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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10547
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I have been having thoughts of setting myself on fire

Customer Question

i have been having thoughts of setting myself on fire shooting and stabbing thoughts. I currently take prozac 120mg and latuda 80 mg im being switched to risperadal ive been taking prozac since november and latuda since september. thoughts are not changed they are all day with severe intensity the only thing that gives me relief is sleepping with klonopin. what does this sound like and what would you recommend. i have thoughts images and urges all of my waking hours and it feels like i will act on my urges
Submitted: 10 months ago.
Category: Mental Health
Expert:  Dr. Z replied 10 months ago.

*This website DOES NOT constitute treatment and only provides information and advice in a Q&A format. For treatment (therapy and/or medications) you must go to a licensed professional in your area. Please note that anything said here is not private or confidential, as this is a public forum.

Hello and thank you for using JustAnswer. I am very sorry that you are having these intrusive and violent thoughts, I can understand how distressing this can be. I would like to ask a couple questions...when you take Klonopin the thoughts significantly lessen? And you have never actually acted on these thoughts, correct?

Customer: replied 10 months ago.
the thoughts dont lessen with klonopin i take it for sleep ive never acted on thoughts except i had a phone charger once around my neck and a knife to my chest for a second that i took away
Customer: replied 10 months ago.
i always get thoughts of hurting myself and others
Expert:  Dr. Z replied 10 months ago.

Thank you for your response. It sounds like the primary diagnosis is going to be Harm OCD, which means that you have repetitive, unwanted, and intrusive thoughts of hurting others. Individuals with OCD as severe as this typically will never act on these thoughts, so that is reassuring. The other possibility is that these intrusive thoughts could be related to a Psychotic Disorder, although I doubt it because you are not hearing voices, as these are actually just thoughts, also you have not fully acted on these thoughts which is no typical for a Psychotic Disorder as these individuals do act on these thoughts. I do want to mention that you are taking an overdose of the Prozac and if it has not helped you than your doctor should consider switching you to Luvox, which is more effective for treating OCD, and you can combine it with Anafranil, which provides a very good regimen for treating OCD. The Risperdal can help lessen OCD, but it also helps to lessen violent and aggressive impulses. Most likely your doctor is considering that this could be a Psychotic Disorder and is covering his/her bases with the Risperdal in case it turns out that this is a Psychotic Disorder. So right now I would say that Harm OCD is the most likely diagnosis, with a rule out of a Psychotic Disorder.

Customer: replied 10 months ago.
can the images urges and thoughts be all day
Customer: replied 10 months ago.
i wake up to the scary thoughts and they switch from my kids to strangers to myself,etc
Expert:  Dr. Z replied 10 months ago.

With OCD it can unfortunately. Typically the pattern of OCD is one of waxing and waning meaning that there will be periods of time where the thoughts occur near 24/7 and then there will be periods of time where they may not occur at all. It usually will come in waves, but no one can predict the pattern of OCD as it is not cyclical. An individual with a psychotic disorder will usually never have recurrent intrusive thoughts 24/7 as there will be periods of no psychotic symptoms throughout the day. This is again one reason why I think Harm OCD is the primary diagnosis.

Customer: replied 10 months ago.
i always feel like im a second away from acting on the thoughts what does it mean that i put a knife to my chest and a phone charger around my neck
Customer: replied 10 months ago.
does that go with ocd
Customer: replied 10 months ago.
there is never a time i dont have the thoughts just when im sleeping i dont
Expert:  Dr. Z replied 10 months ago.

But you stopped yourself from doing this, which is a good sign. Like I said typically an individual will not act on their OCD thoughts, but it can occur, it is just uncommon. So this still fits the OCD pattern.

Customer: replied 10 months ago.
i never tried to do things before like that i can not switch over my thoughts i constantly think im gonna set myself on fire does that sound like an ocd thought
Expert:  Dr. Z replied 10 months ago.

Right now it does sound like Harm OCD. When did these symptoms start?

Customer: replied 10 months ago.
since i had my baby 8 years ago
Expert:  Dr. Z replied 10 months ago.

It is unusual for a psychotic disorder, like Schizophrenia, to manifest after the age of 30, so I would put OCD as the leading suspect for a diagnosis.

