There’s a post at Furious Seasons today commenting on the Portland Identification and Early Referral programme in Portland, Maine and an Associated Press article about the program. My personal favourite part of the programme’s web site is the line “Mental disorders are diagnosed in the same way as asthma, diabetes and cancer.”

Ah, so mental disorders are diagnosed with a pulmonary function test? No? A blood glucose test? No? A biopsy? No? Is there any type of biological test that can conclusively prove someone’s particular psychiatric diagnosis? Again, NO.

I was in an early psychosis programme when I was nineteen. The psychiatrist I was seeing for depression when I was eighteen thought I might be schizophrenic, so she prescribed me Risperdal, only saying that it would “help my concentration” and not bothering to tell me that she thought I had schizophrenia. Six months later, she moved away and my GP referred me to the psychosis prevention programme based on whatever was in my file. The next summer, another psychiatrist I saw told me that my file said the first shrink thought I might be schizophrenic because I had told her that I was bullied in junior high school and sometimes I still worried that people might not like me. That was the basis upon which she had prescribed me an antipsychotic: she somehow mistook my occasional worries caused by past trauma for delusional paranoia. The best part is that the bullying was something I had mainly worked through and it bothered me so little at that point in my life that I didn’t even remember mentioning it to her. It was just something I’d said in passing.

During the psychosis prevention programme itself, I saw a psychiatrist and a psychiatric nurse and talked to them about my depression. I knew the programme had something to do with psychosis, but didn’t know why I was in it. Nobody told me that my previous psychiatrist thought I was psychotic. Nobody told me I wasn’t psychotic. Nobody told me they thought I might become psychotic. Nobody provided me with any education about psychotic disorders. Nobody thought they should take me off my Risperdal, so I stayed on it (and my Zoloft, which has been nearly ever-present in my life for the past eight years). I think I just quit seeing the psychiatrist and the psychiatric nurse on my own without them referring me elsewhere; I think my psychologist eventually referred me to my next shrink.

So I wound up in a psychosis prevention programme because I made an offhand remark about sometimes worrying that people might not like me. Even before I was in the programme, I wound up on an atypical antipsychotic because of that same remark. I was not schizophrenic then, and I’m not now, although I was tentatively diagnosed as such at the time. I was not psychotic then, nor was I showing any signs of psychosis. I didn’t get psychotic until years later. My worst psychotic episode was when I’d been off all of my medications for months, but I’ve been more mildly psychotic while on antipsychotics, too. I was misdiagnosed, unnecessarily prescribed heavy-duty medications, and kept in the dark about everything. I don’t believe AAPs caused my eventual psychosis (although such a thing is not impossible), but I sure wish I hadn’t been taking drugs with such serious side effects for years before there was ever any real sign that I might need them. In the long run, being prescribed antipsychotics at eighteen didn’t stop me from getting psychotic at twenty-one or twenty-two. I’ve also been off AAPs for over a year and a half without having any serious episodes of psychosis in that time.

Years later, I reread some old journal entries from the three weeks I was taking Zoloft but hadn’t yet started taking Risperdal. I seem pretty damn hypomanic in them, which I didn’t realize at the time. Although my behaviour shortly before being prescribed Risperdal wasn’t entirely normal, it appears that the only rationale for the prescription that my psychiatrist actually bothered to write down was that one comment I had made. Either that was her entire basis for considering me a possible schizophrenic, or she mistook my hypomania for schizophrenia and did a really sloppy job documenting it.

P.S. I should have knocked on wood while I was writing yesterday’s post. I didn’t sleep very well last night.

This entry was posted on Wednesday, April 11th, 2007 at 11:20 pm and is filed under Meds, Doctors, Diagnoses, Treatment, Psychosis. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.