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Forum Name: Psychiatric Topics

Question: ADHD + Paranoia + Obsessions + anxiety + Grandness = ?


 Swapnil - Sat Sep 01, 2007 3:02 pm

1. Age : 24
2. Sex : M
3. Past diagnoses : Anxiety Disorder, ADHD , Social Phobia , Paranoia, Obsessive tendencies
4. Past surgeries : None
5. Family history : Possible Schizophrenia in second degree relatives
6. Current Medications : Adderall.
(Abilify prescribed , but to be taken after second opinion)

Respected Sir/Madam

I am originally from India. I am here in USA to pursue my Master of Science degree since Aug 06. All these mental disorder diagnosis and medications have taken place when I am in USA.

Summary : I have been diagnosed with Anxiety Disorder , Obsessive Behaviour by psychologists. ADHD , Social Phobia , Paranoia by my psychiatrist. My paternal aunt , who died in 1955-56 most probably had Schizophrenia though she was never treated and reason of her death is not known. Maternal uncle of my father too had some mental illness , as I have heard from my mother several times.

Family History : I came to know about this history of mental illness some 2-3 weeks back but I had begun to suspect it since May 07. My father is very caring and hard working guy , who has made this all out of nothing. He is very silent guy and well respected in relatives and colleagues for honesty. My mother too is loving and caring . But sometimes she has horrible rage problems , which I have witnessed since my childhood. They included swear words of worst possible kind , frequent fights with my father over trivial issues. I witnessed quarrels between my sister and mother for at least 7-8 years. Many a times when my dad was out of town for his work. I frankly , don't care much about my sister , even though she cares for me. My family does not maintain any contact with relatives , only occasionally like marriages etc. Otherwise it is very private world for 4 of us. I have seen my parents especially my mother doesnt like when someone arrived in our house.

Childhood : I was always afraid of new people , new settings from beginning. . I recall being taunted by whole colony where I had shifted when I was 6-7 for being awkward style of walking. I was mocked for my style of running even when I was 16. I don't think frankly that these mockings are anywhere near to be termed "abuse".
I had some friends in school , but I was pretty much alone for 2 years starting 1991-93 and to finish 1996-98. I was always 1st in my class from beginning. Worst I had was 2nd rank. I don't at all think it is any special. In short : I did not have any problem with performance in school.

Adolescnece : I had problems with my rapid speech and people made fun of me publically , in whole class especially in 10th , 11th ( when I was 16-17). Again I had no friends for 2 years of junior college. And I perceived slights to be grave insults. When I started my engg I used to study hard and got good grades. I was ashamed of my good grades and felt I should get less grades. My grades steadily declined starting 2nd year. I started mastur***. I had my first major depression in 2003. I managed to get a job in a Software firm and finish my engg with decent grades. I spent my whole engineering almost alone though sometimes I used to visit dorms. Otherwise I was isolated from whole college for 3 years and didnt care much about it. I had began worrying about world events in this age.

Early Adulthod: At my workplace I used to have severe anxiety over trivial issues. I didnt talk much with my project colleagues in first 3-4 months. It took me long time to get going with them. I had gotten into serious drinking problems there and had started chain smoking at the end.

I liked a girl of my age in my office who had come one year after I joined. We used to work together. Though , I never had guts to ask her out when in office, talk with her in public for fear of ridicule and people making fun of me by mentioning her . I really liked her and used to drink when I felt she didnt talk with me on some days. In fact , I started smoking thinking she has started disliking me for my drinking habit.

When I was about to leave India , I couldnt suppress it. I went to Bombay and proposed a girl (whom I will refer to as "The Girl") I had liked from very long (at least 1 year). She agreed to wait till I finish my education and come back with a job and convinced her parents about me. But because of strangest possible turn of events , for which I myself is to blame, she was humiliated in front of my parents. I can go on in details about that , but bottom line is : she was nicest possible girl ideal from all aspects who forgave me for my worst of worst mistakes and tantrums.

