Q. Kindly explain whether my disease is delusion disorder or paranoid schizophrenia.
Hi doctor,
I would like to know whether my disease is delusion disorder or paranoid schizophrenia. I have been taking Risperidone 2 mg for 16 years, Escitalopram 10 mg for 7 years and for hypertension Met XL 25 mg for 5 years. My cholesterol levels are normal. I am a pure vegetarian. I do not smoke. I am not even an occasional drinker. My thyroid hormone levels are normal. I am not a diabetic, but my weight is 227 pounds and my height is 5'7". I walk around 5 km for five days a week. I have been working in shift for the past 15 years. I am working as a senior engineer with full competence, but with little nervousness. I experienced delusions alone and not hallucinations when I was broken down for first time before 16 years when I was studying post graduation. Earlier than that, I used to suffer from severe anxiety. Before 8 years, with a doctor's prescription, I reduced Risperidone 1 mg to 0.5 mg and Escitalopram 10 mg. It proved fatal and relapse of delusion occurred. From then onwards, Risperidone 2 mg and Cita S 10 mg followed. I am a bit anxious, but mentally fine. Except the two above events, I never experienced delusions. Except obese, I have no other problems. There is no one to remind me for tablets as I am living alone. I am married, but my wife is working in another location. I am having one daughter, who is healthy and active. As there is a family history, from your answer only I do will decide about my daughter's higher study.
Hi,
Welcome to icliniq.com.
I am sorry to hear about your mental state, but at the same time I do appreciate you for being on regular medicines. However, even though your question is very direct, I am sorry to say that I cannot give you a straight forward answer or diagnosis. First and most importantly, I implore you not to go chasing after a specific diagnosis as the DSM (Diagnostic and Statistical Manual) and other books that are used for diagnosing psychiatric conditions. They keep changing some criteria every decade or so. Hence, as long as you have understood that you have delusions which get better with regular treatment, that it is more insight than most people with your condition. Secondly, I cannot figure out why you want to link your daughter's career with your diagnosis. Please do let her live her own life. Though there is a genetic risk of schizophrenia in her, it is in no way a certainty. Now, coming to your actual question, if the delusions that you had were deemed bizarre by your treating psychiatrist, he would be right in fitting you into a diagnosis of paranoid schizophrenia even if you have not had any sort of hallucination. So, it would depend on the content of your delusions too. Apart from delusions and hallucinations, there are a variety of other criteria too, like disorganized speech or behavior or negative symptoms, which could give you a diagnosis of schizophrenia. So, once again, I would like to end my response saying that it would be best if you discuss the reason for your diagnosis with your treating psychiatrist. But, please do not let it affect your daughter's future in any manner. Take care.
The Probable causes:
The probable cause is to rule out any congenital syndromes.
Investigations to be done:Investigations to be done are CBC (complete blood count), LFT (liver function test), RFT (renal function test), electrolytes, FBS (fasting blood sugar), PPBS (postprandial blood sugar), FLP (fasting lipid profile), TFT (thyroid function test) and CT (computerized tomography) brain, preferably MRI (magnetic resonance imaging) brain.
Differential diagnosis:The differential diagnosis is
1. Delusional disorder.
2. Schizophrenia.
3. Unspecified psychotic disorder.
4. Anxiety disorder.
The treatment plan includes:
1. Continue antipsychotics and SSRI (selective serotonin reuptake inhibitor) if you feel better.
2. Reevaluate the diagnosis if no improvement and optimize the drugs.
3. Get examined for extrapyramidal symptoms.
4. Consider drugs for obesity and investigations, including metabolic profile to assess obesity.
The preventive measures are regular exercise, a balanced diet, regular sleep, regular medication and regular follow up with a psychiatrist.
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