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Ralph LMHC
Ralph LMHC, Therapist
Category: Mental Health
Satisfied Customers: 872
Experience:  20+ years as therapist, supervisor, clinic director at mental health, substance abuse treatment ctrs
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I am having my diagnosis changed from complex post traumatic

Customer Question

I am having my diagnosis changed from complex post traumatic stress disorder to a disasociative disorder.
Is it curable or is it something to live with.?
I can sometimes miss up to three days and have no recollection of time.
I am agrophobic and manphobic. I have OCD, and also hear voices (15 different ones) and sometimes see a shadowy figure who is scary. I have suffered sexual and physical abuse as a child and then have two failed marriages, in which I was also abused until I was rescued 4 years ago, when I had a complete breakdown. I am 56 years old and self-harm, also attempt suicide every 2 or 3 months. My son was taken into care as I wanted to poison him and myself. I have very bad memory, and often can't remember my address. I never go to bed. I hardly sleep as I am overanxious, on guard all the time.I have restless legs syndrome and often suffer recurring nightmares.
Submitted: 4 years ago.
Category: Mental Health
Expert:  Ralph LMHC replied 4 years ago.

Hello>

 

I am sorry to hear that you are experiencing multiple emotional symptoms that are so problematic in living a fulfilling life with a minimum of symptoms. Of course you are experiencing the after effects of all the abuse. At the same time, you may be experiencing problems that result from severe mental illness (the cause of which maybe a brain disorder in its function and the neurotransmitters that make it work effectively. With the proper treatment, both medication and psychotherapy you have every reason to hope that things will improve. That is not to say that all the problems will disappear and everything will be normal. At best given the severity of the problems the best outcome that you can probably look forward to is improvement with reduced symptom, not a complete cure.

I have a number of questions in order to provide a more in depth diagnosis?

1. What diagnoses have you been given?

2. What medications are you taking now and what have you taken in the past, and to what degree has any of them helped?

3. Have you been hospitalized? How many times and when was the most recent?

4. Are you under the care of a. a psychiatrist? b. neurologists?. c. What type of psychotherapists?

5. Who is in overall charge of your care?

4. What is the most important question that you wish answered?

Sincerely,

Ralph LMHC

Customer: replied 4 years ago.

Complex post traumatic stress syndrome, coupled with depression and severe anxiety.

I currently take 14mg Diazepam a day. Bumetanide 1mg twice a day. Venlofaxine 75mg three times a day.Pramipexole dihydrochloride 250mcg (180 mcg base).Cetirizine hydrochloride 10mg once a day. Ferrous sulphate 200mg twice a day. Paracetamol 500mg up to 8 tabs per day (for frozen shoulder). I used to take citalopram and zopiclone, but they didn't help after a few months. Three months ago i was given an antipsychotic drug (can't remember the name) but it interferred with the drug for restless legs and so I am waiting for a review of my medicines. I am under the care of a psychiatrist, with a community mental health nurse and a care plan is in force. I am in art therapy for 6 weeks now. I have been hospitalised three times in the last 6 months. Once for an overdose, and twice for cutting myself severely. I want to die all the time and so I am only allowed 2 days meds at a time. My psychiatrist Eva Dietrich is in overall care of me, but my care co-ordinator has just left to go to another job. I think I will never get better and the voices are getting worse, so can I be cured? Can I take any antipsychotic which won't interfere with my restless leg meds? Right now I have murderous thoughts, but am very passive and miss my care-co-ordinator so much , I really don't feel safe or trust myself. Should I stop taking all the drugs?

Expert:  Ralph LMHC replied 4 years ago.

Hello.