Despite disapproval from her parents she continued to communicate with me secretly from India. I managed to hurt , humiliate her from Aug 06 to Feb 07 to unimaginable extent despite all this, with utter lack of insight. Finally she said enough in Feb 07 which left me broken and I started chain smoking again. Though I managed to recover and I had better grades in Spring compared to Fall and I got an internship at a good company. So my behaviour has caused me enormous damage in a relationship with a really caring and wonderful girl.

People around me have called my psycho since long(Engg,workplace and in USA) . I was about to go to mental health provider in May 07 just to ask whether I am a "psychopath", prospect which I dread. I never realised that I am always "lost in my world". I retire there frequently to daydream. Daydreaming is not always for good of mine. Sometimes it is morbid and I think of myself dying painfully because of sins I have committed , especially with The Girl I loved. Many a times , daydreaming consists of my failure. Which makes my heart heavy, wets my eyes and I seem to like it as I go in this type of daydream often.

Most of symptoms I have written below have come from trusted people , but I still had very hard time to admit them myself.

Diagnosis and past 3 months:
I have quit smoking some 4-5 months back. Started meditation ( Yoga) , excercise to better myself. When I found something is stil wrong I approached psychologist who said I have anxiety disorder. She based it on my behaviour and trivial points which I did not like. I then approached psychiatrist and she said I might have ADHD and gave me Adderall of increasing dose. She once judged correctly and asked me about being lost in own world. She has said I might have Social Phobia. She recently as given me medicine for paranoia.

Symptoms and self observed behaviour
Here is a list of symptoms which I have come to realise, after long time.Some of these are self-doagnosis , exact phrase for which has to be looked up in Wikipedia/Internet.

