Dr. Aditya Gupta
Psychiatry
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have been suffering from anxiety, panic disorder, and perhaps OCD as well (but I have not been diagnosed with that yet) since I was 11. However, I had been completely anxiety-free for about four or five years until three months back, when I got a horrible panic attack that started it all. Technically, I had some weed muffins last year, and I got a panic attack from which it took me over a week to recover, but I was fine again afterward. Anyway, first I was obsessively worried about my physical health, but that has now shifted to mental health. I have also been suffering from derealization on and off. Anyway, just a couple of days I got this horrible intrusive thought like 'what if I got psychotic and heard voices that would tell me to hurt my family or my dog or myself' (note that I love my family, I love my dog, I love myself, and I hate and despise violence of any kind. I have never acted violently in my life) and basically, since then, I have been feeling worse and worse. I read a lot about schizophrenia, mainly real life stories and experience of people, which at first made me go 'okay, now I certainly do not have this,' but as time progressed, I started getting more and more intrusive thoughts. Like 'what if I start being paranoid, what if I start believing that the posters in my room are real people, etc.' Occasionally, I ask myself 'what if these people are not real, what if I am not real?' I have also had a blank mind, pretty much unable to think of anything else, since I got this bad last week. I get this constant picture of myself, confined to the bed and crying somewhere in a white room, all by myself. I have also been feeling this kind of gut-fear since then. On the outside, with other people, I behave normally, much kinder, actually, I think. I am a bit slower and find it a bit harder to concentrate on two things at once, which had never been a problem before, but that could as well be due to anxiety. Anyway, my question is, could this be indicative of actual psychosis or prodromal stage of schizophrenia? Or is it more likely just anxiety and OCD? Thank you very much for your response.
Hi,
Welcome to icliniq.com.
From your description, it appears to be ruminations. Following differentials are likely: Health anxiety disorder, hypochondriasis, OCD (obsessive compulsive disorder). It is unlikely to be psychosis, as you are well aware of the absurdity of these thoughts. But a confirmed diagnosis can only be made after a detailed evaluation. So kindly consult a psychiatrist in person for detailed evaluation and treatment. Get your thyroid profile done. Besides, patterned breathing exercises like Sudarshan kriya can be helpful, as they ease out anxiety and help you relax and focus. Avoid caffeine and substance use. Remember every problem has a solution you just need to try solving it and help is just a step away. Feel free to ask if you have any further queries. Thank you,
Patient's Query
Hello doctor,
Thank you very much for your response. I am seeing my psychiatrist this week, but I am in so much panic. I had to seek some medical help. Is it possible that just the OCD or anxiety is making me feel this bad, though? I will literally see things in my peripheral vision, which are things that really are there, but they always cause me to 'jump up.' I am scared to even look at posters in my room because 'what if I start believing that thing that one girl from the internet did,' and I feel so scared. I just like to sleep all day so that I would not have to go through this hell. I also have to note that I have no family members with psychotic disorders. I do have relatives with depression, anxiety, and OCD, though. I am not sure if this is a right question to ask, but what medication do you think would help most with this problem? I tried Citalopram, but it did not even last two days, as I got very panicky. Thank you.
Hello,
Welcome back to icliniq.com.
As you have said it is the fear of getting ill not the illness itself. Severe anxiety and panic can get that bad. Actually, it is the ruminations or the fear that you will turn psychotic, resulting in severe anxiety. SSRI (selective serotonin reuptake inhibitors) like Fluoxetine and Sertraline can help with this problem. Short term benzodiazepines can also be helpful. Hope this solves your query. Feel free to ask if you have any further queries. Thank you.
Patient's Query
Hello doctor,
Thank you for replying. I have a query about my new medication. I have just started taking Citalopram today. I am supposed to be taking 5 mg for a week alongside with a benzodiazepine. For the whole day today, I have been experiencing all kinds of visual illusions, like I will see some white or black shapes in my peripheral vision, or will think that some black dots, for example of dirt, around me are actually flies. I have actually been surrounded by them for a couple of days or had a feeling that something I saw in my peripheral vision was moving when it was not. It could have been the fly flying, but I did not notice in time. Even a reflection in my glasses will cause me to 'jump up.' Long story short, my question is, could these be caused by the medication? Or is it just health anxiety and OCD made worse because my main fear is schizophrenia? Thank you very much.
Hello,
Welcome back to icliniq.com.
If it is because of medications cannot be ascertained, as you have started medications only today. Also, the symptoms for which you are taking treatment were similar to present complaint, making it more likely due to the illness itself. In my opinion, you should wait for the medications to kick in and in the meantime, you can ask to up titrate the dose of benzodiazepine for relieving anxiety. Hope this solves your query. Feel free to ask if you have any further queries.
Patient's Query
Hi doctor,
Thank you for your reply. Is it possible that this side effect will get worse over time? Or is it more likely it will diminish?
Hello,
Welcome back to icliniq.com.
It is more likely to diminish as the drug effect kicks in. Hope this solves your query. Feel free to ask if you have any further queries.
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