Category: Schizoaffective Disorder

The Psychotic Spectrum

Auditory Hallucinations, Delusions, Mental Health, Psychosis, Schizoaffective Disorder, Schizophrenia

“Psychotic” is a term that gets tossed around a lot in American culture.

To start, psychosis represents a spectrum of disorders with many different origins. People are most familiar with the term schizophrenia, but schizophrenia is probably going to turn out to be an umbrella diagnosis for many different conditions. People can be psychotic for all kinds of reasons, in the wake of substance abuse — with hallucinogens, for example— or because of schizophrenia. People who are bipolar can become psychotic, and so can people with various degenerative disorders. The interaction between biological and genetic vulnerabilities with family and cultural factors is known to be complex.

What are the chief symptoms?

The symptoms most people are familiar with are what we call positive symptoms: hallucinations, delusions, paranoid beliefs, unusual behavioral or mood manifestations. Those are often treated acutely with medications and patients respond well to that.

Once the positive symptoms have been treated, people can enter what’s called the negative phase of a psychotic disorder: lack of motivation, lack of direction, flatness. There’s a quality of just being slowed down, and a withdrawal or social isolation. This can be debilitating. It is also much harder to identify and treat. Everyone is familiar with the worst-case psychotic disorder, which is the disheveled person in the street who makes everyone anxious. That’s the more obvious, positive symptom.

People in the negative phase don’t look so disorganized because they’re not having hallucinations or delusions, but they can be very isolated and shut down. They often don’t really know what they want to do. They may feel lost and ashamed. They’ve gotten help from medication, but they have a whole other road ahead of them. How are they going to pick up the pieces of their lives, go on and adapt?

One feature of these disorders is tremendous denial that a person is troubled, or needs treatment. It can be very hard to treat someone who other people think is impaired when that person doesn’t think so. Typically, you see problems with family members, problems in employment. These individuals see themselves in the world quite differently, and often aren’t interested in receiving any treatment. This creates a lot of frustration in attempting to offer help.

Sources: Austen Riggs Center

A Few Facts About Schizophrenia

Mental Health, Psychosis, Schizoaffective Disorder, Schizophrenia

~ It is estimated approximately 50% of patients with schizophrenia do not take their prescribed medications as directed. The most common reason is anosognosia, meaning they are unaware of their condition.

~ Lack of treatment leads to severe negative health outcomes, including a life expectancy shortened by an average of 28.5 years. 

~ Approximately half of individuals with schizophrenia have co-occurring mental or behavioral health disorders.

~ Co-occurring medical conditions such as heart disease, liver disease, and diabetes contribute to the higher premature mortality rate among individuals with schizophrenia.

~ Following illness onset, 25-50% of those living with schizophrenia attempt suicide.

~ At least 50% of people with severe psychiatric illnesses like schizophrenia smoke, compared to 23% of the general population. 

~ Smoking-related illnesses cause half of all deaths among people with psychiatric disorders. 

~ Those diagnosed with schizophrenia smoke more than half of all cigarettes produced in the United States, and they are only half as likely as other smokers to quit.

Types of Delusions

Delusions, Mental Health, Psychosis, Schizoaffective Disorder, Schizophrenia

1) Collapse delusion: A transient condition that occurs frequently in acute illnesses, coinciding with the cessation of febrile states; 

2) Reference delusion: The patient attributes a special meaning to objects, events or people close to him; 

3) Touch delusion: It consists in the excessive mania of touching certain objects; 

4) Nihilistic delusion: It is found in melancholic depressions, and is made up of an incoherent mass of negative ideas; 

5) Oneiric delusion: It consists in a disturbance of the conscience that leads to emotions similar to those present in the oneiric phase (the conscience of the disturbed person enters a phase such that it is unable to distinguish reality from the oneiric profile of itself); 

6) Professional or occupational delusion: It consists in recreating, on the patient’s part, the usual conditions and places of work; 

7) Residual delusion: Represented by the persistence of delusional representations at the level of thought, even after the perturbation has ceased; 

8) Interpretative delusion: The subject interprets random facts as facts linked to him, feeling that he is the main actor or feeling indicated as a party in the case; 

9) Persecution delusion: The patient believes he is the object of persecution (a situation often identified also with the term paranoia); 