1. Terrible mood swings: It takes nothing for my mood to become worse. I like to be in world of my own , and if someone tried to talk me out of it , I get really mad.
2. Temper Problems : I sometimes get enraged to the point of yelling at people. I have reduced it to almost nil. But it still happens.
3. Paranoia : I have felt since long that people talk about me , laugh about me. I misinterpret comments, threats. Sometimes it becomes too much and I walk around with head down to avoid eye contact. If I look some stranger in the eye , sometimes I get sinking feeling in heart that this person is going to harm me.
4. Sense of grandness: I have long been feeling I am special , have special purpose for my life. Consider others as mortals with no goal. I have always felt I am God and I don't need society/friends. I have recently began feeling that all these mental illnesses are conspiracy against me, and I still feel that to mild extent. I have started feeling that my thoughts become true in real life and I can decide future. I feel things that are said around me have prophetic meaning for me. And I refuse to call it as delusion or grandiosity.
5. Feeling of Unreality : Recently I had a derealisation experience. It lasted for 3-4 hours , but that feeling pops up every now and then.
6. Social Isolation : It has been there for long since I can recall and I don't feel about it. I am quite content to be alone. Though I move out with my friends sometimes , most of the times I want to be alone and lost in daydreams. I find it hard to get back to reality from my daydreams and in fact many a times I am confused when it happens (daydream breaks) , and I try to reenact it. I didnt have close friend in Engineering though there were people with whom I could talk. I had a philosophy that once you move out of place people there wont matter. I followed it for school , Jr College and my Engg. I have been forced to correct this when I moved to USA.
7. Low self esteem : Despite inner grandiosity I have what can be described as cripplingly low self esteem and low confidence.
8. Obsessiveness : I have obsessive tendancies , which make me depressed for long time. Worst of such intrusive thoughts involve The Girl. One such thing is obsessing with the thought of being narcissist stalker. Another being horrifying images especially about girl which just break my mind. And sometimes i cant control them. Often I have to neutralize them by thinking good. eg. when I see leather belt I think of hitting her with it and when I realise this I have to imagine in my mind I am hugging her or she is slapping me to get rid of it. Sometimes it drived me mad.
9.Superstitions : I am superstitious, cant throw away old things , I still have all the books from my engg even from 1st year. I feel someday it will be useful. I relate two unconnected events for this. e.g. if basketball goes in basket I get internship. If I turn off microwave at 1 then I get so and so. This has started when I was in 6th , in 1994. It persists even today.
10. Indecisiveness: Decision , courage , truth , trust , determination are dictionary words for me. I have started trying to imbibe them but it is mechanical process. I have fickle mind and I change my mind in an instant.
11. Thought Disorder : I have all traits of thought disorder. Pressured speech , derailment , repetition of words. Unintelligible sounds in place of words. etc.
12. Very very short attention span. : Even when I am watching a movie , reading a book , talking with someone. But , sometimes I have managed to finish books I liked without getting up from seat for 3-4 hours. My project partners used to call me "absent minded" meaning of which I didnt realise back then.
13. Lack of empathy: I don't much care about anyone around me. I don't have "empathy". Unless I am in that situation , I find it hard to recognize someone's problems. I love to point out people's faults , but have difficulty accepting mine. I laughed once loud in class when I heard my college friend had an accident - head injury and he is in hospital because he has partial amnesia.
14. Lack of hygine : Again this is something I had to read somewhere to understand I have it. I cant explain it , as it will be gross. But take my word for it.
15. Verbal Communication : I have often found that I am much much better when it comes to written communication compared to my verbal communication.Because I am impulsive in talk and don't think much before talking. While in written form I have time to order my thoughts properly and present in nice way. Which becomes impossible when I am talking or even chatting. I cannot properly arrange my thoughts in logical manner in real-time.
16. Self harm : I had my first thought of suicide in 1998 ( Age : 16). It occurred again in 2005. And again in 2006. In fact in Nov 2006 I had decided to "finish it all" and went to do it, but decided against it finally. I don't have any such thoghts these days.
17. Depression : I am depressed frequently thinking about my life , future and sometimes nothing at all. though it does not last for more than 4-5 hours these days , I still have less energy /motivation to do things than I will like to have.
18 : Immaturity : I often blurt things that are inappropriate for my age and culture. Though I don't really care much about religion / culture. But I find it really good to offend people of my religion / sect. I think of myself as some militant / free spirit / rebellious in that way. Pride , whatever that is missing from me.
19 : Need of love: I have very powerful need of love and I want talk to some female. This is the reason I selected female psychologist and psychiatrist. I am frequently moved to tears because of someone's soothing / caring voice or gesture even at this age. It used to happen especially while talking to The Girl. Her single caring inquiry was enough many a times to bring lump in my throat , reason I could not comprehend at that time. All along my life I have shied away from girls/women. Now I find their talk is my ever increasing need. Though I am not desparate to "hook" some girl, I just want to talk to some female all the time.
20: Talking/Laughing with myself : I frequently talk/laugh with myself. Usually it happens because I always imagine some conversation in my brain , imagine people their responses and then all of a sudden I find myself talking loudly to them or gesturing wildly.
21: Flat Affect: I am not the best person to talk about this. But I have been told that I should "bring emotions in my voice" in daily life. When I recorded and listened to my voice imagining different moods recently, I found it to be frighteningly same , only variation was that of volume.
22. Lack of appropriate emotional response: Again this term is borrowed. I never felt bad when my grandmother died as I didnt like her. She was never ever bad to me , mind you. When I came to know my father was going to have major operation my first reaction was "Is it necessary for me to come ? I will have to ask for leave". I didnt feel any happiness when my sister got married / had spectacular success in 10th exam. Same cold detached feeling.
23. Faking emotions : I myself do not have any insight how to react to any news. Hence I use terms I have heard from people in such circumstances and use them without feeling anything that those senteces convey. "I am happy for you" , "Even though you said some bad things I know it was not in your intention" , "I did all this for you" and such things which I perceive very good. None of them are mine , but I use them often robotically.
24: Frequent Crying Spells : Despite being a 24 year male , I have cried often , since my school. Sometimes sobbing almost like a school girl. Though I don't feel like it at all , in fact I have found I cant cry at all because The Girl repriminded severely me for crying at the news of her intention to end it. I don't blame her. I have used crying as an excuse with her for lots of things , even for physical contact by emotionally blackmaling her.
25. Argumentation : I am argumentative with people who care about me and like me. My parents , sister, one close friend from Bombay. Otherwise I just listen to others and don't react even if they insult me.

