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Did My Boyfriend Get Misdiagnosed with Bipolar When He May Have Schizoaffective Disorder?

A couple of months ago, my boyfriend appeared to go through a manic episode leading to a psychotic episode. He was depressed and anxious for a few months time, then suddenly stopped sleeping, eating, and had some false ideas about his capabilities (i.e. starting signing up for dance classes and bee keeping courses out of the blue). I had never seen that behavior in him before.

On the day of his major episode, he was suffering from some paranoid delusional thoughts that made him believe someone was going to kill him and the world was ending. He left work, threw away all of his belongings, starting running, ended up in a random building ranting to the doorman about how one of the residents was going to be able to save him which thankfully lead to his hospitalization.

He was in the hospital for a week where he received anti psychotic medication and a bipolar diagnosis. When he was released, he seemed no longer manic but still very depressed and anxious. He continued to experience paranoid delusions about being possessed by a demon, the doctors in the hospital being actors, etc.

It is now three months later and he is on anti anxiety, anti psychotic, and mood stabilizer drugs. He sees a therapist weekly and psychiatrist monthly. He is doing okay, but has a hard time concentrating at work, still seems anxious and depressed, can’t sleep, and still having delusions.

I recently came across Schizoaffective disorder and almost feel like it’s more fitting because his delusions are still occurring though I don’t think he’s going through a manic or depressive episode. I was hoping for advice about if this could be the case.

I am so worried about him and feel so bad for how much his life has changed. He can no longer perform as well at his job and hardly is able to leave his apartment. Any insight would be greatly appreciated.

Thank you

It’s important to understand that diagnosis is not an exact science. If he were to be evaluated by 10 mental health professionals, it’s possible that he could receive 10 different diagnoses. They would disagree on the exact nature of his condition, but their treatment recommendations would likely be similar. Thus, in some respects, diagnosis isn’t as important as treatment.

When it comes to psychotic disorders, medication is usually the treatment of choice. It often takes a good bit of trial and error to find the right medications. Even when the right combination is found, adjustments will likely be needed over time. It’s the norm.

For you, the focus should be less on diagnosis and more on ensuring that he continues treatment. Among people with psychotic disorders, it’s common for them to stop taking their medication. Because they feel better, they often reason that they no longer need the medications. Predictably, when they stop the medications, they relapse. It’s important to be vigilant about his continuing treatment.

It’s good that he participates in treatment. It is a positive sign. It will hopefully prevent him from experiencing future psychotic episodes. Be certain to report his progress and your concerns to his treatment team. The more information they have about his condition, the easier it will be to treat his symptoms. For instance, they should know that he is continuing to experience anxiety, depression, sleep problems, and delusions. Medication may not be responsible for all his symptoms, but a medication adjustment may still be necessary. Having open communication with his treatment team is vitally important to treatment success.

You also might consult your local National Alliance on Mental Illness (NAMI) support group chapter. This organization provides psychoeducation and support to individuals caring for loved ones with serious mental illnesses.

I hope this helps. If you have additional questions, please don’t hesitate to write again. I am glad to help in any way I can. Good luck with your efforts.

Dr. Kristina Randle

from Ask the Therapist

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