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)

Bipolar?

I HAVE just been scanning the internet to find out what on earth is supposed to be wrong with me. What I found out is not very reassuring.

~ It can't be drug-induced psychosis. That is a paranoid-schizophrenia type condition. I do get paranoia but the other stuff I get is way more extreme. I don't have the symptoms of paranoid schizophrenia or drug psychosis

~ I thought there was a condition called "substance-induced mood disorder (bipolar)" but there is not. Substance-induced mood disorder is mania, hypomania (mild mania), depression or a mixed state, all of which I've had in the past 2 months. What doesn't seem to happen in substance-induced mood disorder is that the mood switches poles eg from depressed to manic (as mine did about 3 or 4 weeks ago) and if symptoms last more than a month from last drug use it's generally NOT considered substance-induced

~ Drugs can worsen bipolar disorder (a phenomenon known as kindling) but this doesn't mean they necessarily caused it. Bipolar has a strong genetic component. If you have one parent with type 1* bipolar or recurrent depression, you have up to a 40% chance of getting bipolar i disorder [my mother "can tell by the calendar" when she's going to be depressed and it happens every year. Recurrent clinical depression]

~ Heroin flattened out my moods markedly. That was the first change I noticed in my life: no more mood swings. In fact I had practically no depression in the first 2 or 3 years, so to me heroin was a mood-stabilizer, a mood stabilizer that has now been taken away

~ heroin is not generally associated with drug induced mood disorders; the culprits tend to be crack, speed, ecstasy (uppers); cannabis; psychedelics and benzodiazepine withdrawal

~ at least 50% of people with bipolar disorder abuse drugs and even more abuse drink

~ I have had literally every symptom in the diagnostic criteria for both mania and depression in the last 2 months

~ the hallucinations I had were actually more extreme than is normal. Apparently when most bipolars hear voices they just hear murmuring sounds and can't make out the words, or hear their name. This stuff was going on with me years ago in depression. Now it's clear words, sometimes sentences, and one time a half-hour monologue; I also have seen visions that is I can stare at a blank wall and a movie appears (this only happened a couple of times when I was extremely hyper)

~ I don't have all symptoms at all times. Nobody does. It's impossible to hear voices in the most intense mania as my head is full of just a roaring noise and I make a roaring noise, think a roaring noise and am a roaring noise. This is what happens when you go so incredibly fast you can no longer think

~ Naomi at the drugs clinic who is a dual diagnosis professional thinks I'm bipolar

~ I have the same symptoms and experience as everyone at Nutter Club who is bipolar. But not the schizophrenics. Since I've been coming we've only had bipolar and schizophrenia in the room

~ I have had bipolar symptoms going back 15 years; in the beginning they were mild and transitory (first triggered by antidepressants); over time they have grown more extreme. And now look at me

~ I am not diagnosed bipolar. I just have all the symptoms.

~ And if you want my opinion: when I'm high I think it's fantastic and don't care what it's called; when I'm low the idea of actually being a real life manic depressive is equal to having no life at all

Comment if you like but don't call me a hypochondriac. You haven't seen me, you've only read me. Nobody who sees me doubts I have severe mental problems. I was so out of it one time a couple of weeks or so ago that one of my friends, a 50 year old man, cried

And if you believe I'm being negative, just bear in mind that telling myself I'm sick is the one thread of reality I have left when I lose it and I do lose it. If you think I exaggerate my experience do us both a favour and drop reading this blog. I tell it as it is

Yes I still feel hyper now but have barely any psychosis (yes you can be psychotic and know it: read Kay Redfield Jamison's memoir. She's type 1 bipolar and a clinical psychologist. Knowing the terminology didn't save her from utter madness. It saves nobody)

My situation is not as extreme as it was previously. It's 4:20 I'll do 5 mins in bed but if I don't sleep in that time I'm getting back up. And that's it.

I am not saying I'm bipolar. I'm saying I have all the symptoms. There's still a chance I could somehow get off the hook on this drug-induced thing but nothing I've heard seems to back this possibility up. So this is the situation. I still don't know, but I need to know. I'm fed up of not knowing.

One last thing: yes I think too much. That's another symptom of a manic episode. "Flight of ideas" (racing thoughts).

Night all. I'm doing that 5 mins in bed in a sec. I fully intend not to sleep. (Why waste the time?)

