How do Aspergeans get misdiagnosed with Schizophrenia?

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Ticker
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07 Jan 2009, 11:42 pm

unreal3x wrote:
As for your many diagnoses, a few of which sound like they should not be a separate diagnosis, but a symptom or effect of a base diagnosis.

Correct me if I am wrong but I see conflictions with APD and ASD

APD:
"They are so preoccupied with monitoring themselves and others that producing fluent speech is difficult."

That just sounds like someone with aspergers and their problems with small talk for example,
an NT will make a comment about the snowy weather, the aspergers person doesn't know how to respond they think "well nice observation, I can see its snowing" but thats not a socially acceptable response, so they might not know how to respond right away hence "fluent speech is difficult" and they begin wondering why people talk like that and how come they don't think the same way so they constantly pick apart peoples thought process including their own trying to find an answer "preoccupied with monitoring themselves and others "
So... "They are so preoccupied with monitoring themselves and others that producing fluent speech is difficult." sounds like it could be a common aspergers trait and not a seperate disorder. Perhaps I am wrong though. I guess maybe the ASD is the cause, and the APD could be the effect it has?


Actually I don't agree with the APD dx either. Matter of fact my main psychologist doesn't either. It's kinda like that old saying "having too many cooks in the kitchen" well I have diagnosis from a neuropsyh and a psych both phD's and they don't agree with one another. I'm more prone to agree with my main psych who I have seen on a weekly basis she said the APD dx was absurd because avoidance is just a manifestation of both Aspergers and PTSD. Now the PTSD is an accurate dx and not part of my Aspieness though it might be for some folks. I have PTSD as a combination of surviving 3 accidents, from being abused and neglected as a child and also being raped 11 yrs ago.

The mathematics disorder I just chuckled at which pissed of the neuropsych when she read off her diagnoses. I mean its stupid that if you suck at math they have a diagnosis for that now. They don't have a diagnosis for people that suck at history or home economics class. :lol:



ike
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07 Jan 2009, 11:57 pm

Vimse wrote:
Spokane_Girl wrote:
For one: Aspies might take this question literal, "Do you hear voices?" So the doctor is going to thin they hallucinate. They don't even ask "What voices do you hear?" "Are you hearing any now?" "How often do you hear them?" "Where are the voices coming from?"


That happened to me. Think that may have been one of the reasons I was diagnosed with schizophrenia. Have never heard voices that noone else could hear. "Do you hear voices?" is a stupid question. If I didn't hear a voice I wouldn't have given an answer at all since there would have been no question asked. Unless the doctor asked me in writing, which he didn't.


I'm pretty sure I would have understood that question and answered the way they wanted me to anyway... but my neurologist was pretty good in that regard anyway, he asked "do you ever hear things (not voices) that others can't hear". The question was very well phrased, very specifically designed to produce a particular response. And in spite of my difficulty reading people, I noticed that when he asked that question, his demeanor changed significantly to give the question some emphasis. It made me chuckle a bit actually. :)


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08 Jan 2009, 12:43 am

Mw99 wrote:
DeaconBlues wrote:
DwightF wrote:
Mw99 wrote:
DeaconBlues wrote:
Well, in my own case it was because AS wasn't a diagnosis in 1989, and the psych thought my flatness of affect was a lack of affect - one of the signs of schizophrenia. He also thought that I seemed angry. Sounds odd, because at the time I wasn't terribly angry about anything - a little stressed, because my job was to plan World War III, but not angry...


if you told the psych you were planning WWIII, it's not that hard to imagine why you got misdiagnosed with schizophrenia.

LOL

Yeah, if you couldn't produce a pay stub and official documentation for your job description that might get misconstrued.

