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Dr. Kaushik
Dr. Kaushik, Doctor
Category: Medical
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Experience:  Doctor ( General Medicine)
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Hi, this question is for my son whom was diagnosed with schitzo-affective

Customer Question

Hi, this question is for my son whom was diagnosed with schitzo-affective disorder and drug induced paranoid schizophrenia..... he says that he never really had schizophrenic symptoms and that his paranoia was logical and related to a real life event. He says he does not hear voices or see things but the doctors are at least considering him schitzoaffective..... he wonders if you can have schizophrenia if you don't experience these symptoms one of his psychiatrists have said yes you can. What does anyone else think of this? His symptoms were waking nightmares of a sexual content, rumbling in his ears. Thinking he could hear other peoples thoughts about him. Mood euphoria with no drugs. Feelings of inexplainable bliss.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. Kaushik replied 2 years ago.
Greetings.
Welcome to the site.
Well, based on the narrative above the diagnosis of schizo-affective disorder may actually comes closest to define his clinical picture and i shall be mentioning examples to support this, however a one to one evaluation session with the patient would have been the best possible way to come to differential diagnoses.
1) Mood euphoria with no drugs.
2) Feelings of inexplicable bliss.
These two support affective diagnosis since these features can be seen in manic or hypomanic episode of bipolar disorder.
1) rumbling in his ears -- could be a type of auditory hallucination.
2) Thinking he could hear other peoples thoughts about him -- could be a type of delusional belief. In addition the same indicates towards presence of paranoia since he is suspecting others through this trait of thinking about him in an ill way.
These two support schizophrenia like psychotic picture.
So since he has traits which mimic affective diagnosis and schizophrenia/psychosis therefore a provisional diagnosis of schizo-effective can be considered.
Nightmares of sexual content can be an extension of either of the two diagnoses which the doctor has been merging to form a schizo-affective diagnosis which i feel is plausible based on the information that you have provided above.
I hope this helps.
Wish you all the best.
Please kindly leave a Positive rating if you are satisfied with the answer.
Regards
Customer: replied 2 years ago.

Hi Dr Kaushik, thank you for your kind and prompt replies.... Although I did experience paranoia with the adderall and the dexderine.... I experience no paranoia on a low dose of vivance. Inf act there is no paranoia at all. It gives me a feeling and energy that I can engage in my life after almost three years of weight gain and exhaustion from the risperdal..... please can you advise on this basis....

Customer: replied 2 years ago.

Also I find that the abilify makes me feel so good that I do not want to do anything..... even on a low dose..... I am unsure if this is healthy for my life.....

Customer: replied 2 years ago.

I have also ordered:






























Pramiracetam

and




























Adrafinil to help with overall learning ability.....








Expert:  Dr. Kaushik replied 2 years ago.
Both adrafinil and pramiracetam are stimulant drugs which are used to promote wakefulness, alertness, focus and concentration and other cognitive functions, however, only one of them shall be used since too much of these can precipitate psychosis and paranoia. In fact a better option than these two would be to try phenyl piracetam as mentioned by me in the other post.
Vyvanse is known to uplift mood but if that leads to overconfidence , feeling of euphoria without any reason and feeling of well being then this may hint at development of affective/hypomanic symptoms of the underlying disorder. So this general feeling of well being may actually be an indication towards the possible onset of affective symptoms.
So he shall stick only to abilify and in addition may take phenyl piractem but using vyvanse will just compromise the recovery.
I hope this makes sense.
Regards
Customer: replied 2 years ago.

Dear Dr Kashik,

I am sorry i am taking so much of your time but i cant help it because you are saying things that make sense and i keep gravitating back to you to answer more and develop better understanding.

My son was diagnosed with adhd in childhood.I was given the choice of having him put on ritalin or doing nothing about it. I decided not to medicate him in the hopes that his adhd could be managed by more natural means.

