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Experience:  Clinical and Forensic Psychologist
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i just got out of the psych hospital for psychosis nos. it

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i just got out of the psych hospital for psychosis nos. it was very helpful as i am no longer psychotic.

FYI: The only reason the last answer was 'closed' was because i couldn't get to the Expert's answer. I didn't have any difficulty retrieving prior answers.

i had been seeing mice everywhere, as well as insects. i also believed that they were altering important components of my car that affected how it drove. i believed that they had switched out the passenger and driver's seat. i saw huge packages of itty bitty babies that they were leading to nest inside my furniture. if i interfered a large mouse would growl like a pit bull at me. i thought they were inside food packages and getting into the refrigerator and my clothes. it was absolutely terrifying! My psychiatrist, psychologist and a friend persuaded me to go to the hospital. anyway, at the hospital they changed my medication. they said that my severe anxiety over cleaning my disastorous house triggered the episode. my current meds are: klonopin, propranolol, seroquel, lamictal and latuda. they discontinued lithium, reduced seroquel, increased propranolol and added latuda. i may be bipolar, but it is somewhat unclear. i do have ptsd and gad. what do you think about the anxiety explanation. also, i have a 3/15 appointment with the psychiatrist. i'm going to ask her to discontinue the seroquel. do you think i have a chance that she'll agree? I'm only on 150 mg of it. I feel like I'm on too many meds. The Seroquel makes me gain weight [45 lbs in 4 to 5 months]. I`m also pretty unsteady on my feet. [Thanks in advance.]

For the record i have never prior to this episode had a hint of altered perceptions - much less psychosis! I an on disability but use to practice international patent law. It is unfathomable how I've fallen so far.
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr-A-Greene replied 2 years ago.

Hi hon -

I hesitated on responding to this question because there was just so much information there! But I've read it a few times and feel like I'm ready now. You mentioned that you didn't have altered perceptions before. It's interesting to me that this would be the case (age 47 is older than expected for a psychotic break). However, Bipolar I Disorder and PTSD can both have occasional psychotic symptoms if the mania or stress becomes too great. So, don't let the label of "Psychotic Disorder NOS" freak you out too badly. "NOS" means "Not Otherwise Specified" (which basically means we don't know). Once your psychiatrist or other treating clinicians get some more time assessing the situation, the diagnosis may change to something that makes more sense to you. I think that's where the stress explanation comes in.

As for decreasing the Seroquel, there's a fair chance. As long as you've been stabilized on the Latuda and it seems to be working for you, your psychiatrist may go along with a reduction. Stick with it for the time being and monitor your thoughts for any return of the altered perceptions. Keep your stress level down if possible too.

 

Once everything is under control, you'll be able to hone the diagnosis a bit - maybe it's Bipolar and the Lithium stopped working for you, hence triggering a mania with psychotic features. Or, maybe it's the PTSD and exposure to recent stress caused the paranoia inherent in PTSD to overact a little, affecting your perception. Regardless, it will get more manageable and you'll be able to get your meds worked out to where they work for you. Don't rush the transition and listen to those around you that care for you. They're your best barometer of what's happening right now. Give yourself time to adjust and once you have, you can start conquering the world again.

Take good care,

Dr. G.

Customer: replied 2 years ago.
Dear Dr. G.,

Thank you so much for your 'on target' and helpful answer! I think you're right that I need to transition slowly and listen to my friends and loved ones - even my 11 year old daughter who has casually offered some reality testing.

My psychologist, Janet, was also very surprised that this happened at 47 yo for the first time.

In terms of monitoring myself, will I have insight that I'm becoming or are psychotic?

My psychiatric intern, Dr. J, told me on the phone that she thought I was manic w/psychosis.The hospital told me that they didn't think I was manic. When they increased my Klonopin from 0.5 tide plus one prn, to the same regimine at 1.0 mg I had to tell the med nurse that I was falling asleep. The point being that I don't think I was manic or i wouldn't have been so tired.

It is hard to slow down and rest as a single mother. I had been depressed for over a year before this psychotic break. I am trying to make everything as normal as possible for my daughter.

Oh, a dear friend is helping me clean my house which i think my beginning to work on was a trigger for the psychotic break. It was so overwhelming and seemingly hopeless. It is emotionally exhausting for me to work with her on, but she is going out of town Friday so tomorrow is our last day to work on the house. My daughter is having a friend over Saturday - a self-imposed deadline :(

I sure do hope I can get off the Seroquel when I see Dr. J on 3/15. She's out-of-town now, but the doc on call said I could go ahead and drop down from 150 mg to 100 mg. That was somewhat encouraging.

You're awesome! Thank you so much for making the effort to get through my question. Can I write you again sometime? Sara
Expert:  Dr-A-Greene replied 2 years ago.

Dear XXXXX,

Of course you can! I would love to hear from you and see how you're doing. Also, I'm really glad that they were able to decrease the Seroquel for you. It can be so sedating and the side effects can be a lot to handle. Interesting what you said about the Klonopin too - I agree that it seems unlikely that you were manic if you were falling asleep like that. The other possibility that I didn't mention before was Major Depressive Disorder, with Psychotic Features. If depression gets bad enough for some people, psychotic features can pop up.

One more thing to consider (and then rest!) - but if you haven't been to see your OB-GYN lately, you might want to think about it? Although very rare, menopause (it would be quite early in your case) or a major fluctuation in hormones could trigger psychotic symptoms too. Getting your hormone levels checked couldn't hurt.

 

Overall though it sounds like you are coping well and listening to the people around you. Don't worry about not knowing that you're having symptoms. If you continue to use your loved ones for occasional reality checks, it won't sneak up on you.

Take good care,

Dr. G.

Dr-A-Greene, Doctor
Category: Mental Health
Satisfied Customers: 190
Experience: Clinical and Forensic Psychologist
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