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How To Rule Out Schizophrenia?
Question: Hi D-r Solanki,
I am trying directly as reply to this , but not sure if you will get it. So in your last email you suggest My son might have a severe depression with psychotic features. Could it be also a severe anxiety, i.e. health anxiety, since he is worrying about his health condition, he feels those sensations from the head - like tension, which worsens, when he is talking with anybody, that's why he avoids talking, he talks very shortly, because he gets very sick after that, get's severe exhaustion. We communicate mostly with emails, but his emails are short too, especially now, when he has a psychosis. The diagnosis from the hospital in Bulgaria is Paranoid syndrome. Is this schizophrenia? I am not agreed with that. He doesn't have feelings of being followed, or threatened by some one, that someone is there to get him. He doesn't have this flat expression on his face, not blinking,disorganized speech , or behavior. Relatives and friends are telling me, If they don't know he has a psychiatric disease, they wouldn't notice anything bizarre. Now since he started having this psychotic features, he is extremely intolerant towards any notice, or even colors. Before he was admitted in the hospital, he had the feeling, when he was walking on the street, that the buildings are running towards him. That's how he feels psychotic. But does this mean schizophrenia? And this psychotic feeling started couple months ago. Before he did not tolerate the noise well, but wasn't that extremely intolerable, didn't have this problem going on the busy city streets. Now he comes back home exhausted. Is this schizophrenia or neurasthenia? Before he was able to work around the house, In May he changed the some of the XXXXXXX shingles on the roof of our 2 level house, working on the edge of the roof, tight to the chimney with a rope. He was reading a book, Now he had big difficulties concentrating to fill out the forms for renewals his XXXXXXX passport. He filled them, but then was anxious how he will travel with the bus to the XXXXXXX Consulate in XXXXXXX 300 km. Finally he did go but came back sick, exhorted and with vomiting. We are bagging him to come here, in USA for a treatment, he is afraid, he will get sick here. When he was in XXXXXXX hospital they did MRI and other tests, everything was normal.
And you mentioned the onset is important, for the diagnosis. It started with worrying after he graduated college for Criminal justice, and went trough vigorous tests physical and psychiatric, and other writing tests if he will get a job as police officer, if he will be able to fulfill his duties, so he started loosing sleep and with the insomnia loosing energy, feeling fatigue and feeling sick, searching on internet for some answers, and prescribing himself different diagnosis, until he started feeling neurotic, irritated from notices, his insomnia increased, he decided to go to Bulgaria to get a rest there. He didn't want to go to doctors, believing he needs a rest. Then when he worsened did go, he was diagnosed with generalized anxiety, prescribed medication, but did not follow treatment, being afraid of the strong medication. We were sending him all kind of relaxation supplements from here, Omega 3, brain support, acids,5 HTP, sleep supplements, nothing was helping. And then he became worse and gut the first psychosis, which when we brought him here, was admitted in XXXXXXX hospital and was given antipsychotic - Seroquel and some antidepressant and 3 years he was relatively O.K, did not have psychosis until now, when he tried to stop the Tewaquel Seroquel).
Sorry for the long email, but his situation is so complex, so I cannot be short. I would appreciate any thoughts about that.
Best regards
I am trying directly as reply to this , but not sure if you will get it. So in your last email you suggest My son might have a severe depression with psychotic features. Could it be also a severe anxiety, i.e. health anxiety, since he is worrying about his health condition, he feels those sensations from the head - like tension, which worsens, when he is talking with anybody, that's why he avoids talking, he talks very shortly, because he gets very sick after that, get's severe exhaustion. We communicate mostly with emails, but his emails are short too, especially now, when he has a psychosis. The diagnosis from the hospital in Bulgaria is Paranoid syndrome. Is this schizophrenia? I am not agreed with that. He doesn't have feelings of being followed, or threatened by some one, that someone is there to get him. He doesn't have this flat expression on his face, not blinking,disorganized speech , or behavior. Relatives and friends are telling me, If they don't know he has a psychiatric disease, they wouldn't notice anything bizarre. Now since he started having this psychotic features, he is extremely intolerant towards any notice, or even colors. Before he was admitted in the hospital, he had the feeling, when he was walking on the street, that the buildings are running towards him. That's how he feels psychotic. But does this mean schizophrenia? And this psychotic feeling started couple months ago. Before he did not tolerate the noise well, but wasn't that extremely intolerable, didn't have this problem going on the busy city streets. Now he comes back home exhausted. Is this schizophrenia or neurasthenia? Before he was able to work around the house, In May he changed the some of the XXXXXXX shingles on the roof of our 2 level house, working on the edge of the roof, tight to the chimney with a rope. He was reading a book, Now he had big difficulties concentrating to fill out the forms for renewals his XXXXXXX passport. He filled them, but then was anxious how he will travel with the bus to the XXXXXXX Consulate in XXXXXXX 300 km. Finally he did go but came back sick, exhorted and with vomiting. We are bagging him to come here, in USA for a treatment, he is afraid, he will get sick here. When he was in XXXXXXX hospital they did MRI and other tests, everything was normal.