:lol:

Oddly enough, I could - I was in the US Air Force at the time, assigned to HQ SAC/XOXPC (Headquarters Strategic Air Command/Nuclear Deconfliction Office, Software Section), and dually assigned to the Joint Strategic Target Planning Staff (JSTPS/JPPPC). Our job was to plan out WWIII, and make sure the nukes wouldn't destroy each other on the way in (for instance, once a nuke has been armed, it can be set off by passing through the neutron flux from another nuclear explosion, which would be embarrassing at the least).

One problem with the job was that one's sleep tends to become troubled once one really begins to grasp what the term "megadeaths" (used as a measure of a weapon's target efficiency) really means...


Come on, but if you tell the psychologist that you are planning WWIII, and don't bother to explain the nature of your job with the Air Force, you are begging her to take you for a lunatic.

But the military would never trust a civilian psychiatrist - I spoke with a major, in fact. He was well aware of my job - I had to speak with him because there weren't many psychs there with a high-enough security clearance (I might let something slip, and the AF didn't want to take that chance with someone with a Top Secret-ESI, SIOP Category 9, and NATO Cosmic Top Secret ATOMAL clearance).

On the plus side, it meant that when I was discharged, I didn't have to report in to a reserve unit - the official categorization of the discharge was "Honorable - Condition Unsuited To Military Service."


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08 Jan 2009, 1:22 am

Ticker wrote:
unreal3x wrote:
As for your many diagnoses, a few of which sound like they should not be a separate diagnosis, but a symptom or effect of a base diagnosis.

Correct me if I am wrong but I see conflictions with APD and ASD

APD:
"They are so preoccupied with monitoring themselves and others that producing fluent speech is difficult."

That just sounds like someone with aspergers and their problems with small talk for example,
an NT will make a comment about the snowy weather, the aspergers person doesn't know how to respond they think "well nice observation, I can see its snowing" but thats not a socially acceptable response, so they might not know how to respond right away hence "fluent speech is difficult" and they begin wondering why people talk like that and how come they don't think the same way so they constantly pick apart peoples thought process including their own trying to find an answer "preoccupied with monitoring themselves and others "
So... "They are so preoccupied with monitoring themselves and others that producing fluent speech is difficult." sounds like it could be a common aspergers trait and not a seperate disorder. Perhaps I am wrong though. I guess maybe the ASD is the cause, and the APD could be the effect it has?


Actually I don't agree with the APD dx either. Matter of fact my main psychologist doesn't either. It's kinda like that old saying "having too many cooks in the kitchen" well I have diagnosis from a neuropsyh and a psych both phD's and they don't agree with one another. I'm more prone to agree with my main psych who I have seen on a weekly basis she said the APD dx was absurd because avoidance is just a manifestation of both Aspergers and PTSD. Now the PTSD is an accurate dx and not part of my Aspieness though it might be for some folks. I have PTSD as a combination of surviving 3 accidents, from being abused and neglected as a child and also being raped 11 yrs ago.

The mathematics disorder I just chuckled at which pissed of the neuropsych when she read off her diagnoses. I mean its stupid that if you suck at math they have a diagnosis for that now. They don't have a diagnosis for people that suck at history or home economics class. :lol:


Its not so much that they suck at the subject, its more that their brain some how does incorrect calculations that they think to be true, like 1-1= 1 cause you took one from one so you still have one left (thats not actually an example...but)

Anyways I am not so sure I agree with most psychologist's whose job is to preform diagnoses, typically I am more likely to agree with a psychologist who thinks because they like to (for writing books maybe) but not for a job.

If you are true to your self, look at everything, don't expect to gain advantage (but rather personal knowledge about your self) and are not afraid of diagnosing your self with something "bad" then I think the best person to diagnose you is you.