10) Bizarre delusion: The patient adheres to a system of totally implausible beliefs (in the culture of reference); 

11) Control delusion: The patient is convinced that his thoughts or emotions are under the control of some external force; 

12) Insertion delusion: Similar to the previous one; the patient is convinced that some of his thoughts are imposed on him by an external force; 

13) Erotomanic delusion: The patient is convinced that a certain person (often a celebrity) is secretly in love with him; 

14) Jealousy delusion: The patient has the unfounded and obsessive belief that he is betrayed by his partner. Among delusions, it is the most frequent; 

15) Delusion of grandeur (megalomania): The patient has the conviction that he is extremely important, for example, that he has been chosen by God to carry out a mission of fundamental importance, or that he is the only holder of extraordinary knowledge or powers; 

16) Somatic delusion: The patient is convinced that his body has something unusual, such as a rare disease, some kind of parasite or an unpleasant smell; 

17) Religious delusion: The patient is convinced that religious forces (almost always belonging to his own religion) protect him from misfortune, or from a disease (real and existing); 

18) Identity delusion: He who is affected believes he is another person, often important people such as Kings, Princes or Presidents.

Schizoaffective Disorder: What are Hallucinations?

Auditory Hallucinations, Mental Health, Psychosis, Schizoaffective Disorder

Hallucinations are a psychotic symptom of schizoaffective disorder. People experiencing hallucinations may hear, see, smell, taste or feel things that aren’t really there, and which other people can’t hear, see, smell, taste or feel.

Auditory hallucinations are the most common type of hallucination. They are mostly experienced as voices. To a person with schizoaffective disorder, these voices sound just like people speaking to them, and people with the illness cannot differentiate between what is real – for example a friend speaking to them – and what is a hallucination.

Voices might be heard in the second person – for example someone saying “you stink”, “you’re ugly”, “they hate you”. Sometimes voices might command a person to do something – by saying, for example, “jump off the bridge”, “take an overdose”. People with schizoaffective disorder may also have third person hallucinations, which commonly take the form of two or more voices talking among themselves or commenting on the person’s behaviour. Third person hallucinations are common in both schizoaffective disorder and schizophrenia, but are seen less frequently in bipolar disorder.

In most cases the experience of auditory hallucinations in the form of voices is unpleasant. Voices are frequently accusatory, reminding the person of past misdeeds, some imaginary, and some real. However, in a minority of cases, voices can be pleasant or even helpful.

In addition to voices, auditory hallucinations can involve noises, such as buzzing, screeching and ringing. Additionally, people with schizoaffective disorder may think that their own thoughts are being broadcast, or can be heard by other people. They may also think that other people’s thoughts are being forced into their own minds, or that their thoughts have been stolen from their heads.

Hallucinations of all five senses may be experienced. In addition to auditory hallucinations, people may have tactile hallucinations – such as feeling as though you are being pushed, touched or held down – visual hallucinations – such as seeing things that aren’t there or feeling that colours are brighter than they should be – hallucinations of smell and hallucinations of taste.

Visual hallucinations occur much less frequently than auditory hallucinations, and are more common in conjunction with auditory hallucinations – for example seeing and hearing someone who no one else can see. Hallucinations of smell and taste are more unusual and tend to focus on things tasting or smelling different than usual. This can lead to people with schizoaffective disorder thinking that their family and friends are trying to poison them.

Sources: Schizoaffective Disorder Simplified

Schizoaffective Disorder and Atypical Depression

Atypical Depression, Depression, Mental Health, Schizoaffective Disorder

People with schizoaffective disorder, like those with bipolar disorder, may experience depression differently from people who have unipolar depression. It is common for people with schizoaffective disorder to experience atypical depression, which means that instead of experiencing insomnia, loss of appetite and being sad and tearful, which are common with typical depression, people feel the need to eat and sleep more and tend to feel very flat and slowed down when they are depressed. Other hallmarks of atypical depression are fatigue and being sensitive to rejection.

Not being able to feel
A lot of people with schizoaffective disorder experience what they describe as an absence of feeling as part of depressive episodes. This is sometimes also described as feeling flat or empty.

Not caring about anything
People suffering from depression often state that they are unable to care about anything, even things that used to be important to them.