PS I've had ONE drink today a White Ace cyder at 3.75 units alcohol (at 10mls alcohol in a unit).

*type 1 bipolar is more severe than type 2, which involves depression (which may be severe) and mild mania. Type 2 never has psychotic features; type 1 involves full mania and 70% of sufferers become psychotic at some time or other. Hearing voices or seeing visions qualifies as psychosis, whether or not you're also "delusional"

For those who are interested, BipolarAbout.com probably has the best info on the condition.

Drink/etc Diary Day 1 (Saturday)

I SLEPT! 4(ish)PM TILL 4AM. 12 glorious hours. I dreamt about this boy I went to school with at my 1st 2ndary school. He left midway through the first year because his parents moved to Bedford. Then came back, still living in Bedford. His Dad still worked in London or Hertfordshire (where we were) and drove him in every day. The time before when I slept, with the exception of an hour or 90 mins early Saturday morn was Thursday afternoon into Thursday evening when I dreamt I was in Madonna's house. I found a crappy old radio in the corner, picked it up and said "whose is this?" and Madonna said "that belonged to my mother". Then I realized I had really upset her and Madonna started ignoring me. Madonna's mother died when she was about 6. She says it was the worst thing to happen in her life.

OK I said I would do an alcohol diary. I had 2 cans, 1 litre. 7.5% ie 75mls alcohol, 7.5 units. Being as I partly couldn't and partly didn't want to sleep and was drinking quite a bit of black coffee, I set my mood from -.15 to +1.5 peak then it dropped back to -1.5 because I was exhausted I felt sick, hungry but couldn't eat.

OK IF YOU'RE AS BORED AS ME OF MENTAL HEALTH SHIT SKIP THE ITALICS.

The mood scale works like this. Zero means absolutely normal and not at all depressed. If something funny came on telly I would laugh my head off. If something good happened I would feel really good. -1 is noticeably depressed but able to shrug it off, except it returns within half an hour. I distract myself a lot by using the internet. -2 is the higher end of "moderate" on a doctorly scale meaning feeling pretty rough but still able to act out, sometimes snap out of it except it crashes back, still able to use distraction. I could sleep 10 hours every night. -3 is the worst I usually get, lower end of "moderate" meaning absolutely abysmal mood. Whereas suicide crosses my head in any low, here the impulse or fantasy to do it can get relentless and I just want to curl up and die. Self-esteem goes low, concentration is terrible, I can write but not read much. I can sleep 14-17 hours or longer every day. -4 is very rare for me, I've only ever been down here for hours or days at a time, it means total incapacitation, staring into space, unable to put on any meaningful act. I feel broken and injured, totally worthless, guilty and filthy. I don't feel suicidal, this has always felt like the very end, life is over. You can start tripping out in this state but I've never tripped intensely (thank God). -4.5 would be so bad I wouldn't be blogging at all, not even single lines. I hope I never go that low. In this state they'd seriously think of ECTing you. ECT is the treatment I least want. I know someone who had it and had half a life wiped away. Google ECT, you'll find witness to this fact. Look at what doctors say, they'll never admit it happens apart from "partially impaired short term memory loss". Yeah I know a lot about this subject I used to have a stock of how to (or rather how not to) books with titles like Depression Workbook. Ukh. Lent them all away and sold the rest for heroin money.

O crap, now I have to explain pluses. OK here we go. When we get to the + and - 2s and higher bear in mind not everything happens at every moment, most things happen at some time while it's going on:

