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Dr-A-Greene, Psychologist
Category: Mental Health
Satisfied Customers: 298
Experience:  Clinical and Forensic Psychologist
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Dear Psychiatrist I need to know the best treatment for

Resolved Question:

Dear Psychiatrist

I need to know the best treatment for early psychosis with comorbid OCD (OCD diagnosed, early psychosis not but I know that I have it). I am a 33yo usually functioning male who developed sleep apnea about 2 years ago. It was untreated till about 1 1/2 months ago. Ever since I have been on CPAP treatment I believe that I am developing early psychosis.

My symptoms are,

(this is started with depersonalisation and anxiety/ocd)

Tired all day, terrible memory and concentration, racing thoughts with random images and sounds even when not anxious, anxiety from the thoughts, racing thoughts, depression, thought stopping, confused thinking sometimes, feels like my personality is fragmented or split in my mind, weird nonsense thoughts that make me worry that I am being controlled or I am an automaton, weird thoughts about the nature of time and SEVERE introspection. I have to fight the thoughts to stop believing them. I feel like I am in a trance state. The worst thing is my high suggestibility at the moment, I read something and can't tell it from reality or fiction without really trying. I have many delusions of reference that I have to fight to not believe (ie I hear a song on the radio and think it is giving me a message, certain objects that I see mean things to me when they have nothing to do with anything etc)I have been off work for 1 1/2 months now and am not improving. Even when trying to distract myself my mind races about this and I cannot stop it. My memory is so bad right now that I put something down 2 minutes ago and forgot where I put it. I have severe brain fog. I am also less aware of my surroundings.

Another example of being suggestible and almost believing a delusion I had - I read about possession on the internet and likened it to my symptoms. All of a sudden I was obsessed that I was not controlling my body although I KNEW I was. My introspection zoned in on the habitual nature of the body and I was deluded into thinking I did not act when I did I had panic whenever I thought this.

I KNOW that there is some sort of minor early psychosis mixing with my anxiety and OCD. It is making everything worse.

I have the thought disorder and thought stopping and bizarre constant thinking but I am rational enough to stay in control. I do not have auditory or visual hallucinations or COMPLETE delusion but I have the rest of it.

The only thing I can do right is drive and still function but it is difficult, and people say I act normal like my wife so she doesn't know what I am going through and it is difficult to get help because my behavior (which is well controlled) is always calm and collected.

The weirdness is getting worse and I need pharmacological help to stop it. I am on 50mg's of Zoloft sertaline (down from 100mg and it hasn't done anything so my GP told me to slowly ween off it and try prozac, I still had all these symptoms on 100mg's for a month).

Also can CPAP use cause psychosis?

What drug(s) and dosage do you recommend to stop the early psychosis that I can recommend to my GP that will bring this under control? Also what are my chances of recovery? Do I have hope and with the right treatment will my cognitive abilities come back and my sense of self restored?
Submitted: 4 years ago.
Category: Mental Health
Expert:  Dr-A-Greene replied 4 years ago.

Dr-A-Greene :

Can I ask what your background is? You sound relatively well-educated on some of the syptoms you are experiencing and are using the correct terminology?

Dr-A-Greene :

Okay - well, I didn't hear back from you and I want to open the question up again to others. Just know that the correct medication regimen can do wonders for both anxiety disorders and psychosis (if that is what's going on with you). It will take more than an SSRI though. Possibly a combination therpay with an SSRI like Paxil and an anti-psychotic like Seroquel or Olanzapine. That said, the medication and your therapy should be administered by a psychiatrist in person rather than a GP. That might be the root of the problem right there.

Dr-A-Greene :

Best of luck!

Customer: replied 4 years ago.
I just missed you! I was on another page, can you reopen the question?
Customer: replied 4 years ago.
I think she's gone, can someone else please help me with my question?
Expert:  Dr-A-Greene replied 4 years ago.
I'm still here - where would you like to start?
Customer: replied 4 years ago.
Hi Dr Greene,

My background is I am an electrician, but suffered from severe mental health issues since I was a child. I was but on dexamphetamines when I was 4yo for ADD and taken off again when I was 12. I developed OCD and know alot about psychiatry and the mind because I have seen LOTS of psychologists and psychiatrists as a child. During the past 3 months in crisis I have been researching what could be wrong with me (my knowledge of the mind isn't helping me because my OCD automattically scans functions of my brain and mind, it is scary, the thoughts have degraded somewhat into sometimes nonsense, and this causes anxiety as well. If it wasn't for my education in psychiatric problems I think I would be delusional now because I can refute delusions of reference straight away although my mind ponders them for a short period. Is that enough info?
Expert:  Dr-A-Greene replied 4 years ago.