Losing interest and motivation
People with schizoaffective disorder frequently experience a loss of interest in, and motivation to do, things. The things that they used to enjoy don’t give them pleasure any more.

Feeling tired and drained of energy
It is common for people experiencing an episode of depression to feel tired all the time. Some people have described this as feeling as though they have just run a marathon and have no energy left.

Feeling worse at particular times of the day
People experiencing an episode of depression may find that they feel worse at particular times of the day. For some people, mornings are worse, whilst for others it is during the evening that they feel worse.

Feeling worthless
People with schizoaffective disorder who are depressed often suffer from feelings of worthlessness. Their self-esteem drops considerably, leaving them lacking in confidence and feeling as though they are useless. Depression can make people forget about their strengths and make them only focus on their weaknesses.

Feeling guilty
Guilt is a very common problem for people experiencing an episode of depression. People tend to feel excessive guilt for minor mistakes and normal human errors.

Becoming more sensitive
When people are depressed they tend to become much more sensitive to both criticism and rejection.

Irritability
It is common for people experiencing depressive or mixed episodes to become much more irritable than usual.

Feeling hopeless and helpless
It is very common for people experiencing depression to feel extremely hopeless about the future and helpless because of feeling unable to change the way they feel.

Feeling worried and anxious
Worry and anxiety are common features of depression. Anxiety can be very disabling for some people. It can be ‘global’, where everything is a worry, or specific, where anxiety is focused on certain things, for example physical health.

Feeling lethargic
Lethargy, feeling tired, slowed down and unmotivated, is a common symptom for people experiencing episodes of depression. Lethargy can make people talk much slower than usual, use shorter sentences and move around more slowly. In severe forms, lethargy can make it difficult for people to get things done – or even to get out of bed.

Withdrawal and avoidance
It is common for people suffering from depression to withdraw from the things that they used to enjoy doing. They may also start to avoid social situations and turn down invitations from friends.

Thinking negatively Everyone can think negatively from time to time, but depression has the potential to make people think negatively all the time, or the majority of time. Rumination about past failings is also common in depression.

Sluggish thoughts
One of the hallmarks of depression is the way that people feel as though their head is full of fog. This causes them to have difficulty remembering things or concentrating on things a lot of the time. It can also make decision making and planning very difficult.”

Sources: Schizoaffective Disorder Simplified by Martine Daniel

Paliperidone (Oral Route)

Medications, Mental Health, Psychosis, Schizoaffective Disorder, Schizophrenia

Brand names:

  • Invega
    • Extended-release tablet: 1.5 mg, 3 mg, 6 mg, 9 mg
  • Invega Sustenna
    • Extended-release injectable suspension: 39 mg, 78 mg, 117 mg, 156 mg, 234 mg

Generic name: paliperidone (pal ee PER i done)

Paliperidone is a medication that works in the brain to treat schizophrenia and schizoaffective disorder. It is also known as a second-generation antipsychotic (SGA) or atypical antipsychotic. Paliperidone rebalances dopamine and serotonin to improve thinking, mood, and behavior.

What Should I Discuss With My Healthcare Provider Before Taking Paliperidone?
  • Symptoms of your condition that bother you the most
  • If you have thoughts of suicide or harming yourself
  • Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
  • If you ever had muscle stiffness, shaking, tardive dyskinesia, neuroleptic malignant syndrome, or weight gain caused by a medication
  • If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require changes in the medication.
  • Any psychiatric or medical problems you have, such as heart rhythm problems, long QT syndrome, heart attacks, diabetes, high cholesterol, or seizures
  • If you have a family history of diabetes or heart disease
  • All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have
  • Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
  • If you are pregnant, plan to become pregnant, or are breast-feeding
  • If you smoke, drink alcohol, or use illegal drugs

Paliperidone tablets are usually taken 1 time per day with or without food.

Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.

The dose of the tablets usually ranges from 3 mg to 12 mg. The dose of the Sustenna brand of long-acting paliperidone injection formulation usually ranges from 78 mg to 234 mg every month. The dose of the Trinza brand long-acting paliperidone injection formulation ranges from 273mg to 819mg every 3 months. Only your healthcare provider can determine the correct dose for you.

The tablets should be swallowed whole. They should not be chewed, crushed, or broken.

