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Severe depression and possible schizophrenia

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I have been drinking about 9 units of alcohol a night (usually one bottle of wine), and taking legal highs most nights, some of which have been fairly strong.
I haven't done this since over 24 hours ago now. This level of intake has been going on for about a week-a week and a half, not very long, but its been a dramatic change from not drinking at all or taking drugs for over a year.
I keep twitching, and not being able to keep still. I also have a really bad headache which comes and goes, and I hear white noise-like sound in my head periodically. I also have stomach ache with comes and goes, but is quite severe.
I am not on any medication currently, but I've treated for severe depression. Before I started the drugs/alcohol I was hearing voices, hallucinating, getting really paranoid and irritated and overworking for a period of about two weeks.
I do have a psychiatrist, but I find it very hard to talk to him. My GP when I've gone to him before has said he has 'nothing to suggest' So I feel a bit stuck about what to do, with things getting worse it seems.
I'm a 21 year old Female.

Category: Family Physician-GP

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Your current symptoms including twitching, irritability hearing voices etc are most likely from an underlying psychiatric condition. I am pretty sure that you are also aware of this. Apart from depression there could be a component of Schizophrenia which need evaluation. Alcohol and getting high could worsen these symptoms but they are not the cause for these.

I understand when you say you do not want to be "controlled". But in this stage there is no other option, but medication. You will require anti psychotic medication for immediate control of the symptoms. If feel you feel like harming yourself, DO NOT PROCEED - get in touch with National Suicide helpline. Get in touch with your friends and family.

I would like to know (1) are willing to under go a formal Psychiatric evaluation and take medication if you can find a trustable medication (2) What is the most troubling / worrying thought ? (3) Are you constantly worrying about something personal / work ? (4) Do you find it difficult to find pleasure in life general ? (4) What you do think could make you feel better ?

YOu can reply as a followup
Thank you

Patient replied :

1. I'd have to be in the right mindset/environment. I have had two appointments with a psychiatrist since January, both which lasted no longer than ten minutes and were more of a monitoring thing I think. But in the first appointment when I started to explain why I would take legal highs which I don't know the contents of, and why I wouldn't take prescription drugs, he laughed at me. So now when I go to the appointments I shut down, and don't really say much. I wouldn't be able to change doctors because I don't have the drive to do that, and I've tried to change doctors, but whenever I try to do this I'm told "he's the best in the country" and its brushed aside. I do try to take the Sertraline 50mg I've been prescribed, but I can never actually do it, because I just don't trust it. So I think, under the right circumstances I'd be okay to have an evaluation, but I don't think I'd willingly take the medication.
2. I worry the most about being watched. The hallucinations I've had are these laser-like flashes coming out of things like wooden doors and toilet roll holders. And I think they were 'scanning' me or something. While I know that rationally can't be true, my gut instinct still tells me it is. And I don't want to be watched because I get scared that people know more consciously what I am. Because I'm wrong/less than human. Like, a curse. I bring bad things to people.
3. I worry a lot about this 'wrongness', and because the problem is myself, and not a situation, the only way I can stop the problem is by stopping myself. I have plans in place to end my life late June, I just really need help getting by until then. Because I need to graduate, end my tenancy, sort out my finances and tie up loose ends before I do it.
4. Yes, I used to have a lot of hobbies, now I can' be bothered to do anything.
5. I don't know. I am asked this a lot. I have been asked 'how can we help you' by many different people. I usually just say I don't know. Because I don't know. And I don't really think I can be helped, because the problem is what I am.


Thank you for the reply. Your symptoms and suicidal ideation are suggestive of Schizophrenia pattern. You should get medical help as soon as possible. I understand you are not comfortable with your Psychiatrist, but I am afraid atleast as first step you need medications. You do not seem to have a reality distortion and you seem to be aware of your mental changes. In that case consider your Psychiatrist as a necessary intermediate for treatment and diagnosis (and nothing more).

Psychological counselling and CBT (Cognitive Behavioural Therapy ) can help you in this in a great extend. But the issue is that you need anti psychotic medication for the initial control of symptoms. You should see whether you can work something our with your Doctor. Sertra alone is not enough for your symptoms.

From what I understand you are aware of your symptoms and you need understand that you need help. This is a very good sign. You should capitalise on this make urself accepting to treatment atleast for a short while before CBT can be considered.

Meanwhile try to stay positive . Get back to atleast one of the hobbies you had. Stay active.
I am not an expert in Psychiatry, but I will try my best to help you out here. Feel free to ask followups/ clarifications.

Thank you

Patient replied :

Surely if I have insight into my mind set, the problem isn't that bad? I have an appointment with my psychiatrist on the 17th February, would you advise bringing this forward? I'm not coping very well at the moment, and finding it very hard to resist taking drugs/drinking.

Yes if you have insight the problem isn't very bad. Infact many individuals lose insight by this stage and it could be really troublesome. Keep an open mind for the psychiatrist appointment. I would even say just consider your MD as a tool for diagnosis and initiation of treatment. If you can get past this first stage then things will be better.

Meanwhile just focus two things - Moderate aerobic exercise, 1 hobby you like. There are strong evidence to say these two activities can bring some amount of change in outlook. Medication is really necessary. In case if you get any suicidal ideation do contact the National Anti Suicide Support line.

Hope this helps
Thank you

Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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