|
warlock's
Aeonity Blog view recent entries / profile / friends / archive / rss / Aeonity Blog |
| check this out idiots and say something!!!! |
Dec 6th, 2006 8:27:27 pm - Subscribe |
| Alner Samala Psych10 2006-12-5 My Former Self: The Nature of a Schizoaffective Schizoaffective disorder is one of the more frequent, chronic, and disabling mental illnesses. As the name implies, it is characterized by a combination of symptoms of schizophrenia and an affective (mood) disorder. There has been a controversy about whether schizoaffective disorder is a type of schizophrenia or a type of mood disorder. Today, most clinicians and researchers agree that it is primarily a form of schizophrenia. Although its exact prevalence is not clear, it may range from two to five in a thousand people (- i.e., 0.2% to 0.5%).Schizoaffective disorder may account for one-fourth or even one-third of all persons with schizophrenia. The reason I wanted to find out more about this type of disorder is that I was diagnosed as schizoaffective when I turned 23. I wanted to be familiar with and have knowledge about what causes my former illness. I have lived with the diagnosis for about over a year now and I expect and have been insistently told by my last doctor and therapist that I'm going to have to take medication for it for the rest of the period until the psychotic symptoms clear out. On the other hand, some of the symptoms still exist but somehow I believe I am much better than before. Within those periods, I am predisposed to being socially withdrawn and irritable most of the times; whenever I am in a public place and my restlessness and agitation during night time has increased. Alongside with those symptoms, my self esteem has diminished. I began hating myself, been feeling tremendous guilt and suspicious about what everyone thinks. Throughout that period, I realized that most of the time I get discontent and bored with life easily, that's why I end up feeling restless and purposeless after a while. Whether it comes to being interested in something new, or learning a new skill, or playing a new game, or listening to a song, or liking someone, it all just eventually dies off. It makes me wonder what stays and what goes beyond interest and novelty. That’s how I considered suicide as a way to get through. I have felt I wish I don't have to bring anything with me to the next day, so everything will be new to me everyday. Schizoaffective disorder is an often debilitating mental illness that maybe difficult to treat, as the symptoms of the thought disorder are typically treated with different medications than the symptoms of depression and mania. To diagnose schizoaffective disorder, a person needs to have primary symptoms of schizophrenia (such as delusions, hallucinations, disorganized speech and disorganized behavior) along with a period of time when he or she also has symptoms of major depression or a manic episode. Accordingly, there may be two subtypes of schizoaffective disorder: (a) Depressive subtype, characterized by major depressive episodes only, and episodes are often characterized by feelings of worthlessness, hopelessness, indifference and the inability to concentrate and remember details along that with the thoughts of death or suicidal ideations. (b) Bipolar subtype, characterized by manic episodes with or without depressive symptoms or depressive episodes. Such episodes bring on sudden elation, euphoria, or extreme irritability to the point of serious impairment. Since Schizoaffective disorders bears a close resemblance to schizophrenia and bipolar disorders, people with this illness experience a combination of symptoms associated with both diseases. To be diagnosed with schizoaffective disorder, a person must meet the criteria for either schizophrenia or mood disorder. However, a person must have one at a time experienced both a schizophrenic and a mood disturbance, and at another time experienced psychotic symptoms without the affective symptoms. These symptoms include … Psychotic Symptoms: Delusions Hallucinations Lethargy or Lack of Concern Disorganized Thinking Agitation Lack of drive or initiative Social withdrawal Apathy Affective Symptoms: Extreme mood swings Hyperactivity Thoughts of death and suicide Decreased need for help Acute psychosis Loss of appetite Medical Treatment Both drug and psychosocial therapies are necessary to successfully treat schizoaffective disorder. Because of the unemployment, poverty, and homelessness that often complicates schizoaffective disorder, drug therapy alone usually is insufficient. Drug therapy usually can stop the patient's psychosis, but often only social and occupational rehabilitation therapies can overcome the associated unemployment, poverty and homelessness. Recovering from schizoaffective disorder is an extremely lonely experience, and these patients require all the support that their families, friends, and communities can provide. Schizoaffective disorder appears to be a combination of a thought disorder, mood disorder, and anxiety disorder. Thus the medical management of schizoaffective disorder often requires a combination of antipsychotic, antidepressant, and antianxiety medication. Unfortunately, after the first year of treatment, only a minority of schizoaffective outpatients remain on their oral medications. Thus long-acting, depot antipsychotic medications that last 2-4 weeks between injections (e.g., depot haloperidol, pipotiazine, or fluphenazine) usually are required to overcome this noncompliance problem. Hospitalization Treatment of an acutely psychotic patient often requires psychiatric hospitalization. The presence of adequate family or social supports will often shorten the length of this hospitalization, or permit the psychotic patient to be treated solely on an outpatient basis. Antipsychotic Drugs Antipsychotic medications are the treatment of choice. Evidence to date suggests that all of the antipsychotic drugs (except clozapine) are similarly effective in treating psychoses, with the differences being in milligram potency and side effects. Clozapine (Clozaril) has been proven to be more effective than all other antipsychotic drugs, but its serious side-effects limit its use. Individual patients may respond to one drug better than another, and a history of a favorable response to treatment with a given drug in either the patient or a family member should lead to use of that particular drug as the drug of first choice. If the initial choice is not effective in 2-4 weeks, it is reasonable to try another antipsychotic drug with a different chemical structure. Often an agitated, psychotic patient can be calmed in 1-2 days on antipsychotic drugs. Usually the psychosis gradually resolves only after 2-6 weeks of a high-dose antipsychotic drug regimen. A common error is to dramatically reduce antipsychotic drug dosage just as the patient improves or leaves hospital. This error almost guarantees a relapse. Major reduction in antipsychotic drug dosage should be avoided for at least 3-6 months after hospital discharge. Decreases in antipsychotic drug dosage should be done gradually. It takes at least 2 weeks for the body to reach a new equilibrium in antipsychotic drug level after a dose reduction. Side Effects Sometimes patients view the side-effects of the antipsychotic drugs as being worse than their original psychosis. Thus clinicians must be skillful in preventing these side-effects. Sometimes these side-effects can be removed by simply reducing the patient's antipsychotic drug dosage. Unfortunately, such reduction in drug dosage often causes patients to relapse back into psychosis. Therefore clinicians have no choice but to use the following treatments for these antipsychotic side-effects: 1. Acute Dystonic Reactions: These reactions are of abrupt onset, sometimes bizarre, frightening muscular spasms mainly affecting the musculature of the head and neck. Sometimes the eyes go into spasm and roll back into the head. Such reactions usually take place within the first 24 to 48 hours after therapy has begun or, in a small number of cases, when dosage is increased. Males are more vulnerable to the reactions than females, and the young more so than the elderly. High doses are more likely to produce such effects. Although these reactions respond dramatically to the intramuscular injection of antihistamines or anti-parkinson agents, they are frightening and are best avoided by starting with lower antipsychotic drug dosages. Anti-parkinsonian drugs (e.g., benztropine, procyclidine) should be prescribed whenever antipsychotic drugs are started. Usually these anti-parkinsonian drugs can be safely stopped in 1-3 months. 2. Akathisia: Akathisia is experienced as an inability to sit or stand still, with a subjective feeling of anxiety. Beta-adrenergic antagonists (e.g., atenolol, propranolol) are the most effective treatment for akathisia. These beta-blockers usually can be safely stopped in 1-3 months. Akathisia may also respond benzodiazepines (e.g., clonazepam, lorazepam), or to anti-parkinson drugs (e.g., benztropine, procyclidine). 3. Parkinsonism: Akinesia, a key feature of parkinsonism, may be overlooked, but if the patient is asked to walk briskly for some 20 paces, diminution of the swing of the arms can be noted, as can loss of facial expression. These parkinsonian side-effects of antipsychotic drugs usually respond to the addition of an anti-parkinson drug (e.g., benztropine, procyclidine). 4. Tardive Dyskinesia: Between 10 to 20 percent of patients receiving antipsychotic agents develop some degree of tardive dyskinesia. It is now known that many cases of tardive dyskinesia are reversible and that many cases do not progress. Early signs of tardive dyskinesia are mostly seen in the area of the face. Movements of the tongue inside the buccal cavity that consist of retraction of the tongue on its longitudinal axis or irregular rotation around the longitudinal axis, with frequent movements in lateral directions, are thought to be the earliest signs. Choreoathetoid movement of the fingers and toes may also be observed, as may respiratory dyskinesia associated with irregular breathing and, perhaps, grunting. Tardive dyskinesia is thought to result from dopamine receptor supersensitivity following chronic receptor blockade by the antipsychotic agent. Anticholinergic drugs do not improve tardive dyskinesia and may make it worse. The recommended treatment of tardive dyskinesia is to lower the dosage of antipsychotic drugs and hope for gradual remission of the choreoathetoid movements. Increasing the dosage of an antipsychotic briefly masks the symptoms of tardive dyskinesia, but symptoms will reappear later as a reflection of the progression of receptor supersensitivity. 