What Are Possible Side Effects Of Paliperidone?

Common side effects:

Tachycardia, drowsiness, extrapyramidal symptoms, restlessness, headache, increased prolactin, cholesterol abnormalities, increased glucose, vomiting, tremor.

Rare/serious side effects:

Paliperidone may increase the blood levels of a hormone called prolactin. Side effects of increased prolactin levels include females losing their period, production of breast milk and males losing their sex drive or possibly experiencing erectile problems. Long term (months or years) of elevated prolactin can lead to osteoporosis, or increased risk of bone fractures.

Some people may develop muscle related side effects while taking paliperidone. The technical terms for these are “extrapyramidal symptoms” (EPS) and “tardive dyskinesia” (TD). Symptoms of EPS include restlessness, tremor, and stiffness. TD symptoms include slow or jerky movements that one cannot control, often starting in the mouth with tongue rolling or chewing movements.

Temperature regulation: Impaired core body temperature regulation may occur; caution with strenuous exercise, heat exposure, and dehydration.

Second generation antipsychotics (SGAs) increase the risk of weight gain, high blood sugar, and high cholesterol. This is also known as metabolic syndrome. Your healthcare provider may ask you for a blood sample to check your cholesterol, blood sugar, and hemoglobin A1c (a measure of blood sugar over time) while you take this medication.

Schizophrenia and Trauma

Mental Health, PTSD, Schizoaffective Disorder, Schizophrenia, Trauma

Trauma and psychosis can each derail a person’s daily life by causing mental and physical disturbances which significantly disrupt even basic day-to-day functioning and skills. When experienced together, they can wreak emotional and mental havoc if left untreated.

When the onset of a psychotic disorder like schizophrenia happens to occur after a traumatic event, it can be tempting to blame the development of the former on the occurrence of the latter. Causality is comforting, in a way—being able to answer the larger question of why your loved one is living with the symptoms and challenges they currently face is somehow less daunting than having no answer at all.

What causes Schizophrenia?

Scientists identify a variety of causes and risk factors for schizophrenia. Research shows the disorder is brought on by a combination of neurological, genetic and environmental factors, including life experience. Schizophrenics have an imbalance of the neurotransmitters dopamine and serotonin in their brains, which is why they are often prescribed antipsychotic drugs. There may also be a genetic component; the risk factor of one person developing schizophrenia goes up if other close blood relations have been diagnosed with it.

Other factors which play a part in the development of schizophrenia include psychoactive drugs, such as methamphetamines or LSD. These drugs can cause brain damage, psychotic episodes, or trigger a schizophrenic onset.

Childhood factors may also affect onset and development. Fetuses exposed to malnutrition or viral infections in the womb may have a higher chance of getting schizophrenia. And childhood trauma can significantly change how children’s brains and thought processes develop and affect their adult lives.

Can trauma cause Schizophrenia?

While the jury is still out on whether trauma directly causes schizophrenia, according to research conducted by the University of Liverpool, children who experienced trauma before the age of 16 were about three times more likely to become psychotic in adulthood than those who were randomly selected. The more severe the trauma, the greater the likelihood of developing illness in later life. They even found indications that the type of trauma experienced may determine what specific psychotic symptoms will manifest themselves later on.

It is also certainly true that trauma which occurs after the onset of schizophrenia can exacerbate psychotic symptoms—especially if it leads to the development of a co-occurring trauma disorder, such as PTSD. Separately, these conditions can pose serious challenges to a person’s ability to live a “normal” life—together, they can become overwhelming and debilitating without proper care and support.

Source: BrightQuest

On Schizoaffective Disorder

Auditory Hallucinations, Delusions, Mental Health, Psychosis, Schizoaffective Disorder

On Schizoaffective Disorder & Hallucinations:

“I awoke, went to drink a glass of water and walked back toward my room. I stopped dead in my tracks. My room was red and four cloaked figures floated above my bed with fire circling around them. Inside of the cloaks was a black abyss and I knew they had come for me. As long as I stayed out of my room they wouldn’t see me. I stared at them for what seemed like an hour before they went away. I slept on the couch that night.”

~ Thomas Wallingford, The Mighty Contributor

#MentalHealth #SchizoaffectiveDisorder #Hallucinations #EndStigma