very owner. And you can't even have the comfort of telling anybody how bad you feel.
Added to that is the knowledge that you have been cursed, for some inexplicable reason, with the most humiliating of all possible diseases.
I have severe mood swings. My moods cycle between an ecstatic phase and a
depressed phase. For three or so hours, I will be ecstatic, upbeat. Then something will trigger a depression. I will then be depressed, again, for three or so hours, then something will cause me to cycle back into a ecstatic mood. This pattern is regular, except for sporadic periods where I have normal emotional responses.
When i am in an ecstatic phase, I am very outgoing. I always want to talk and
interact with people, and my delusions get less convincing, as well as not being as negative. I am very creative when I am in a ecstatic phase, I am very artistic, and am able to play drums very well, because my creativity is through the roof. I am able to come out of my head more, and I can communicate more clearly. My sense of humor also is more keen.
Usually, what triggers my descent into a depression is almost always social. By
"social" I mean my close friends. When I don't communicate with any of my friends for a notable period of time (3-4 days) my delusions start getting more aggressive, and start telling me that my friends don't want to be with me, that they hate me. Or, if I had made plans, and my friend(s) could not hang out, my delusions would take over, and convince me that I am unneeded and undesired (this is less common). Another example is when I see my friends communicating with each other, and leaving me out. Again, my delusions start, and I am convinced that they despise me, etc.
These delusions inspire the most revolting, disgusting depressions. These
depressions are horrible because I know somewhere, in my head, that it is not me feeling these things. It is my brain, convincing itself (and me) that I am horrible, worthless, unneeded, hated, shunned. It is difficult to explain. I am unable to fight them, because it is my own head doing it, and everything that my head dreams up.makes sense. During my depressions, I am uncommunicative, closed off, I speak as little as necessary, and I am very unresponsive. I have trouble "getting" jokes, and I am very mentally clumsy. It is hard for me to communicate %100 percent of what I am trying to say in a conversation. My outlook on life and my future plummets. I think that I probably wont go to college, or get a job, or that anyone will help me. I get very frustrated at my mind and my depression, Because I should be happy, I know that there really is no reason for me to be depressed. Often, I start screaming very loudly in my head-it is a reflex like breathing-at my mind, at my depression, in frustration. This screaming is very loud, I can actually hear it, it is painful. Sometimes there is also crying, I think that means that myself has given up. I find myself craving physical contact, cuddles, kissing, etc. When I am depressed, I find that cuddling with someone gives me something to hold on to. I do not really get "triggered" out of a depression, it slowly dissipates.
I sometimes get psychotic episodes. My delusions come out from my brain and
enter my head as independent voices. They then start shouting at me, and at each other.
There are four; the one that thinks that people hate me; the one that thinks people want me; the one that disagrees with both of them; and "the black guy" who just tells the other voices to shut up. I get lost in my own head, and I am unable to find me. I have trouble referring to my self as "I" and I become an "Us". My delusions, since they are in my head, swarm me and crush me, and I have trouble assigning myself my own name, "Sean". I actually do not know when I get out of a psychotic episode.
I am incredibly frustrated when I try to tell my friends about my experiences. That
has been a large obstacle for me. I try to get them to understanding, and they think that it has no real effect on me. That is Partially why I am writing this. I want them to understand so that they can support me better, because when I am with my friends my delusions almost disappear, they fade into the background. I am happier for longer periods of time when I can see my friends, and I am much more emotionally stable.
http://agu-fm13.abstractcentral.com/s1agxt/com.scholarone.s1agxt.s1agxt/C844. CONTROL ID: 1801605 TITLE: Laboratory evaporation experiments in undisturbed peat columns for determining peat soil hydraulic properties AUTHORS (FIRST NAME, LAST NAME): Ullrich Dettmann1, Enrico Frahm2, Michel Bechtold1 INSTITUTIONS (ALL): 1. Institute of Climate-Smart Agriculture, Thünen-Institut (TI), Bra
Erläuterungen zur Applikation von SANDOZ-Präparaten über Ernährungssonden (Suspendierbarkeit, Sondengängigkeit) Wir möchten Ihnen als behandelndem Arzt oder beratendem Apotheker mit diesen Angaben zur Suspendierbarkeit und Sondengängigkeit eine Unterstützung bei der patientenindividuellen Therapie bieten. Die Daten sind mit größter Sorgfalt recherchiert, aber alle Faktoren,