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08 Jan 2009, 1:33 am

ike wrote:


I'm pretty sure I would have understood that question and answered the way they wanted me to anyway... but my neurologist was pretty good in that regard anyway, he asked "do you ever hear things (not voices) that others can't hear". The question was very well phrased, very specifically designed to produce a particular response. And in spite of my difficulty reading people, I noticed that when he asked that question, his demeanor changed significantly to give the question some emphasis. It made me chuckle a bit actually. :)


I don't think he asked a very good question. There are plenty of people with keen hearing that "hear things others can't hear". It doesn't mean they have schizophrenia though. When I was younger they tested my hearing and were astounded I could hear high pitched sounds that no one else could here. The doctor said I was in the "cat hearing range" though I seriously doubt that. Though years later I end up needing hearing aids so go figure. But anyway I think that's a bad way he phrased that question.

I also don't think the typical "Do you hear voices" is a good question for doctors to ask Aspies. As a naive younger Aspie I would have naturally answered "Of course I hear voices" meaning Yes I can hear I don't have a hearing problem. Though the intent of that question is to inquire if you hear voices no one else hears.



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08 Jan 2009, 2:05 am

unreal3x wrote:
Its not so much that they suck at the subject, its more that their brain some how does incorrect calculations that they think to be true, like 1-1= 1 cause you took one from one so you still have one left (thats not actually an example...but)


I'm not sure about the validity of scoring my test the way she did. For one I didn't attempt about 1/3 of the math problems because it was either stuff I didn't remember or else never studied. Aren't they suppose to take cultural surroundings into account with administering neuropsych tests? I mean I grew up in a little hillbilly town and never studied things like calculus. Even in college I was not required to study Calc to get my degree as the highest math required was Statistics. Then some of the math problems I just couldn't remember how to do. She didn't buy that excuse either but come on when its been over 15 years since you have been in school how are you suppose to remember some of that stuff because I've worked a variety of jobs and never ever had to use any higher math than addition and subtraction. I literally had not had to work on mixed fractions since I was in 9th grade. I'm 40, so its been a LONG time. Plus I have diagnosed brain damage so how can you judge whether its mathematics disorder or the older beaner just can't remember how to solve the problem but once could?

unreal3x wrote:
Anyways I am not so sure I agree with most psychologist's whose job is to preform diagnoses, typically I am more likely to agree with a psychologist who thinks because they like to (for writing books maybe) but not for a job.

If you are true to your self, look at everything, don't expect to gain advantage (but rather personal knowledge about your self) and are not afraid of diagnosing your self with something "bad" then I think the best person to diagnose you is you.


I'm not sure a person can always diagnose themselves well. People aren't always as objective about themselves as they think. I know someone self diagnosed with Aspergers that I am quite sure has Rhetts. I would like to think I am more in touch with myself than most yet I never had a clue I had Dissociation (though not multi identity just losing time) until the psych pointed it out. Actually had never heard of the diagnosis before. At least it makes me an interesting patient now. LOL I've often noticed psychs tend to be disappointed if you say no you don't hear voices because I think they find people with Schizo and Multiple Personality more intriquing to work with. Come to think of it the most intriquing mentally disturbed friend I've known had MPD. She was 6 people. I kinda miss them and keep thinking maybe I should call one of them up for a chat.



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08 Jan 2009, 4:08 am

Ticker wrote:
ike wrote:
I'm pretty sure I would have understood that question and answered the way they wanted me to anyway... but my neurologist was pretty good in that regard anyway, he asked "do you ever hear things (not voices) that others can't hear". The question was very well phrased, very specifically designed to produce a particular response. And in spite of my difficulty reading people, I noticed that when he asked that question, his demeanor changed significantly to give the question some emphasis. It made me chuckle a bit actually. :)


I don't think he asked a very good question. There are plenty of people with keen hearing that "hear things others can't hear". It doesn't mean they have schizophrenia though.


Yes, it's true that people hear into different ranges. A friend of mine in high-school got headaches from a sound-based pest-control device his parents bought. However that answer would be very different from the answer I would have given if I were hallucinating. If I had said "I seem to hear some sounds that are very high pitch that are out of the range that others can hear", that would have been a very different thing than an answer of "yes, no one else can hear when God is speaking to me". And I'm pretty certain, based on the way he handled the other questions, that he would have sought clarification if he weren't sure, but either of these answers would have been pretty clearly what he was looking for or not what he was looking for. So yes, I believe it was a good way to phrase the question. The alternative would be to screw the analysis by making the question way too specific, i.e. "do you ever hear people talking to you, that other people can't hear, when no physical barriers to hearing are present?"