 

I am going to be candid and share my thoughts and then turn it over to other experts for their input. It sounds like you are receiving excellent care both treatment and custodial care. I have looked up all your medication and it appears that only 2 are psychotropic. The diazepam for anxiety and the Venlofaxine which is a SNRI antidepressant anti anxiety. medication. The other medications are for pain, , anemia. restless leg, and anemia. There may be good reasons but you describe psychotic symptoms, but are not presently receiving an anti psychotic and psychosis appears to be the worst of your symptoms so I would ask the prescribing doctor about that. I do not believe that you should stop taking any of your medications without consulting with your physicians as the results could be disastrous.

 

So to recap you are taking at present 2 psychotropic medications and I would question why you are not on an anti psychotic. I would ask the doctors if you are experiencing in their opinion a psychotic disorder as well as the possibility of borderline personality disorder. I would continue with the CBT psychotherapy as it is proven effective in both depression and anxiety. Again, I am sorry that I could not provide you with more information and I am sending this as needs information so there is no charge and will be opting out so that another expert more familiar with your disorders will have an opportunity to respond.

 

Sincerely,

Ralph LMHC

 



Edited by TropicalMoe on 10/5/2009 at 6:17 AM EST
Customer: replied 4 years ago.

 

I am not taking an antipsychotic (dopamine something) because it reverses the effect of the restless legs tablets which is also dopamine something but does the opposite.

Thankyou for your help. Maybe one of the others will know of a different antipsychotic drug that will enable me to keep my legs under control.

Expert:  Ralph LMHC replied 4 years ago.

I certainly hope so, because the psychotic symptoms are the most pressing. I appreciate that you understand my desire to get you the best and most complete information available on the JA site. Best wishes and good luck.

Sincerely,

Ralph LMHC

Customer: replied 4 years ago.
Thankyou
Expert:  Carol Kryder LMFT replied 4 years ago.
Hello:

I agree with Ralph's answer, but was wondering if the drug they gave you for restless legs was Gabapentin (Neurontin). If so, it would probably have had a positive impact on your mood.

Please do not stop taking your drugs, that will only make things worse. I suggest you call Dr. Dietrich first thing in the morning and ask her to review your medications,and suggest an anti-psychotic for you to take that will not interfere with the RLS medication. I am sure there is one available.

Please do not give up. There are many people willing to help you. Take care.
Customer: replied 4 years ago.

TheRLS medication is Pramipexole dihydrochloride 250mcg(180mcg base) and the dose is two each evening.

I'm sorry but I can't remember the name of the anti-psychotic drug we tried together with the pramipexole, but it had the effect of acting in the opposite way to the RLS drug which meant that my legs were back as though I wasn't taking the pramipexole, and I spent hours each night pacing up and down rubbing my legs to ease the pain. Are you saying that Gabapentin would work together with the Pramipexole?

Expert:  Ralph LMHC replied 4 years ago.

Hello,

I have been giving this question a great deal of thought and all was as I explained to you in that the psychotic symptoms need to be addressed and you should be speaking to the doctor. Although Carol is correct about Neurotin helping with mood swings (I am not a physician but am quite aware of psychotropic medication) but the type of drugs usually indicated for RLS are of the Anti Parkinsonian type such as pramprexole and levodopa rather than anti seizure medications such as Neurotin which is indicated for mood stabilization which I have not heard you mention. Again, I believe as does Carole that the priority issue to be addressed is the psychosis and the appropriate anti psychotic medication to control it without worsening your RLS. So your next step should be to contact Dr. Dietrich to obtain a medication to control your psychotic symptoms. Best Wishes and Good Luck..

 

 

Sincerely,

Ralph LMHC

 

Please click green "ACCEPT" button on this page if you are satisfied with my answer so that I get credit for my work. Your positive feedback and bonuses are always welcomed. If this is a mental health, or medical emergency, please call emergency services (911 in the USA), or go to your nearest Emergency Room. The opinion provided does not replace an evaluation by an appropriate professional.

Ralph LMHC, Therapist
Category: Mental Health
Satisfied Customers: 872
Experience: 20+ years as therapist, supervisor, clinic director at mental health, substance abuse treatment ctrs
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