I am really perplexed as to what exactly is wrong with me. Adderall gives me temporary "high" but thats the end of it. Despite being on Adderall I still suffer from bad / depressed mood. I am seldom energised during the day , and when I am it takes me no time to relapse to bad mood and disinterest in everything. I excercise regularly to have better frame of mind. I do Yoga (breathing excerise) as it has soothed my anxiety to great extent. But still question remains : if wirinign in brain itself is faulty , how to get rid of root symptoms?

I am pretty sure my mother , unfortunately , suffers from some personality disorder / bipolar. But question here is me. I have been unable to achieve what I could have because of my mental problems. The thought that I seldom have is : are these problems or are these symptoms of something that is even bigger ? I want relief from all this as soon as possible. I have appointment with my school psychiatrist on 13th but I wanted some relief. Hence I am writing here. I will really appreciate quick response, as this weight refuses to go off my neck. I will graduate in this Fall 07. And I really want to know and have correct diagnosis before it is too late.

Your help is really appreciated. I don't really believe in God , but still , God bless you. Thanks for all your help and advice.
 Dr. K. Eisele - Mon Sep 03, 2007 7:38 pm

User avatar Dear Swapnil:

I think that the treatment your psychiatrist prescribed is likely appropriate. You have so many symptoms, it is difficult to really tease out what is prominent. You have a very interesting family history, which complicates the diagnostic picture even further.

Abilify is an antipsychotic medication, and you mentioned it was prescribed for you for paranoia. Abilify has been shown to be effective for this purpose.

I'm sorry I cannot help you more, but as potentially serious as your diagnosis is, I think the best person to diagnose you would be a psychiatrist who can sit down with you and talk.

Good luck!
 Swapnil - Mon Sep 03, 2007 11:20 pm

Hello Dr. K. Eisele,

Thanks for the reply. Though I am disappointed , I think I presented way too long list of symptoms. All of them are present in me but to varying degree. I have had problems with Motivation. I read somewhere about Dopamine theory of Motivation. Anyways , you said "my family history complicated diagnosis". I can almost surely say that my deceased aunt had Schizophrenia as the she was normal till her youth and all of a sudden it these symptoms appeared. But how can this complicate my diagnosis ? I am perplexed.

Also please guide me in how best to approach my School Psychiatrist , whom I will meet soon. Because I don't want to present list of all these symptoms in short time again confusing him/her.

Your help in this matter is highly appreciated.

Regards,
Swapnil
 Dr. K. Eisele - Wed Sep 05, 2007 11:57 pm

User avatar Dear Swapnil:

What I meant by your family history "[complicating] the diagnostic picture" is that you have family members with different types of psychiatric diagnoses. I should have been more clear in my reply to you.

Basically what this amounts to is that your mother has "horrible rage problems," which could be many, many different things, but probably not a psychotic disorder, such as schizophrenia. Then, there is your aunt with a psychotic disorder, likely schizophrenia. Statistically, your diagnosis would most likely be more similar to that of your mother rather than your aunt.

In addition, you are from India, which is a much different culture than that of the US, just as as the culture of China much different than yours and mine. Different cultures have different ideas, whether associated with somatic illnesses, psychiatric illnesses, spiritual/religious issues, relationships within the family, etc.

To answer your last question of how to present all this information to a psychiatrist, I would avoid altogether the use of medical terms such as "thought disorder," etc. That is because such terms imply interpretations of symptoms and/or diagnoses, not symptoms. The reason this is important is because the psychiatrist you see will not know how much you know about the definitions of these terms, and will ask you, for example, "what does the term 'thought disorder' mean to you?"

When the psychiatrist asks you, "what brings you in today?" You should mention just your symptoms. Tell him/her about the rage, feeling disconnected, sad, etc. Also make sure to bring a list of all past and present medications with you.

Good luck to you!

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