Family and Caregiver Schizophrenia Discussion Forum

Looking for an article on BP and Schizophrenia spectrum Scale or Continuum

I read an article in the last year on a somewhat radical idea of a scale or Continuum between Unipolar Depression, Bipolar 2, Bipolar 1, Schizoaffective, Schizophrenic.

It basically said that DSM categories are artificial and people don’t fit into neat categories. They may have some characteristics but not others.

For example, I was initially treated for Major Depression and Anxiety Disorder with SSRI’s. Since one of my symptoms was being EXTREMELY wired and unable to sleep for 3 months (torture) as well as having Depression, (feelings of self loathing, thinking I would be better of dead, thinking I was a burden on my family.)
I also had a really bad reaction to one of the SSRI’s where my anxiety and wired feeling went through the roof. My new Psych Doc diagnosed me with Bipolar 2, even though I DON’T have a lot of the symptoms (grandiosity, anger or irritability at other people.) He weaned me off SSRI’s and put me on a mood stabilizer. (I have also been on relatively low dose of Seroquel for sleep since my hospitalization 5 years ago, which I am continuing.)

My son exhibits some symptoms of ultra rapid-cycling mood swings (within the same day), depression (manifesting as anger) grandiosity, and Schizophrenia (auditory hallucinations come and go, vague hallucinations come and go, decreased executive functioning: impaired ability to organize, follow through on plans and inability to make a decision and stick to it.)

This article describes a continuum between all of these “Diagnoses.” I have tried Googling Bipolar/Schizophrenia scale, spectrum and continuum, but cannot find it.

Anyone remember reading anything like this?

You might want to look at various debates and comments prior to DSM 5 coming out. I was following it, because there was a faction that wanted to get rid of the SZA diagnosis altogether.

I’ve said this before, but it bears repeating. Don’t get too tied up on fitting diagnosis categories perfectly. Every brain is different, personality-wise, cognitive thinking style-wise, brain chemistry-wise, experience and neural network-wise. No one expression of a mental illness will be the same, even in the same family. There’s been talk of a spectrum of SZ and bipolar disorder for years. Some say that schizophrenia is actually a plurality of multiple schizophrenia’s. Unless you are a researcher or a psychiatrist, I think you are more likely to be confused by all this debate than illuminated.

I’m diagnosed as SZA, although SZ might be a better fit, but I too have had periods of depression and an inability to sleep. My brother has a DX of bipolar disorder of some stripe or another. Similar genetics, similar upbringing and environment. He has trouble with alcohol, I do not. And so on. Siblings share much more DNA than parent child, so I think what’s more important are you doing better on your mood stabilizer? If so good. If not maybe the doctor will try something else. My point is, leave the nuances to the doctors or get another doctor.

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@Maggotbrane.

“Siblings share much more DNA than parent child”

Not necessarily, a child gets 50% from each parent -there’s no guarantee that siblings will receive the same 50% from each parent. The child is “guaranteed” 50% from each parent while siblings can vary greatly.

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You’re correct. I should have said potentially. There are also some caveats depending on the sex of the siblings or parent child. In my family there are some visible similarities between between the brothers with SMI and those siblings without. Mental illnesses also appear to run on my father’s side and largely in males.

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I do agree.

Who qualifies as “neuro-typical” how far can you deviate and who gets to decide? Different doctors and therapists, different labels. And how fair is it for a Psych Doc who hardly knows you to check off some boxes and define who you are?
My therapist said the main reason they need a diagnosis is so that insurance will pay. But being labeled can be devastating due to stigma. I think diagnoses can be unhelpful, possibly harmful, but on the other hand, if the person is in distress there must be some consensus on which clinical pathways to follow. (Though a lot of times it feels like trial and error.)

How was it for you to be diagnosed as SZA or SZ? Did it take you a long time to find self-acceptance? It sounds like you were motivated from the beginning to get help and actively take whatever steps necessary to get well. It appears that you did not deal with anosognosia or denial like many people do.

As for genetics, I have anxiety and depression, my husband’s sister was bipolar and probably had borderline personality disorder characteristics.

Our other son is leading a full life, has many friends, travels and plays music, while his brother is in near constant distress due to his mental illness.

