Psych Central

Chance of Relapse?

By Kristina Randle, Ph.D., LCSW

Have you ever been so afraid of being attacked or hurt that you would try to stay on guard constantly? If you asked me this question about a year ago, I would answer yes. Why did I feel like this? I am still wanting to find out. I will find out in the future.

I was born the youngest of 4 in a small town in the middle of nowhere, West Virginia. I never felt like I was home there. I wanted to live in cities like Los Angeles, CA or Seattle, WA or some city like that. I wanted to live in a big city. I was a product of a high risk pregnancy and I had motor difficulties in my early childhood. The doctors thought I was Autistic, yet they never fully diagnosed me with it. I can’t remember anything before I was 8, which I think may be unusual? I do remember what my mother told me.

In my freshman year of high school, I started experiencing extreme crying fits and cutting episodes, along with hallucinations, which would make me scream into nothingness. I feel like without them I would be lonely, so I never told anyone, not wanting them to leave. Even though, they were upsetting me and blatantly insulting me every minute of every hour of every day of every week and of every year. I would cut just to appease them, they seemed to want me to harm myself. I wanted them to be happy. I want everyone to be happy, no matter what I have to do to appease someone, I will do it. It continued into my Sophomore year, then my mother noticed the scars and forced me to go to the psychologist. After seeing me for a while, they diagnosed me with Major Depressive Disorder with Psychotic Features. I was put on Prozac and Risperidal. It was all well, until my Junior year. I thought I was better, so I quit the medicine. Needless to say, the voices continued again. I started cutting more than I ever had and eventually cut a vein and ended up the next day in the hospital. they sent me to a hospital in Pennsylvania and I stayed there for a while.

I am now a Freshman in College and a pre-law major. I want to know if there is a possibility that I might go into this again? And if it will be worse, if it does? Is it possible that it could be worse than Psychotic Depression, like Schizophrenia, Schizotypal, or Schizoid Personality? Is it even possible to fully recover from this disorder, without any relapses?

A. There are several things I wish to address in this answer. One is the idea that you have been diagnosed with major depressive disorder (MDD) with psychotic features. This disorder is very similar to other disorders such as schizophrenia and in particular, schizoaffective disorder. There are some people diagnosed with MDD with psychotic features who might have been diagnosed with schizophrenia or schizoaffective disorder by any number of other mental health professionals. The abovementioned disorders are similar and it’s not usual for an individual to be diagnosed with MDD with psychotic features and then later diagnosed with one of the other disorders. The possibility exists that you were misdiagnosed and perhaps have schizophrenia or schizoaffective disorder. I’m not saying that you were in fact misdiagnosed; I’m simply saying that it is a possibility.

Another aspect of your question I wish to address is that at some point you were taking medication but you stopped because you felt better. This is very common. Individuals often mistakenly believe that because their symptoms have improved they no longer need medication. What they fail to realize is that it is the medication that accounts for symptom improvement. Stopping the medication abruptly may induce a relapse. If you want to prevent a relapse then it is important to stay in treatment and to take the medication consistently.

I understand you may not like the medication and it may have side effects that are unpleasant. No one wants to take a medication that makes them feel unpleasant, tired or sick, and so forth. It’s worse, however, to risk the return of symptoms such as hearing the voices or having a psychotic episode. Psychotic episodes may lead you to engage in behavior that is dangerous to yourself or others and possible future hospitalizations.

If you want to stop the medication then you should do so with the assistance of a doctor. He or she can slowly reduce the medication dosage over time. This process is called titration. It is one way to prevent a relapse. It can significantly reduce the likelihood of a relapse which can be caused by suddenly stopping a medication. Relapses are more likely to occur when an individual abruptly stops the medication versus slowly reducing the dose. This is an important point to remember.

In addition, there is some evidence that psychotic episodes cause brain damage. Each psychotic episode may lead to actual damage to the brain. This means that with each psychotic episode, it may be more difficult to return to your previous state of functioning. This is known as stepwise decompensation. It is important to prevent psychotic episodes when possible. As I mentioned above, I understand that you may not want to take medication, but it may be better than risking a relapse and damage to your brain.

In your specific situation you are attempting to complete college. The best way to handle this situation is to be in contact or in treatment with a mental health professional and to stay on a medication if you have been prescribed one. Generally, among individuals with psychotic disorders, this is the most effective way to prevent a future relapse.

It’s also important to you keep your stress levels low. High stress has been linked to an increase in psychotic episodes. A mental health professional can help you learn strategies to deal with stressful circumstances when they arise.

MDD with psychotic features, schizophrenia, schizoaffective disorder and other related psychotic disorders may not be curable but they are manageable, if you’re willing to abide by the advice of your treating mental health professionals. Thank you for your question.

Photo

 

 

Last reviewed: By John M. Grohol, Psy.D. on 27 Oct 2009

APA Reference
Randle, K. (2009). Chance of Relapse?. Psych Central. Retrieved on April 18, 2014, from http://psychcentral.com/ask-the-therapist/2009/10/27/chance-of-relapse/