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Date of last update: 8/24/2017.

Forum Name: Psychiatric Topics

Question: about re-diagnosis of "high functioning schizophrenia"

 col_n_99 - Mon Jul 19, 2010 3:30 am


Years ago, with some justification (unusual thoughts & behaviour) I was diagnosed as having schizophrenia - now it is described as high functioning schizophrenia.

I think the truth is that way back when I was an idealistic youth I think I suffered PTSD (from 1978) from my involvement with a crackpot cult (political) - they overworked me, psychologically abused me, and finally rejected me (from about 1980) - my loyalty to this crackpot cult remained until 1998.

Closer to 1978 I couldn't get past certain traumatic events – constantly reliving them in my mind - and then later, for some years, I tried to re-live the past, re-establish my cred with the cult (political), be a success in the cult (political) - but gradually it all means nothing to me now - and I've been building a new life, especially since 1998, a new life of education, prospective family, employment, business ideas.

Also I smoked marijuana from 1975 to 1998 - at first recreational, then as self-medication to relieve the side effects of psych medication. I think a lot of my problems were also from immaturity, like youthful mistakes. Also my family is very working class, no middle class knowledge and sophistication, no money for private doctors, no power – when I left home I was like a lamb to the slaughter, quite ill-prepared and naive.

Since 1998 I have 2 uni degrees (one was started before 1998), and I'm over half way thru a third. I have also had a part-time job since 2007 - marking and tutoring at uni level.

But now, career wise and family wise (for my kids one day; I am now engaged for the third time) - and if accurate - I really need a re-diagnosis, something like that, to something less socially detrimental, like PTSD or Borderline Personality Disorder.

Any advice on this?

A few years ago I discovered and began to practice cognitive behaviour therapy (as best I could; learned outside of state psychiatry, through radio and reading), and together with a deliberately cultivated quieter, more reclusive, and more productive lifestyle, this has resulted in virtually zero trouble and complaints.

I'm not seeking a reduction in my medication (risperdal 2mg daily) - and I don't deny I had mental health problems in the past - at least - and I don't deny that some underlying condition (or another) might persist (and I don't deny this might be schizophrenia).

But I wonder if it’s possible that my condition should properly, or can properly, be re-diagnosed as something that is (1) more accurate, and (2) less alarming, and less socially detrimental—(PTSD or Borderline Personality Disorder are two possibilities that I have encountered—possibly there are others)

My life is blossoming, after years of no trouble or complaints, and high productivity – with education, marital engagement, job, and further career prospects - can you advise on this question of "re-diagnosis".

Being labeled is detrimental for anyone, but I'm not sure if my old diagnosis is still accurate.

If possible, I'd prefer a reply from a psychiatrist.
 Faye Lang, RN, MSW - Mon Jul 19, 2010 3:28 pm

Hello, col_n_99,

I have worked with many persons having the diagnosis of schizophrenia, as well as many other adults with serious mental health conditions. Although I am not a psychiatrist, I can help provide some information for your consideration.

First, I'll review schizophrenia. Symptoms show up as abnormal interpretation of reality, and can include delusions, disorganized thought processes and behavior, and the condition tends to deteriorate over time. The person may gain some stability in their older years, but the condition remains chronic and lifelong. Common effects are loss of interest in daily living and loss of ability in performing the usual activities of daily living. The person shows descreased emotions, poor personal hygiene, short attention span, memory issues, and problems comprehending information. The person often has up and down mood swings, which leads to social isolation. Suicidal thoughts are common.

The Diagnostic and Statistical Manual prepared by the American Psychiatric Association is the standard by which symptoms for any mental condition are measured and the condition diagnosed. In order to establish a diagnosis of schizophrenia, the evaluator would first rule out a substance abuse diagnosis, other mental health disorders or a medical condition that might produce similar symptoms. Then, the person must have at least 2 of the common symptoms (delusions, hallucinations, disorganized speech, disorganized behavior, or catatonia) in any combination. These symptoms must be present for a significant portion of time for at least one month. The person must also demonstrate significant impairment in the ability to work, attend school or perform normal daily tasks for at least 6 months. There are subtypes of schizophrenia, with the most common being Paranoid, Catatonic, Disorganized, Undifferentiated and Residual. All are serious diagnoses involving significant combinations of the symptoms I've list above.

Treatment of schizophrenia is most effective with a full team approach by psychiatrists, psychologists and social workers, plus anti-psychotic medications. The treatment focus is to build social skills, involve family therapy, vocational rehabilitation and supported employment, and individual therapy. Assertive Community Treatment teams have been developed specifically to work with those having the diagnosis of schizophrenia. Related diagnoses may be schizotypal personality disorder, schizoaffective disorder, and schizoid personality disorder. All include social avoidance.

Your letter is well organized and demonstrates coherent thinking. Your educational pursuits also demonstrate social ability and intellectual organization. You report having 1:1 personal relationships that have had some success. Your past history of substance abuse may be significant. A case could be made for a diagnosis related to social adjustment and personality issues. Anyone with any diagnosis is justified in seeking clarification of its accuracy, and you appear to be at that point, regardless of any social stigma attached to your current diagnosis. Discuss your concerns in detail with your psychiatrist and/or therapist, and request a re-evaluation. A complete battery of psychological testing would help clarify your strengths and indicate an appropriate diagnosis, whatever it may or may not be. Perhaps a second opinion would be useful.

I hope this information is helpful to you, and I wish you good luck.
 col_n_99 - Tue Jul 20, 2010 12:00 am

Hi Ms Lang, Faye,

Your reply makes sense, very helpful, thank you.

If possible, I'd really appreciate an opinion from a psychiatrist (doctor) - that would/could give me added confidence as I seek a review/further opinion in my home city.

Thanks, from col_n_99.

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