5. Neuroleptic Malignant Syndrome: Antipsychotic agents potentiate anticholinergic drugs, and toxic psychosis may occur. This confusional state usually appears early in treatment and, more commonly, at night and in elderly patients. Withdrawal of the offending agents is the treatment of choice. Antipsychotic drugs often interfer with body temperature regulation. Therefore, in hot climates this situation may result in hyperthermia and in cold climates hypothermia. The neuroleptic malignant syndrome is an exceedingly rare but potentially fatal condition characterized by parkinsonian-type rigidity, increased temperature, and altered consciousness. The syndrome is ill-defined and overlaps with hyperpyrexia, parkinsonism, and neuroleptic-induced catatonia. Coma may develop and result in rare terminal deaths. This syndrome is reported most often in young males, may appear suddenly, and usually lasts 5 to 10 days after cessation of neuroleptics. There is no treatment; therefore, early recognition and discontinuation of antipsychotic drugs, followed by supportive therapy, are indicated. 6. Hypersomnia And Lethary: Many patients on antipsychotic drugs sleep 12-14 hours per day and develop marked lethary. Often these side-effects disappear when treated with the newer serotonergic antidepressants (e.g., fluoxetine, trazodone). These antidepressants usually are given for 6 or more months. 7. Other Side-Effects: Depressed S-T segments, flattened T-waves, U-waves, and prolonged Q-T intervals may be caused by antipsychotic drugs. This situation is cause for concern, is more liable to occur with low potency agents, particularly thioridazine, and could increase vulnerability to arrhythmia. It is not possible to say to what extent antipsychotic drugs are involved in sudden death. Serious reactions to antipsychotic drugs are rare. Photosensitivity reactions are most common with chlorpromazine; vulnerable patients should wear protective screens on their exposed skin. Pigmentary retinopathy is associated with thioridazine and may impair vision if not detected. This complication occurred at dosages below the considered safe limit of 800 mg. Dosages of above 800 mg is, therefore, not recommended. Antipsychotic agents may affect libido and may produce difficulty in achieving and maintaining erection. Inability to reach orgasm or ejaculation and retrograde ejaculation have been reported. Antipsychotics also may cause amenorrhea, lactation, hirsutism, and gynecomastia. Weight gain may be more liable to occur with any antipsychotic drug which causes hypersomnia and lethargy. Studies suggest that many antipsychotic drugs taken during pregnancy do not result in fetal abnormalities. Because these agents reach the fetal circulation, they may affect the newborn, thus producing postnatal depression and also dystonic symptoms. "Drug Holidays" From Antipsychotic Drugs It was once thought that patients should take a "drug holiday" by periodically stopping their antipsychotic drugs for a few weeks every year. This practice is no longer recommended. Research has shown that these "drug holidays" increase the risk of relapse of schizoaffective disorder, as well as increase the risk of tardive dyskinesia. Antidepressant Drugs The older (tricyclic) antidepressants often worsen schizoaffective disorder. However, the newer (serotonergic) antidepressants (e.g., fluoxetine, trazodone) have dramatically benefited many apathetic or depressed schizoaffective patients. Antianxiety Drugs Benzodiazepines (e.g., lorazepam, clonazepam) often can dramatically reduce the agitation and anxiety of schizoaffective patients. This is often especially true for those suffering from catatonic excitement or stupor. Clonazepam also is an effective treatment for akathisia. When Not To Use Antipsychotic Drugs Development of a Neuroleptic Malignant Syndrome is an absolute contraindiction to the use of antipsychotic drugs. Likewise, development of severe tardive dyskinesia is a contraindication to the use of all antipsychotic drugs, except clozapine (Clozaril) and reserpine. Lithium If the patient does not respond to antipsychotic treatment alone, lithium may be added for 2 to 3 months on a trial basis. Combined lithium-antipsychotic drug therapy is helpful in a significant percentage of patients. Anticonvulsants The addition of carbamazepine, clonazepam, or valproate to antipsychotic drug refractory schizoaffective patients has been reported to sometimes be effective. This benefit is more often seen in patients suffering from bipolar disorder. Acute psychotic agitation or catatonia often responds to clonazepam. Other Drugs The use of megavitamins and special diets have apparently little or no effect for schizoaffective patients. Electroconvulsive Therapy Electroconvulsive therapy (ECT) has been used effectively in small percentage of schizoaffective patients, particularly those of the catatonic subtype. Patients with an illness duration of less than 1 year are most responsive. This therapy offers little hope for lasting improvement in chronic schizoaffective patients. Basic Principles Psychosocial Treatment Untreated schizoaffective disorder will often leave a patient friendless, penniless, and homeless. Thus circumstances often force schizophrenic patients to rely heavily on their family or psychiatric group homes. There is frequently an inverse relationship between the stability of their living situation and the amount of antipsychotic drugs they require. Supportive Psychotherapy Traditional