Customer: replied 10 months ago.
i have had no relief for 8 years i have been on and off meds but now im sticking to medication regimen does shooting police officer and shooting my kids sound like ocd
im unaware of where the thoughts come from
Expert:  Dr. Z replied 10 months ago.

As I said before yes OCD causes intrusive and unwanted thoughts that are recurrent.

Customer: replied 10 months ago.
i dont have a gun but it still scares me
i dont know why i think about going outside with a knife do u?
Expert:  Dr. Z replied 10 months ago.

As of yet we do not know the causes of OCD or even if this was a psychotic disorder, we still do not know the causes. All you should consider is not the cause but working with your psychiatrist to treat it with the right medication regimen.

Customer: replied 10 months ago.
how long does it take for prozac to work and if i was psychotic would risperadal take it away
Expert:  Dr. Z replied 10 months ago.

Risperdal can lessen both OCD symptoms and Psychosis. Prozac at that dose should have started to be effective within 4 weeks and then reaches a maximum effectiveness around 2-3 months

Customer: replied 10 months ago.
i started prozac 80 mg on december 5 before that i was on lower dosages i just started the 120 mg a couple of days ago
Customer: replied 10 months ago.
is december 5 long enough to work
Expert:  Dr. Z replied 10 months ago.

Well 120mg is definitely an overdose, so I am not sure how you will respond to it. But you should have started to receive some benefits from the 80mg of Prozac by now.

Customer: replied 10 months ago.
i have not had any improvement with the thoughts
Customer: replied 10 months ago.
does that mean it wont work
Expert:  Dr. Z replied 10 months ago.

No one can predict that unfortunately as it is a trial and error process with the medications. It is possible the Risperdal and Prozac combined could help or you may need to switch to another SSRI antidepressant. Like I said it is a trial and error process.

Customer: replied 10 months ago.
should some medication lessen the thoughts
Expert:  Dr. Z replied 10 months ago.

Typically yes

Customer: replied 10 months ago.
my how much a lot less or just a little cause i find thereapy not to help in this severe case
Expert:  Dr. Z replied 10 months ago.

As I said before no one can predict one's reaction to the medication. Sometimes it helps a lot and others it helps very little, but usually there will be some benefit.

Customer: replied 10 months ago.
could the prozac stilll work im weaning down off the latuda and on 1mg of risperadal now he will increase
Expert:  Dr. Z replied 10 months ago.

Yes it is still possible.

Customer: replied 10 months ago.
whats the highest dose of risperadal you can take
Expert:  Dr. Z replied 10 months ago.

For the oral dose, it is 16mg, but I have never seen anyone higher than 10mg for the oral dose.

Customer: replied 10 months ago.
1mg is a low dose then right how fast can it be increased
Expert:  Dr. Z replied 10 months ago.

Usually it can be increased by 1mg every 5-10 days.

Customer: replied 10 months ago.
how do you know if it is is a psychiatric emergency cause it is always hard to tell cause like i said i always feeel like my thoughts will lead to actions
Expert:  Dr. Z replied 10 months ago.

But you have had these thoughts for 8 years and have not acted on them, so most likely the thoughts are not a psychiatric emergency. If you start to put a knife to your chest again or wrap a telephone cord around your neck than that is a psychiatric emergency as that shows intent.

We have drifted away from the original question on what your diagnosis could be so if you could ask one more last question and then rate me as I have to help other customers.

Customer: replied 10 months ago.
i always feel like i will do that again with the charger or knife
Expert:  Dr. Z replied 10 months ago.

Feeling like you are going to do that or thinking it is not the same as actually doing it. If you find yourself picking up a weapon and unable to resist the urge to hurt yourself or someone than that is a psychiatric emergency.

Customer: replied 10 months ago.
it would be if you attempted the action right?
Expert:  Dr. Z replied 10 months ago.

Yes

Customer: replied 10 months ago.
you can have strong urge and still not do it right?
Expert:  Dr. Z replied 10 months ago.

Yes that is how OCD works.

Customer: replied 10 months ago.
thank you
Expert:  Dr. Z replied 10 months ago.

You are most welcome. I wish you all the best with your continued treatment

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