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Is Paranoia A Destiny?

Question:

I am 32 years of age and a resident of the UK. I have been receiving mental health treatment for three years now after a two month stay in hospital with major depression which occurred shortly after starting a university course in a new city. I have received three additional diagnoses, what my psychiatrist describes as ‘a very severe form of depression’ by which I think he means dysthymia, a ‘non-specific psychosis’ and paranoid personality traits. I take 400mg per day of nefazodone and two mg per day of Stelazine, which I am hoping to change to a newer and stronger anti-psychotic with fewer side effects if I can (a help line recommended quetiapine.) I see a psychiatric nurse about once a month and my psychiatrist about once every three months for a very short session. I also meditate and sometimes practice relaxation techniques. I generally suffer worst in the evenings from paranoia and anxiety, and I find I lack a sense of direction in my life, am confused about my sexuality and sometimes I feel I am a bit impulsive. Before I was diagnosed I found person centered counseling very useful provided the counselor is experienced and self aware.

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p>I have several questions about my condition, which I hope you will not mind answering. The first is about the prognosis for my condition. From your site and others it seems that there is little that can be done as far as paranoid personality traits are concerned and that these usually either get worse or reach a certain level of severity and then stay there. Also from the little information I have gained from medical abstracts it seems that paranoia is often associated with violence, suicide and stalking behaviors. I find this very worrying as I do not want to be this sort of person, or am I taking this too seriously? What are the best treatments for my condition, if any? Are drugs the only realistic option? Secondly, I wonder about having so many diagnoses. The National Schizophrenia Fellowship here in the UK suggested seeking a second opinion and recommended a psychiatrist who could do this, not to go against my existing doctor but as a one off thing to clarify matters. I would like to do this but I am not sure how my psychiatrist will take it, and there may be funding issues too. Do you think this is a good idea, or have I just not accepted the diagnoses that I have been given?

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Answer:

I’m glad to see that you are accepting your treatment and taking it seriously. Things tend to get worse with serious mental illness when people do not maintain their medication regimes. Regarding paranoia or paranoid traits and the negative ‘destiny’ this seems to imply, I wouldn’t’ worry too much. Paranoia is a condition, not a destiny. I’ve known people with fairly severe paranoid schizophrenia who were very loving people who were able to form relationships despite their conditions. While these people were clearly paranoid and needed care, they were not a threat to themselves or others. On the other hand, I’ve known ostensibly healthy people who were quite guarded and suspicious and nasty to be around, and people who were not paranoid at all who have killed themselves. Having a little paranoia going on may or may not push you towards self-harm or harming others. If it isn’t a problem now then it won’t necessarily become a problem in the future. Staying on your medications will probably help you to be as safe and oriented as possible. Regarding your diagnosis and treatment, it isn’t clear what your condition is in the first place (at least not to me) so it is impossible to say what the best course of treatment would be. I agree with the Fellowship recommendation that you seek out alternative diagnoses to better understand your condition. This shouldn’t threaten your psychiatrist (if he or she is any good) and it will help you to feel more comfortable. It is good to become an advocate for your own treatment, as many doctors are interested in maintaining you in a stable form (and not necessarily in getting you more efficient or safer treatments). I’m not recommending that you doctor-shop, but I do think that your diagnosis can be refined. As it stands it seems a bit vague. If supportive therapies have helped you in the past, there is no reason (beyond the money issue) why you would not benefit from them now. In general, getting more support into your life (in the form of supportive psychotherapy, group therapy, or just socialization as you can handle it) will probably be a good thing.

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