Yes, thank you. Well, first off - I wouldn't expect a CPAP to cause psychosis. In fact, I would expect the opposite. There have been multiple studies documenting that not using the CPAP machine can cause psychotic or manic symptoms to develop in vulnerable individuals. I could find only one study of a CPAP exacerbating psychotic symptoms and it was a case study of a known schizophrenic. So, I hope that answers your first question.

As for stopping early psychosis, there is no way to definitely stop it, no. Additionally, since the symptoms have existed for 2 months, but less than 6, you wouldn't be classified with a bonified psychotic disorder like Schizophrenia yet. We would likely be in a wait-and-see scenario. Even though you experienced some symptoms years ago, we would be looking for consistent symptoms over time. If they persist for longer than 6 months, a true diagnosis could be given.

More to type - I want to post this first...

Customer: replied 4 years ago.
Okay no worries, I presume I have to reply for you to continue?
Expert:  Dr-A-Greene replied 4 years ago.

No, sorry - it keeps erasing before I can post. *sigh*

Okay, so if you are diagnosed, an SSRI (like Prozac) and an atypical antipsychotic medication will likely be prescribed to treat both the symptoms of OCD and the hallucinations and delusions.

Once a regimen has been perfected and individualized, it should be very effective. Many people who take these meds are indistinguishable from those who don't. The trick is working with a psychiatrist who can tweak things to lessen the side effects and boost the effectiveness so that its just right for you.

As for your cognitive abilities (which are obviously very good), I wouldn't expect them to diminish.


That said, have you been checked for all potential medical causes first?

Customer: replied 4 years ago.
I am getting checked out now because I am sure there is a physical element involved. I had slightly abnormal liver function and my blood gas test was borderline strange with some abnormalities. It has been shown in a blood test that I am chronically low in Vitamin D. I think my level was 33mml or something and <60 is considered deficient and <30 is considered chronically low. My white cell count was slightly raised also. That is all I can remember. I have the tests all in a PDF if you want to see them. Could this have a physical element?
Expert:  Dr-A-Greene replied 4 years ago.

Absolutely! I would want to be sure to rule out all physical causes of your symptoms first and there are definitely quite a few physical maladies that could cause problems. Low vitamin D could indicate a thyroid problem. Hypothyroidism is linked to psychotic symptoms and hyperthyroidism is linked to manic symptoms. I always want to rule out a thyroid condition first. The white cell count being raised could be nothing, but it could be indicative of an infection. Other vitamins that can affect brain function are the B vitamins - chronic deficiency of B12 can result in psychosis.

Elevated blood ammonia and liver disease can also mimic psychosis.

I would go over all these results with a qualified psychiatrist or other MD in person to see what they think and what other tests need to be run before jumping to the conclusion that it is purely psychiatric.

Expert:  Dr-A-Greene replied 4 years ago.

I know it may sound like an arduous process, but I would hate to see you medicated for a psychotic disorder when it was all physical to begin with.

Always be wary of shrinks who just want to give you meds without taking a close look at your physical medical charts!

Customer: replied 4 years ago.
Dr Greene thank you so much, I have a feeling something is a bit out and is stuffing my brain chemicals chronically. One last question then I shall accept, how do I convince my GP for an ammonia test? I am in a small town and the GP here never changes his mind. If it is anxiety it is anxiety he says but he is not the one suffering this hell.
Expert:  Dr-A-Greene replied 4 years ago.

Hmmm - good question. You could tell him that you have a history of having Reye Syndrome as a child (due to your mother giving you aspirin)...Of course I'd say that only if its true...Wink


Best of luck to you - I really hope this helps some. Please ask if you have more questions!

Take care,

Dr. G.

Customer: replied 4 years ago.
Okay one more, I feel so guilty asking one more you are the best DR I have found on JA. I have been given Zyprexa by my GP and she said *if I like* I can take half a tablet of the minimum dose, it won't hurt in the mean time while I wait for tests?
Expert:  Dr-A-Greene replied 4 years ago.
No guilt! That's what I'm here for! I think it would be alright if your GP says it is. It won't affect future tests and if he thinks it will be alright on your liver, then go ahead. It might give you some well-deserved relief!
Dr-A-Greene, Psychologist
Category: Mental Health
Satisfied Customers: 298
Experience: Clinical and Forensic Psychologist
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