Quote:
When I was younger they tested my hearing and were astounded I could hear high pitched sounds that no one else could here. The doctor said I was in the "cat hearing range" though I seriously doubt that. Though years later I end up needing hearing aids so go figure. But anyway I think that's a bad way he phrased that question.


If so, then there's no good way to phrase the question.


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08 Jan 2009, 5:51 am

Symptoms of AS, schizophrenia, and schizotypy in general, overlap to a large extent.

This is particularly so for the negative symptoms of schizophrenia: flat affect, restricted interests, social withdrawal etc. These are around the same level as for AS, whereas the positive schizophrenia symptoms (eg hallucinations) are not. Both have associations with tangential and circumstantial speech, and catatonic motor behaviors.

AS and schizotypy also share executive function deficits, anxiety, eccentricity. Some thought disorder has recently been associated with AS.

Lack of professional training in AS, being unaware of communication differences when interviewing clients (eg literal interpretation of questions), and even mistaking enhanced perception (like mentioned above) for hallucinations, for example, also contribute to misdiagnosis.



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08 Jan 2009, 6:50 am

Diagnosis and differential diagnosis of Asperger syndrome

Quote:
Schizophrenia spectrum disorders
Schizophrenia (DSM–IV)

Schizophrenia is a disorder in which psychotic symptoms (delusions or hallucinations), thought disorder and so called ‘negative symptoms' cause social and/or occupational dysfunction over time. Because individuals with Asperger syndrome have normal cognitive ability, restrictive behaviours and impairments in social interaction and communication can be misinterpreted as evidence of schizophrenia. People with Asperger syndrome have difficulty understanding the subtleties of social behaviour, but this should not be confused with evidence of psychotic disorder. In a clinical setting, asking individuals with Asperger syndrome whether they hear voices may induce a positive response, and they might concur that they hear voices "when people aren't there", but they may be refering to the voices of people in an adjacent room. Deficiencies in concrete thinking and in understanding how other minds think may cause patients with Asperger syndrome to misinterpret what is said to them, and they might as a result be labelled paranoid. Misinterpreting social contacts can also lead to inappropriate emotional responses, contributing to this impression. Persons with Asperger syndrome sometimes speak their thoughts out loud, which again can be misinterpreted by a psychiatrist.

Language abnormalities associated with autistic spectrum disorders include substitutions, literalness, problems with prosody, staccato speech and monotonous speech that is excessively pedantic and focused on details or obsessive questions. A tendency to direct the conversation towards obsessions could easily be mistaken for evidence of associative loosening. A comparison of thought disorder and affective flattening in patients with autism and with schizophrenia found that they did not differ in terms of affective flattening, and that adult patients with autism showed poverty of speech, poverty of content and perseveration (Ramsey et al, 1986). The autism group showed significantly less derailment and illogicality, suggesting that they would be unlikely to meet DSM or ICD criteria for thought disorder in schizophrenia.

Social and communication deficits can be interpreted as evidence of negative symptomatology, so it is important when assessing functioning to establish premorbid ability. These conditions obviously differ in age at onset, developmental history and mental state examination. In DSM–IV, pervasive developmental disorder is an exclusion condition for schizophrenia and it should be suspected in atypical or non-responsive cases. Schizophrenia can co-occur in autistic spectrum disorders, but the additional diagnosis is made only if prominent delusions or hallucinations are present for at least 1 month (less with treatment). Despite an absence of epidemiological studies of psychiatric comorbidity in autistic spectrum disorders, it has been suggested that delusions or auditory hallucinations may be more common than in the general population, but the prevalence of schizophrenia (at 0.6 %) is comparable to general population levels.