Well, there’s inherent confirmation bias in what brings us to the psychiatrist/psychologist in the first place. Someone, somehow, thought there was a problem and sought advice. Until we get objective tests or scans, diagnosis is inherently subjective. And that’s precisely why you shouldn’t bind yourself up equating diagnosis with identity. You or your loved one might have a disease, but aren’t that disease. And the course of that disease or even the diagnosis is uncertain, so why burden yourself.

Labels only have power if you let them, or people ‘believe’ in or ‘need’ them. They serve utilitarian purposes for insurance companies, or drug manufacturers, or doctors, or researchers or lawyers, legislators and judges, and most of these professionals know their limitations and methodology with assigning them. When they get into the hands of lay-people or people with axes to grind, things tend to go awry, and they can get misused in stigmatizing or otherwise limiting ways.

My diagnosis was handed to me on paper and discussed by the head psychiatrist when I was discharged from a state mental hospital. Maybe it was a legal requirement, or maybe this was the first time I ‘paid’ for services, I don’t know. Prior to this, I’d seen a psychologist for a year without diagnosis. I also had one visit to a psychiatrist and wasn’t told a diagnosis, my mother might have received mine, but she didn’t share it with me.

Insurance was not involved for most mental health services I’ve received for various reasons: at first I didn’t have health insurance; then my employer was self-insured and the ADA was not yet in force, so filing a claim was risky; Then there were limitations on the number of sessions per year I could claim, and psychotherapy was a hard sell for medical necessity; My present psychiatrist refuses to file paperwork and play the insurance company game (this isn’t uncommon in the US). So I generally only file for prescription coverage and the rest has come as tax deductions or out of my HSA accounts. It’s just not worth it for me hassle-wise and risk-wise as long as the medication is paid for.

So with no insurance companies involved and various psychiatrists and psychologists rarely even mentioning a DX, the focus was on my symptoms and problems and what I might do to overcome them. That’s all a DX is in the end, a bag of symptoms that are sort of like other people’s bag of symptoms. And treatment and recovery is trying various tricks and techniques to see if the load can be lightened, or new strengths developed so it can be more easily carried. I don’t think I ever even got or asked for a prognosis. Perhaps they didn’t want to limit or discourage me by expectations, or maybe more realistically they didn’t know.

I forget the exact sequence of events, it may have been before I was hospitalized or before I decided to ask for a referral to a new psychiatrist for neuroleptic treatment, but I had a session with my first Jungian therapist where I declared myself as having SZ and accepting it. I guess it was similar to LGBTQ+ folks saying they identify as such. Without professional comment or confirmation she acknowledged it and effectively said if this had value for me then fine. She avoided labeling at all turns, and at a time I spoke to her on the phone about finding a new psychotherapist upon moving, she pointed me to a list of Jungians and said to be careful of disciplines with preconceived biases of pathologies, etiologies and prognoses.

This was a bit of a phase where I tried to spin my disease and myself as something ‘special’, but at the same time picking the various symptoms apart and trying to make them appear more normal. Sort of a lemonade out of lemons approach. Over time, I became less self conscious about things and realized that ‘normal/neurotypical’ people had many of the same problems, it was more a question of degree and awareness. So recovery for me was a process of losing that feeling of specialness while retaining the self-awareness (which is a hard thing to shake once you have it). And with that came thoughts of where does my illness end, and I begin. My mantra was largely, “you aren’t special, everybody has problems and are more concerned with their own, not yours.” I’m reminded of the quote of Ian Maclaren sometimes attributed to Plato or Philo, “be kind, for everyone you meet is fighting a hard battle.”

I don’t really think about it much any more, accept to post here and take a pill along with various others in the morning. I haven’t had appreciable symptoms in the past two or three years and even if I did, I’m confident I can overcome them. This is after 30 years or so of this, and it wasn’t cheap or easy or pain-free. I recently asked my sister what she thought about my illness and some advocacy efforts I’m working on, and she said she doesn’t think of me as my illness or acting like I have an illness or with or in spite of my illness. To her I’m just me, no label or bag of symptoms, just me.

I see people coming here expecting a quick fix, the perfect P-doc an exact DX and a miracle RX that makes the pain go away. Unfortunately the world and our brains don’t work that way. We have to learn to deal with and embrace imperfections— starting with ourselves.

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