Rural doctor plus asperger plus psychotic (?)

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Bastian Balthasar Bux
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31 Jul 2022, 4:40 am

Hello. I' m a 31 years old male, diagnosed with Asperger syndrome when I was 22. I have a degree in medicine from a southern European country and the last 6 months i work in the same country as a rural doctor.

The problem is I have too many psychological issues (with a strong biological basis, i' m afraid) besides "pure" Aspergers, which make me suffer enormously in a day to day basis. When i was 14 I started thinking I am special, beyond the specialness of my peers, a kind of genius who can only communicate with someone equal... I also confronted, before that and simultaneously, extreme bullying and isolation... Then, at the age of 21, i started having depression, which switched to a manic- like psychotic episode at my 23 (2014), for which i was hospitalized for 40 days... During the episode, i had intense religious, persecutory and grandiose delusions similtaneously, along with continuous panic attacks and strange hallucinations (like seeing intense details at once, the faces of people completely distorted, the colours changing in hue completely, sounds seemingly off key, my name being called everywhere)... Since then, and for six more years I suffered interminently from the same symptoms, but i managed to obtain finally my degree and i had some symptom free periods... The problem is that since 2020 and the first lockdown the hallucinatory symptoms have increased and i have them constantly... And although with the help of cognitive behavioural therapy and medications i have greatly reduced the intensity of the delusions, i can do almost nothing for the hallucinations... Imagine having to work as a physician and having all these symptoms... Moreover, all these years after the psychotic episode I have significant memory problems, which mean I do not possess enough knowledge to perform my duty as I should... So, my first question is, what should i do? Should i continue on the same path, as my psychiatrist obliges me, suffering and with only my girlfriend able to understand me? Or should i search for something completely new as a job (which believe me, is extremely difficult on its own where i live)? And my second question is: is there anybody, in this forum or anywhere, who has this combination of symptoms that are not pure aspergers and not pure schizophrenia? Because the loneliness i feel is enormous... And i yearn for people that can understand me... Thank you...



Dillogic
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31 Jul 2022, 9:51 am

Sounds like you're not doing too bad to me. I mean, a degree, GP, and a girlfriend, all in the face of a combination of symptoms of AS/HFA, Manic Depression and Schizophrenia from what you mention. You're doing great, dude. :) I may just be one to look for positives over negatives, though.

I don't know what you should do, as that's your choice.

However, it sounds like your medication isn't adequate right now in controlling your symptoms. Hallucinations are some of the easiest symptoms to knock on the head with antipsychotics, as it's usually just too much Dopamine and/or Serotonin doing them (D2 and/or 5-HT2A specifically), and there's always the silver bullet known as Clozapine if you're already on a higher dose of a typical or atypical and it isn't working (always best to try another typical or atypical before going heavy, as they're all different in pharmacodynamics, and Clozapine can have bad side-effects). When I up my dosage of Zyprexa, I stop seeing the monsters. The monsters don't bother me, though. I learnt to just see them as part of the background noise, much like how you can do with tinnitus.

I meet full Asperger's/HFA and full Schizophrenia (some other things too), and there's a couple of more around here that do. I'm not doing all that well, but I'm that ever optimist (maybe I am doing well considering).



Bastian Balthasar Bux
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31 Jul 2022, 10:20 am

Thank you very much for the time you took to read my post and for your very helpful reply... I try to keep the antipsychotic that i currently take at a medium to low dosage, mainly because I want to avoid the sedating effect of it at my work... And the problem of sedation (along with the fact that i also have an autoimmune disease and i am immunocompromised- clozapine may cause agranulocytosis) is the reason my psychiatrist refuses to give me clozapine... Although we both know of its effectiveness... My psychologist, on the other hand, wants me to deal with the problem the way you do... As a very irritating tinnitus, which i can ignore if i choose to... But i may have to talk with my carers again about my therapeutic options...

Your reply greatly empowered me... Because up to now i only theoretically knew that there are other people with this combination of symptoms... And the fact that i now get to communicate to one , and one who is optimistic about life and doing well, gave me hope... Wish you all the best...



Dillogic
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31 Jul 2022, 10:45 am

No worries, dude. :)

I understand with the sedation and work, and it seems like you and your psychiatrist ended up with the same thoughts as me. If you aren't aware, there's some atypical antipsychotics out there that hit Histamine less (H1), but still hit Dopamine and Serotonin equally as hard, so you get less sedation but similar efficacy against the positive symptoms. Aripiprazole is one IIRC. I know Haloperidol isn't all that sedating either for a typical when taken orally. Also, if you're on an antidepressant, they can sometimes increase hallucinations if one is susceptible to such via increasing 5-HT2A.

There's plenty of us out that getting by how we do. Likely not too common, but we're out there.

Hope helps a lot.



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