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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?
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.
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.
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.
Right now it does sound like Harm OCD. When did these symptoms start?
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.
As I said before yes OCD causes intrusive and unwanted thoughts that are recurrent.
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.
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
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.
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.
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.
Yes it is still possible.
For the oral dose, it is 16mg, but I have never seen anyone higher than 10mg for the oral dose.
Usually it can be increased by 1mg every 5-10 days.
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.
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.
Yes that is how OCD works.
You are most welcome. I wish you all the best with your continued treatment
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