Schizoaffective Disorder

AS REGULAR READERS will know I have been diagnosed with a relatively rare psychiatric condition that affects approximately one person in two hundred and accounts for approximately five percent of all patients with serious mental illness. Not much is known about this condition. Varying opinions put have it as a variety of schizophrenia, or a variety of bipolar disorder, or a cross between the two or "the unlucky convergence of two psychoses" (that is that I am bipolar and schizophrenic at the same time.) The name of this condition is schizoaffective disorder.

The name "schizoaffective" originated in 1933. And as I say, nobody knows quite what it is or how it comes about. And though it is widely considered to be a midpoint between type 1 bipolar and schizophrenia on a "psychosis spectrum" it is acknowledged that schizoaffective disorder "has a flavour all of its own". For example, schizoaffectives seem particularly prone to "seeing things" as well as "hearing things". For example, when I'm ill I can see animals in the floor. Just as one can see faces and forms in clouds, I can see them not only in clothes an carrier bags but in floors, on walls and even on my computer screen. I sometimes see pairs of eyes at the bottom staring back at me.

When I was in the mental hospital years ago I saw an angel staring in at me through an upstairs window. At the time I had contact lens problems so I had in one constact lens. So through one eye I saw a blurry angel and through the other the angel was clear. Just as if a real form was at the window staring in at me. What shocks me today is that I never saw fit to tell my doctor about this. I think I was minded at the time to get out of there as quickly as possible without saying too much.

Oh and just to complicate matters there are two subtypes of schizoaffective disorder: a depressive type and a bipolar type. My hyper, manic phases are higher than my depressive lows are low. It's totally normal for mania to be more florid an psychotic than depression but my mania has reached, for short periods of time, the outer extreme of how manic it is possible to go. I'm so grateful that I don't go as depressed as you can go. And, because its quite possible to be schizophrenic and depressed at the same time, it's necessary to have more serious depression than I do to qualify as socalled "unipolar" or depression-only schizoaffective. My friend Pinky is depressive schizoaffective. She gets the faces in the floor thing; but her depressive episodes are generally worse than mine. And I don't think she's just describing them more "dramatically" I think she really does get more intensely depressed. Another difference is that her system will tolerate antidepresants while mine goes haywire on them. My mood cycles quickly. I can be quite horribly depressed, suicidally so, for just one day (an would usually have some degree of mania each side) whereas Pinky's depression is like mine used to be: constant lasting months on end. (Some of my depressions lasted years on end.) Another difference is that if you plotted it on a graph, my depression would be a wobbly line "under the water" as it were (that is under the line of "normality" in other words it used to cycle even back then. Now I cycle between high and low rather than merely different levels of low with infrequent flashes of high (I've had bipolar [manic] symptoms off and on (mostly off) since my mid-20s.)

I found the best schizoaffective stuff by googling "schizoaffective bipolar". The best link so far is from McManWeb: http://www.mcmanweb.com/psychosis.html

I've had a couple of comments expressing surprise that I'm not on a mood-stabilizer as well as an antipsychotic. I now know why. My doctor suspected I was schizophrenic not bipolar when he first saw me "ill". So he treated me using antischizophrenia drugs to see what progress I made. And sure enough I have stopped hearing voices and my mania is damped down. But it doesn't seem to do much against depression. I'd rather NOT be on a mood-stabilizer as no mood swings would just make my life too vanilla for words. If he thinks I'm OK on just risperidone, I'd rather go on purely on risperidone, experiencing some mania, because I love being a bit manic. It's like purely natural excitement (this is why it doesn't fit any drug signature if you wanted to be really precise about it, it doesn't match any upper even though being hyper is like being on uppers. I'd say being mildly hypomanic is like being on a bit of amphetamine; being moderately manic is like cocaine; being ultra high is like trippy Ecstasy type drugs; you could go raving in this state on nothing and actually be the most vibed-up person in there). Mania does take you higher than drugs. You just have to think: how many times have you or anyone you knew thought they literally Ruled the World, or felt like they were literally changing into an angel, because they were high on drugs? These feelings are par for the course in severe mania. In other words severe bipolar (or schizoaffective) takes you higher than drugs ever do. You'd fit out, foam at the mouth, and eventually die on uppers before you ever got that high. Which explains how I could stay awake as my head eventually went into a brainfrying high when on drugs, as I say, you'd just fit out or even die.

Sounds lovely, doesn't it!

Well I'm finding out what I can about this mysterious syndrome named bipolar schizoaffective. I can see that I match it perfectly. All I saw before was that I was bipolar. As a "patient" it's the pattern of ups and downs that is easier to grasp than the fact that you actually are in a mania or a depression or a (mixed state). The mind has a way of convincing itself it's not severely ill so I was in depression for months and seriously considered myself not to be ill and not to be worthy of any psychiatric diagnosis. That would have explained behaviour that was to me inexplicable.

