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Sorry to hear of the situation. If he isn't experiencing formal positive psychotic symptoms can you provide some information on the kinds of things you think may indicate psychotic phenomena/ a psychotic component to his condition?
The same year he came home after he stopped attending classes, he complained for some period of time about "not feeling right" and described often feeling like the room was tilted or sideways. It's like he felt the room was distorted. He was quite scared by this. It was then that he probably started dabbling at the use of certain drugs (clonazopan, risperadol, etc) on as needed basis. Eventually that feeling subsided. Since then (a few years ago), he has only had one brief day of feeling that same sensation. But about a year 1/2 ago he had a severe rage episode. It started with being angry and frustrated with moving forward in the world (some mantra about "it's all about the money" meaning since he was not making money, he was worthless) and escalated to screaming that I was not his mother. I took him to the emergency room. He was discharged but has been on a low dose of abilify ever since. It took him a few days to recover from this episode and it greatly frightened him. His pyschiatrist has never change his diagnosis. I's suspicious that there is just a feeling that adding more labels to his condition won't be helpful. Part of me agrees, part of me does not
It's good that you are aware of the potential consequences of diagnostic labels. However, in saying that it is vitally important that if he is experiencing any degree of Psychotic phenomena he be correctly diagnosed and treated in the right way (and this is no doubt why you have made this enquiry).
I agree that the various diagnostic categories don't really fit as a full explanation of the difficulties you describe. What you are telling me is that 'something isn't quite right' with the situation - I have to tell you that in my experience when parents make this kind of statement they are usually spot on.
It's impossible to make any kind of diagnosis via JustAnswer and his situation sounds complex so I wouldn't even try to comment on the likelihood of a Schizoaffective Diagnosis being appropriate in his specific case. Schizoaffective Disorder is actually quite rare and the specific unusual experiences you describe in your last post could be explained by intense anxiety (amongst other things). However, I would strongly encourage you to listen to your feeling that perhaps something is being missed here and get him assessed for a second opinion. It concerns me that he has various long standing diagnoses that have not varied at all over time, numerous medications and what appears to be considerable difficulty functioning at times.
These things suggest potential incorrect diagnosis to me.
Do you have access to getting a new Psychiatric assessment?
Yes, I have fantasized about getting another opinion. But I am afraid to just pick from the list of doctors off some list provided by the insurance. You are correct that his situation is quite complex and there are many isolated instances of one-off events that I have not described here. He has a history of psychiatric issues starting with intense temper tantrums at the age of 7. Meaning he is a little burned out on trying to find answers. The upside is that he is very self aware and understands that he ultimately must learn to manage his condition. But as you said, I know in my heart that it is important to get a correct diagnosis.
Do you have any suggestions on specialized doctors, facilities, etc in the MD/DC/VA area specializing in complex conditions such as Schizoaffective disorder.
We are unable to provide specific clinician recommendations or referrals but I would suggest you contact The National Alliance on Mental Health here. NAMI are a consumer organization that has a network of local branches that can provide a wealth of information on the kind of services offered locally. NAMI is run by individuals suffering from mental health difficulties and their family members and they are often able to provide consumer oriented recommendations regarding assessment services in specific areas.
You are right again, don't pick a random clinician offered by your insurance company. Speak with NAMI and find people who have been in a similar situation to yourself in your local area to give you personal recommendations - you may feel like you are alone in this matter but you would be surprised how many people in your local community face similar challenges.
I hope this has been of some help. Please let me know if you have further questions or you would like me to clarify any part of my answer. If not...Best of luck!