My decision was based upon my experience of my younger sister who suffered a significant trauma at the age of 17 years and as a result was hospitalized .She came home for a year and then was diagnosed with full blown schizophrenia at age 18. She died in a mental institution age 49 just this year. Her diagnosis was treatment resistant schizophrenia. Between the ages of 17 and 25 yrs i was so shocked and sad about her illness and all the different medications she had to take [ none of which brought her back to who my family knew] that when my own son was diagnosed with ADHD i just didn't want to consider medication. I believe i made the wrong decision and suffer those consequences.

when my son was 24 years old he started university. Right at that time [ first week] he experienced the suicide of a loved one. He managed to get through 2 years of university successfully and then it became very apparent to me that he was unwell....his main symptoms were believing that university professors were out to get him.... he said that he was being followed ...hearing peoples thoughts...feeling attacked.

His first diagnosis was bi polar. 2nd- S.affective 3rd paranoid schrenphrenia.

The risperedone helped tremendously apart from tiredness and weight gain. Now he has switched by your advise - and he is feeling better re tiredness . However, his main goal is to finish that university degree that his illness curtailed after 2 years. That is his dream.

These are my questions:

1. Can significant trauma cause mental illness?

2. To what degree is an adhd diagnosis in childhood linked to serious mental illness in adulthood?

3. Has there been any research about how many adults with

S.Affective or schrenphrenia gain a degree and complete there studies?

4.Are there successful professionals with these diagnosis?

5.Was there any validity in depriving my son of ritalin in childhood re : a child's developing brain?

6. As you will know, family closest to a loved one with mental illness

suffer greatly .I made a commitment to my son that i would stand by him and support him because his greatest fear is being instituonalised for whole lifetime like his aunty.

Expert:  Dr. Kaushik replied 2 years ago.
Greetings.
I am sorry to know about your struggle to see your son go through his life which has been full of trials and tribulations in the form of his underlying illness which i feel he could have acquired due to genetic loading from his aunt's side since these conditions are hereditary.
Being a parent myself i greatly empathize with you and earnestly hope that your son gets maximum help from this revised regime and reaches his pre-morbid levels aka euthymic state. Please do not loose hope and stick by him as always, may God bless your son with best of health.
Now coming to answers to your questions.
1) Yes, emotional trauma of high intensity can in fact precipitate psychotic episode and affective episode as well. In your son's case there is heavy genetic loading from his aunt's side plus a definite stressful situation in the form of death of near and dear one, so both these factors could have contributed to his present condition.
2) Adhd diagnosis in childhood can lead to adult ADHD which however cannot be linked to his present condition since a diagnosis of adhd is made after ruling out schizoaffective or schizophrenia diagnosis, in other words these two diagnoses are mutually exclusive towards the diagnosis of ADHD meaning only one of these can be present at one time.
3) No, there is no exact percentage provided by any study, however clinical experience says that a person with schizoaffective diagnosis is much better off and more likely to have a better prognosis than schizophrenia so the former diagnosis can help him complete his studies albeit with some difficulty.
4) With diagnosis of bipolar, yes there are many successful beings and with schizoaffective lesser number and with schizophrenia rare, so you see a diagnosis of bipolar is better than schizoaffective which in turn is better than schizophrenia.
5) The answer here is variable since one can only know if at he was ADHD to begin with and if he actually was ADHD then using medication could have been a better choice instead of not using it.
6) i understand and respect your concern, so my suggestion to you is to continue giving him solid support and encourage him to continue taking medications without fail.
I hope this helps.
Regards
Dr. Kaushik, Doctor
Category: Medical
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Experience: Doctor ( General Medicine)
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Customer: replied 2 years ago.

DearCustomer

I cant tell you how relieved i feel to be able to discuss these matters which are an everyday reality for me and my family and get a straight forward answer.

Are you allowed to say where your practise is? I mean, which country?

Do you diagnose? if i travelled with my son to you for diagnosis would he be able to get follow through advise re meds etc online?

Expert:  Dr. Kaushik replied 2 years ago.
Well, i am based in India, so seeking a personal appointment with me in person is not possible, plus online one cannot prescribe medications, so the best can do is that i can guide you to the right diagnosis and treatment plan. I am sorry but these are some restrictions which come in my way to see your son.
I hope you understand.
Regards

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