And you mentioned the onset is important, for the diagnosis. It started with worrying after he graduated college for Criminal justice, and went trough vigorous tests physical and psychiatric, and other writing tests if he will get a job as police officer, if he will be able to fulfill his duties, so he started loosing sleep and with the insomnia loosing energy, feeling fatigue and feeling sick, searching on internet for some answers, and prescribing himself different diagnosis, until he started feeling neurotic, irritated from notices, his insomnia increased, he decided to go to Bulgaria to get a rest there. He didn't want to go to doctors, believing he needs a rest. Then when he worsened did go, he was diagnosed with generalized anxiety, prescribed medication, but did not follow treatment, being afraid of the strong medication. We were sending him all kind of relaxation supplements from here, Omega 3, brain support, acids,5 HTP, sleep supplements, nothing was helping. And then he became worse and gut the first psychosis, which when we brought him here, was admitted in XXXXXXX hospital and was given antipsychotic - Seroquel and some antidepressant and 3 years he was relatively O.K, did not have psychosis until now, when he tried to stop the Tewaquel Seroquel).
Sorry for the long email, but his situation is so complex, so I cannot be short. I would appreciate any thoughts about that.
Best regards
Brief Answer:
rorschach test may help in diagnosis
Detailed Answer:
Hello,
Thanks for contacting me again.
I go through your current narration as well as our previous communication.
It is good that MRI is normal.
Symptoms you have described suggest possibility of severe apprehension/anxiety about something. Sometime in such cases it is difficult to differentiate that fear is of anxiety or of schizophrenia. He is away from you and you are in contact with emails. So you are also probably cannot say what actually happening with him without observing him. Seroquel can be used in most of the psychiatric conditions and improvement with seroquel also could not clarify any diagnosis.
But yes possibility of anxiety is more and schizophrenia is very less. In such cases we used to do rorschach test to differentiate type of fear. Other option is he can be given anti anxiety medicines in from of benzodiazepine and SSRI for short duration. If he improves somewhat it is likely anxiety and if no improvement at all, possibility of schizophrenia like disorder is there.
The best thing is to ask him to come to you. Explain him that many of the medicines are safe and without significant side effects. And he can be treated and improved if problem is diagnosed correctly.
Take care.
rorschach test may help in diagnosis
Detailed Answer:
Hello,
Thanks for contacting me again.
I go through your current narration as well as our previous communication.
It is good that MRI is normal.
Symptoms you have described suggest possibility of severe apprehension/anxiety about something. Sometime in such cases it is difficult to differentiate that fear is of anxiety or of schizophrenia. He is away from you and you are in contact with emails. So you are also probably cannot say what actually happening with him without observing him. Seroquel can be used in most of the psychiatric conditions and improvement with seroquel also could not clarify any diagnosis.
But yes possibility of anxiety is more and schizophrenia is very less. In such cases we used to do rorschach test to differentiate type of fear. Other option is he can be given anti anxiety medicines in from of benzodiazepine and SSRI for short duration. If he improves somewhat it is likely anxiety and if no improvement at all, possibility of schizophrenia like disorder is there.
The best thing is to ask him to come to you. Explain him that many of the medicines are safe and without significant side effects. And he can be treated and improved if problem is diagnosed correctly.
Take care.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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