Bleuler (1911), founder of the modern concept of schizophrenia, described four primary symptoms necessary for the disorder (the four As): ambivalence, loosening of associations, disturbance of affect and autism, which he defined as dependence on an internal unrealistic world. Both he and Kraepelin (1919) defined subgroups with social withdrawal and affective flattening, ‘oddness' and ‘eccentricity', being timid with a narrow circle of interests and cold relations to companions, and lacking sympathy or attachment. From these descriptions the concept of simple schizophrenia, considered by some to be a diagnostic waste-basket, entered the lexicon. The symptoms described are equally applicable to autistic spectrum disorders, and the subtype ‘simple schizophrenia' has been removed from DSM–IV. Its retention in ICD–10 is a likely source of diagnostic confusion.



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08 Jan 2009, 1:51 pm

But flat effect is not exclusive to Aspergers and Schizophrenia. Its also considered a symptom of Severe Depression and Frontal Lobe Brain Damage.

Perhaps there is an overlap with some as I recently saw a study that claimed there is a connection to having autistic children and the parent having a mental disorder. So if the parent was schizo the child might be influenced into thinking there are voices that exist no one else can hear but not actually hear them.



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08 Jan 2009, 2:07 pm

Ticker wrote:
But flat effect is not exclusive to Aspergers and Schizophrenia. Its also considered a symptom of Severe Depression and Frontal Lobe Brain Damage.

Perhaps there is an overlap with some as I recently saw a study that claimed there is a connection to having autistic children and the parent having a mental disorder. So if the parent was schizo the child might be influenced into thinking there are voices that exist no one else can hear but not actually hear them.

That's a fascinating idea...


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08 Jan 2009, 2:59 pm

I used to take the "Do you hear voices?" literal but I know better now. I know what it means now. They are asking "Do you hear voices that are in your head?"



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09 Jan 2009, 12:26 pm

Ticker wrote:
I've often noticed psychs tend to be disappointed if you say no you don't hear voices because I think they find people with Schizo and Multiple Personality more intriquing to work with.


Actually, my parents (both psychologists) never liked working with schizophrenics. They found it frustrating, because you can't really do too much directly to treat schizophrenia (beyond medication, which psychologists don't prescribe). Mainly what psychologists can do is try to teach the person coping techniques and help them deal with their feelings about it. "Intriguing" doesn't always mean "rewarding to work with." My parents find it far more rewarding to work with patients that they can actually help.

I don't think any psychologist would be "glad" that someone is schizophrenic anyway, even if they find schizophrenia interesting. No reputable therapist would wish such a severe disorder on someone.


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09 Jan 2009, 12:37 pm

LostInSpace wrote:
They found it frustrating, because you can't really do too much directly to treat schizophrenia (beyond medication, which psychologists don't prescribe).


That's what I've found in relation to Autism too. Avoidance is pretty much the only treatment for many of the disabling symptoms of autism (disruption of routine, sensory overload, etcetera), and that's counter to stuff like exposure therapy for specific phobias, and CBT.



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09 Jan 2009, 7:36 pm

Ticker wrote:
But flat effect is not exclusive to Aspergers and Schizophrenia. Its also considered a symptom of Severe Depression and Frontal Lobe Brain Damage.

Perhaps there is an overlap with some as I recently saw a study that claimed there is a connection to having autistic children and the parent having a mental disorder. So if the parent was schizo the child might be influenced into thinking there are voices that exist no one else can hear but not actually hear them.


Severe Depression can cause flat effect and hallucinations. But I understand that Severe Depression is also symptomatic of ASDs. The Frontal Lobe is essentially the personality part of the brain or the social thinking part, but has nothing to do with reasoning or logic. So, severe depression is an indicator of ASDs, but more in depth questioning is needed to determine whether the bigger Spectrum Disorder is present. Hallucinations can be an indicator of an ASD.