insight-oriented psychotherapy is not recommended in treating schizoaffective patients, whose egos are too fragile. Supportive therapy, which may include advice, reassurance, education, modeling, limit setting, and reality testing, is generally the therapy of choice. Psychotherapy can have toxic effects, especially when there is a negative transference. One of the toxic effects of psychotherapy is dependency. A pushing, intrusive approach may make withdrawn patients worse. Group Therapy Group therapy, combined with drugs, produces somewhat better results than drug treatment alone, particularly with schizoaffective outpatients. Positive results are more likely to be obtained when group therapy focuses on real-life plans, problems, and relationships; on social and work roles and interaction; on cooperation with drug therapy and discussion of its side effects; or on some practical recreational or work activity. This supportive group therapy can be especially helpful in decreasing social isolation and increasing reality testing. Family Therapy Family therapy can significantly decrease relapse rates for the schizoaffective family member. In high-stress families, schizophrenic patients given standard aftercare relapse 50-60% of the time in the first year out of hospital. Supportive family therapy can reduce this relapse rate to below 10 percent. This therapy encourages the family to convene a family meeting whenever an issue arises, in order to discuss and specify the exact nature of the problem, to list and consider alternative solutions, and to select and implement the consensual best solution. Self-Help groups, in which family members of schizoaffective patients discuss and share issues, have been particularly helpful in this regard. Behavior Therapy Behavior therapy in hospital often involves rewarding desired behaviors with specific privileges, such as ground privileges or weekend passes. When the schizoaffective patient is no longer floridly psychotic or distractible, behavior therapy usually can successfully teach much needed social and occupational skills. As far as I can remember, I had my first manic episode when I was in my mid teens and then it later evolved and manifest somehow a couple years ago when I fell into depression and down in the dumps when my girlfriend Andrea and my band mate/best friend died all in the same year at the same time I got fired from my job at the hospital,. It came to my basic perceptions that I thought I am doomed to failure and realized that all my dreams have now washed out. My band XtheburningdesireX, disintegrated since my friend died of suicide and at the same time I wasn't done grieving over the demise of Andrea, whom I consider the love of my life at that time. She was the most precious and Before that, all was going well, my social life was fulfilling, I'm doing well at school despite the fact that I am busy with my band, I have the coolest, nicest friends who would do anything for you, I have the most dazzling and adorable girl around me and life was at its full potential of enormous magnitude. All of a sudden me and my friend Mike had a fight and didn't talk for almost a year and I just found out he had committed suicide. A month after that, I heard the tragic news that Andrea and her friends had a horrible car accident on the 580 south freeway and only one of their friends inside the vehicle survived and become paraplegic. I was at a state of shock and couldn't believe what is going on with my life at that time. Why would I loose two of the closest people that I know all in the same month? I keep questioning myself how it happen and still couldn’t accept it. During the course of the last year which also was one of the most horrible, I have experienced various symptoms of mental illness for most of my life. A year ago, I experienced a dreadful case of depression. I have also experienced disturbed sleeping patterns for as long as I can remember - one reason; being a writer is that I can keep irregular hours staying awake all night inscribing down some ideas. I did not think my sleeping habits would allow me to hold a real job for any length of time. In conjunction with that; I turn out to have recurring delusions and hallucinations over the past couple of years. I began seeing things like ghosts and other paranormal stuff while I'm driving. Often, I couldn't distinguish the reality around me, I started having doubts and unnecessary suspicious thoughts to all those around me and my trust factor has become limited even to my circle of close friends around due to the fact that I felt blameworthy somehow. all at once, I became paranoid and started hearing voices and seeing ghostly beings which I thought it were my friends visiting me then at the same time, thinking their after me for some reason. I know it wasn’t the effect of smoking weed and other drugs because as far as I know I’ve been clean for a while. Those voices who keep telling me I am responsible for everything. I set off into paranoia and a sudden state of fear generally. I began to think everything is bleak and hopeless, in which I became a lot more melancholic and dejected. I indulge on self mutilating activities and taking in massive amounts of alcohol and sleeping pills hoping not to wake up someday although I sought after to resort on taking drugs but somehow I couldn’t afford it. My suicidal thoughts have manifested and have become apparent