It’s not schizoaffective. In a nutshell, what is schizoaffective? We’ll go through the five schizos before we are done. Unfortunately, psychiatrists thought it was a good idea to name five similar disorders starting with schiz and there’s no real easy way to sort that out. So we’ve got to go through them one by one. Basically, here’s schizoaffective. Let’s say you are a schizophrenic and you are like a street person and you hear voices, and you believe that the moon is made out of cheese or whatever, and you get depressed. You are not a schizophrenic with major depressive illness. Psychiatrists won’t allow you to be that. You have to have a new special name and that new special name is schizoaffective disorder. It’s like congestive heart failure can coexist with a broken arm. Well, in psychiatry-land if you are a schizophrenic you can’t have major depressive episodes. You magically become schizoaffective. That’s all that is. Major depressive illnesses differ in that when you treat the person, the schizophrenic goes back to being a street person, but the major depressive disorder goes back to being a housewife. She’s perfectly fine between episodes. The schizophrenic is not fine between episodes.
Dysthymic disorder is basically a low-level depression. This is like people who are chronically depressed. Major depressive illness is, people are going along fine and then boom! They are down there and then you put them on Prozac and they come back up to their baseline. People with dysthymia, they are like down here. They are not way down at the bottom but they are not normal. They just can’t get excited about life.
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Bipolar disorder, formerly manic depression. Mania means episodes of irritable moods, severe enough to cause problems with function. Classically people feel great but judgment is impaired. The symptoms include for bipolar disorder: they are grandiose, diminished need for sleep, pressured speech. What’s pressured speech? It’s like they have this pressure to keep talking. Flight of ideas. It’s just one idea after another, and “I’m going to write a book, I’m going to paint my house …” and just a whole bunch of ideas at once. Very distractible. Increased goal-directed activity but often sloppy and not really productive, and bad judgment. They get involved in driving too fast, spending, sex, involved in crimes sometimes. I had a patient who committed a string of bank robberies and did a lot of time for that, and alleged to me that he was bipolar. That he was having manic episodes when it was happening. I don’t know. Some patients will get psychotic. People will come in and say, “I’m a special messenger from God. I am king of the United States” when they are manic.
In bipolar type II disorder, the person is hypomanic. Hypomanic is they have problems with depression and they don’t have problems with mania, they have problems with hypomania which is sort of a low level mania. When people are manic they are bad. They are out of control, they are dangerous, and they are just not sleeping, they’ve got to be in the hospital basically. Hypomanic people sometimes can do well. They are just really really up and really really enthusiastic. Sometimes it can help their career.
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