My psychiatrist is a consultant who specializes in dual diagnosis (that is diagnosing people with drug problems and serious mental conditions) and he can weed out drug psychosis from bipolar or schizophrenic psychosis. Schizoaffective disorder has socalled negative or deficit symptoms for example you can spend hours or days staring into space. This is a part of my illness. I avoid social contact with people and I have impaired motivation, meaning I'm content to do very little, despite being largely off heroin. All the stuff that was blamed on heroin turns out to be "what I was like anyhow". As I myself was starting to suspect. I only had to look around at other addicts to see that no matter how badly addicted they were, they weren't in the mess I was in. They tended to be experts at taking psychiatrists for a ride which is why my "not bothering to try" attitude got me written off. I wasn't going to come in presenting a picture of misery just because I felt down. They only got a florid primary-coloured portrait of me when I was manic, highly expansive and unrestrained and very vocal. Then they saw who I really was. Acting manic must be one of thee most difficult psychiatric states to "put on" because you can't fake the presence of excess energy. It's just too exhausting. Another sign that I was real not faking. I grew to suspect that they considered me a fake or an exaggerator. I used to say that I needed to address my mood issues and I'd get nothing but nods and more nods. Then I went floridly mad and suddenly help is forthcoming. I'm just annoyed it had to get THAT BAD before anyboy listened.

I have sudden flashes of insight as I did today where I suddenly realize how deeply messed up some of the stuff is that I come out with. The glib way I talk about death. It really disturbs me to see that I'm this person in such a mess that I'd say the things I say. If it wasn't for my "no embarrassment, no deletion" policy I'd take a lot of it out to save my own face. But I just leave it all in. It's my own record of where I've been, that's my main motivation for blogging when "ill". My blog posts are my own postcards from the edge. Postcards to myself more than to you. I just am horrified at some of the things I thought. What was going through my head? It's sad, very sad to be this person so desperate he's talking about death as if killing myself shows some kind of character strength, when actually it shows desperation or even delusion. I'm much more disturbed about this than about my using heroin every now and then. All I learned from today's gear was that even though it was top-notch by today's low standards, it's still not doing the job it used to do.

All I can imagine is that being on antipsychotics that have squashed my more extreme manic symptoms and stopped me hearing voices or feeling dissociated from my own thought process (so my thoughts don't feel like my own, they feel like something I'm hearing on the radio). Risperidone stops most of this; heroin used to keep my mood on a far more even keel than it otherwise was, an it did a great deal to keep me sane. This is pretty obvious when you consider how badly I lost it when I suddenly jacked gear in last December. I had the most florid psychotic episode with both high and low mood, of my entire life. I have never ever hallucinated auditorily that vividly. Not on drugs, not on anything. When I became manic in February I was far higher, yet less "psychotic" in that I hallucinated less. All this is schizoaffective stuff. Unlike a bipolar person, I have psychotic-type experiences not related to a high or low mood. I remember some years ago feeling heavily stoned on cannabis with very LOUD thoughts, mild auditory halluciantions and racing thoughts from a COMMON COLD. This was while Maple Syrup my "it's all down to drugs" worker, the one who tried to bully me, the one I sacked. If Maple Syrup had even glanced at my files she'd have seen that I was 38 years old and hadn't become addicted to heroin until age 28. Meaning that I had 28 years of issues at that time. Meaning it was ridiculous to pin all my troubles on a drug. Meaning my intuition was right and hers wrong. I always did envisage myself losing it when I eventually came off. This wasn't "bad attitude" it was me seeing myself the way an insurance assessor would. That every single time without exception that I'd detoxified, dropped dose or switched medications I had experienced manic-depressive symptoms to some degree. I got extra meds in rehab BOTH times I was in there. I spent hours in the counselling rooms crying BOTH times. I spent all night wide awake every single night unlike everyone else who said they didn't sleep and promptly took up snoring for hours on end, BOTH TIMES. In other words something was going on with me that wasn't with them. If everybody had been as upset as I was they'd have employed a team of twelve full-time counsellors every day to meet demand. Somehow other people seemed to do a methadone or dihydrocodeine taper and though they had low points they didn't crack up. Yet somehow I did.

What I didn't expect was to go as floridly crazy as I did, or as rapidly as I did (literally the day I left heroin behind was the day I started hallucinating so floridly I literally could not tell whether I was thinking or hearing, I experienced that many voices.

In a way I look at myself from afar and feel sorry for someone who is a desperate mess. Self-pity is only useful when it gets you the help you need. Otherwise it's a waste of energy. My energy is going into finding out more about this mysterious condition with which I live.

It's diagnosed differently in the USA by the way to the rest of the world.
The World Health Organization's ICD-10 specifies that bipolar and schizophrenic symptoms are experienced together or within a few days of one another; the American DSM IV-TR insists that I must magically be free of any and all marked mood swings for a fortnight and still exhibit psychotic features. So whether or not I'm merely severely "bipolar 1" in America, I've no idea.

I know I have all the features associated with a poor recovery: mood-incongruent hallucinations, deficit symptoms between the severe mood swings, rapid cycling of the mood and mood switches directly between manic and depressed... all these are associated with poor medication response and a poorer prognosis. So whether or not I'm bipolar or schizoaffective in whatever country I am at the "severe end" of "severe mood disorders" and without medication become "severely manic". This word "severe" is cropping up far too often for comfort and it's my googling that has brought it up.

What I'm after now is to be "severely clean" with a "severe recovery" from "severe mental illness"... so there we go.

"Severely well". That's what I wish to be.


Illustrated: schizoaffectives can see amazing things in trunks of gnarly trees!
And I bet you can, too. Especially in the top one!



SCHIZOAFFECTIVE DISORDER

this guy says he took amphetamines as a youngster; but his mother is bipolar
i took amphetamines (etc) as a youngster; my mother has recurrent depression



this one is more like me
someone asked what i talk like this is the accent i have without the northern bits
without medication i go through periods of hearing voices every day
and i get depersonalization too (that means nothing is real)