at that time but somehow I survived those ideations. As soon as my counselor at Jobcorps Treasure Island found out about my situation, they called my parents and I was rushed at the Stanford Hospital where I was given a 5150 hold status and was diagnosed schizoaffective. I have learned that differentiating a schizoaffective disorder from schizophrenia and from mood disorder can be difficult. The mood symptoms in schizoaffective disorder are more prominent and last for a substantially longer time than those in schizophrenia. Schizoaffective disorder may be distinguished from a mood disorder by the fact that delusions or hallucinations must be present in persons with schizoaffective disorder for at least two weeks in the absence of prominent mood symptoms. The diagnosis of a person with schizophrenia or mood disorder may change later to that of schizoaffective disorder, or vice versa effects with the first medication. The same principle applies to the use of antidepressants or mood stabilizers. There has been much less research on psychosocial treatments for schizoaffective disorder than there has been in schizophrenia or depression. However, the available evidence suggests that cognitive behavior therapy, brief psychotherapy, and social skills training are likely to have a beneficial effect. Most people with schizoaffective disorder require long-term therapy with a combination of medications and psychosocial interventions in order to avoid relapses, and maintain an appropriate level of functioning and quality of life Citations/Bibliography www.mentalawareness.com/referenc/knowledg/schizoa.htm http.//.www.mhsource.com/exp/referenc/knowledge/schizoa.htm www.nami.org/helpline/schizoaffective.htm Suicide and Homicide among Adolescents / Paul C. Hollinger 1994, The Guilford Press |
|
| mood: offended |
(1) comments |
| ME AND AMY'S SWEETEST CONVERSATION EVER(LAME) |
Nov 27th, 2006 10:36:16 pm - Subscribe |
| AMY: oh i'm gettin a new phone u'll just have to wait til then. sorry ----------------- Original Message ----------------- From: dysfunctional_kid_number_one Date: Nov 27 2006 4:15 PM alner  k i guess i'll get used to it. i missed hearing ur voice though.. ----------------- Original Message ----------------- From: hows it feel to not feel at all? Date: Nov 24 2006 10:01 PM AMY;sorry i'm out of minutes and i'm gettin bitched out for that so i'm sorry i cant talk to you... ----------------- Original Message ----------------- From: dysfunctional_kid_number_one Date: Nov 24 2006 4:26 PM ALNER: so did u have fun last night i think i texted u and called u before but u never replied oh well im just gonn aget used to it |
|
| mood: hypocritical |
(0) comments |
| if only..... |
Nov 27th, 2006 10:34:45 pm - Subscribe |
| i don't belong here..sometimes i feel i dont even exist in my own world.even though i claim it to be of my own creation. i feel misplaced.im sick of the world already but only you seem to make this even a much more neutral place for me to be in here. why is greed and shallowness and lust everywhere? gameshows on tv encouraging this sin, the bitches i encounter,useless advertisements, fake friends,leech relatives,gold digger blondes that i seem to attract, EBAY, the pornhouse,myspace whores who gather thousnads of friends that they will never even talk to and the impending "shallowness of mankind" displays this even worse.beauty/ materialism isn't the point of life.if you'll ask me, i dont realy own anything valuable at all. i eat really cheap fastfood, sometimes i dont eat all,i try to look the best i could but all i end up with is just looking just like odd at all/all my clothes i brought were on clearance, i dont drive a car, i dont own too many game consoles or uber cool music cds,nor fancy perfumes, i dont comb my hair, i could care less if i go to school unshowered or not, i could care less if you do too.i pick my flock of people to be with amongst the flock of assholes/bitches/douches that i encounter with, sometimes not at all.i always feel like I am better off alone.i guess one is a happy number and no one can beat #1 and im not either, or neither the second best.I am the unsung hero of my own movie diarrhea thats been playing in my whole existence.time will come and we will all be in one place were everything is sort of like a utopian dream. were every one and everything we have is in equality.in fairness and all injustices collide and replaced with peace and security.before that even happens...... we all die alone. we'd like to stop this from happening but it's inevitable |
|
| mood: alive |
(0) comments |
| im not falling in love, i am fallin apart.... |
Nov 27th, 2006 9:50:52 pm - Subscribe |
| why is it always like this? i was just starting to like Suzanne but she already had a new bf.oh fuck..wrong timing once again.besides from that i thought about the consequences...she's hella younger than me and she smells trouble, for real.we still talk alot on myspace. and everytime i got the chance to call her or text her she never reply, i guess im just gonna leave her alone and stay out of this situation. |
|
| mood: hurt |
(1) comments |
| please listen!!!!!!!! |
Nov 1st, 2006 10:39:12 pm - Subscribe |
| I'm a mess of insecurities Attention starved with a narcissistic twist Don't you think that I'm amazing Please tell me I'm worth dating |
|
| mood: smiley |
(0) comments |
| navigation | template by neal |
| previous page | next page |