+1 hyperthymia means a good mood, a really nice buoyant good mood like swimming floats you cannot push it down in my late 20s I'd get like this, constantly, days at a time, but it always meant depression was on the way or I'd just come out of it (ain't life great); +2 hypomania racing thoughts or thoughts flooding the head, distractable, disinhibited, pacing, euphoric and/or irritable, like being on speed. Urge to say stupid stuff, eg repeating same words/phrases over and over, or doing it in head. I used to get flashes of this over the past few years, I just thought it was the heroin now I'm not too sure. +3 mania very disinhibited, saying inappropriate things though I'm not an impulsive person and try not to, periodically rushing high alternating with crystal clear shining mental state, irritability tipping into rage: especially at psychiatrists and drug services, endless composition of letters, posts, monologues in head or online, cannot sleep more than 4 hours max, bad paranoia, don't want to go outside. I was in this state when I saw the shrink last time (unfortunately, now I can't get out of what I rantingly told him), some hallucinations eg hearing words spoken by the tap when it runs +4 hearing voices, floridly at the peak, visual hallucinations e.g. seeing fur growing out of everything, flashes of light, Northern Lights style visuals, lights outside look amazing, police car lights make me ecstatic, extreme paranoia, people are talking about me, intruders in the house, irrational thinking though I'm a very sane person and can still distinguish or remember what's meant to be normal. Like the effects of an extreme crack/uppers binge when you've lost it and just cannot come down. No sleep at all at the very peak. Head feels like national electricity grid wired through brain. Eyes closed my mind is lit up like a TV set, brightly with constant moving pictures. This is what happened in early December it was only this bad for about 2.5 days. Into this got mixed depression of the worst type and suicidal urges which were extreme and terrifying. I wasn't even thinking English at some points just bing bing bang bong ong ong ong! Still able to write and post despite all this. Can't get head round stuff like texting on phone, signing into email, putting key in lock though. Bear in mind I can type by touch so typing is dead easy +4.5 you'd be totally incoherent, wouldn't know what you were doing, where you were going, why you were there, what was happening, could do anything and not know it. Never been this bad, but was able to see this was where it would end up if it got any worse. I've witnessed this from the outside (in nuthouse) it's not pretty. I'm glad I never got this far.

+3 and +4 have only happened once, in December. In summer 2001 I got into a horrible state coming off gear cold turkey, very hyper very depressed. Kept losing touch with what was thinking, what was going on at times. Everybody feels mentally terrible but it was more extreme. This isn't just my opinion the nutnut nurse at the druggie service thought it sounded "manic". Antidepressants (Prozac) used to put me +2 for a few days to a couple of weeks. Last time it was worse and I didn't sleep for 4 days, though i don't remember feeling that euphoric I wrote some ridiculous stuff in a letter to my Gran, I'm so glad I didn't post it. Then I crashed, still on mirtazapine (Remeron/Zispin), still at 30mg a day it bottomed out at -4. For 3 or 4 weeks until someone realized what was going on and I stopped it. I never even knew an antidepressant could make you worse.

OK so that's the scale and it's rated conservatively, you give the minimum applicable number. Feeling really nice for a few minutes doesn't mean a plus whatever that's just feeling really nice. These moods are constant and marked and the more extreme they get so the ability to act normal or snap out of it diminishes, eventually vanishes.

Ukh I'm fed up of all this. I wish I had never seen that dr. I had to. What am I meant to be doing? Cleaning my house. Going to AA. Yeah. House has turned into mess as life turned to chaos this past week. I'm not always the most focused person. Yet I can focus fairly well in certain ways. And nearly everything I am, think and/or feel I'm also the opposite. So I try not to be self indulgent but what is a blog? Self-indulgence of the most extreme kind! Life is like that it doesn't bother me unduly. I'm bothering me far more than anyone else ever has. My own behaviour. Drink drink drinking (still). I shouldn't be drinking 7.5 units a day that's double the maximum recommended allowance. I should be cleaning up. I should be nicely well organized. I should be physically clean. I should cook food from scratch because I know how to do it. I should get up at the same time every day so my sleep cycle is as regular as it can be. I should look through mail that comes and open stuff addressed to me. I should wash my clothes, not sleep in them and buy or at least obtain new ones (you can get free clothes by diving a clothing recycle bin). You can also collect them off the street, which I do. I should also do a million other things I cannot remember/be bothered going into.

That's it. See ya. Wouldn't wanna be ya. Wouldn't wanna be me either. Ha ha har!!!!

Illustrated: top Madonna; bottom Trisch Li or Trishli who appeared in video 1 on Friday manic +3 or more on my lovely scale. In video 2 she's sane and looks amazing. She died 2 years ago. I don't know why. I like her.
You can also find some good links re cocaine or crack psychosis or mood episodes and mixed mood disorders and other nauseating things

PS if you want to see more Trisch Li and Jen on the telephone here's 3 more:

Trisch and Jen on phone 3 Jen's weird night



Trisch Li and Jen on the phone 4



Trischli and Jen on the phone 4 later that night I love the background on this one