90 replies to this topic

[Heh]

I've tried many supplements, many anti-psychotics, brainwave entrainment, and eve affirmations, but I'm still being harassed. I'm currently taking Abilify, and, to this point, it doesn't seem to be working. I've also tried Risperidone, Haldol, Zyprexa, Ativan, etc, and nothing. 5-HTP, niacin, inositol, fish oil, homeopathic remedies, etc.. the list goes on.

Any ideas as to what else I can do?

Edited by Joel, 05 May 2013 - 10:11 PM.

[tunt01]

You might want to clarify what "intrusive thoughts" means. Is this inability to focus (ADHD), is this voices in your head, etc. ?

[Heh]

Not voices per say, just thoughts that seem foreign to me that, among other things, constantly distract me from what I'm doing by saying what I'm doing is wrong, or that I'm stealing, or that what I'm doing is illegal. It's always something stupid, and they frequently bring up idiots from my past, then twist every stupid/wrong thing the idiots did to me until they can say I was the one in the wrong, and that these idiots did nothing wrong, etc.

It doesn't matter what I'm thinking about, I always end up being harassed with these intrusive thoughts. This is very debilitating because I can't think about anything long enough to do anything, and whenever I get an idea or a spark goes off, I instantly get cut off, and then this harassment starts again. This is a miserable place.

I haven't been hearing voices, but when I'm near a noise source (like bathroom ventilation) I hear a noise other than the noise from that source. Also, when I start thinking it's as though something tries to slow me down by repeating whatever I'm thinking about, but slowly. This has been happening since 2011, and while infrequent, the frequency is increasing.

There are also moments when it's as though someone possesses me, and I magically become angry and get an uncontrollable urge to "snap" and break something. I've broken laptops, headphones, etc, and I've put holes in the walls of my mother's apartment.

The intrusive thoughts combined with this "possession" experience make my life miserable. I've been to the Psych Ward three times, and I've tried countless supplements and anti-psychotics. Nothing has helped.

Edited by Joel, 06 May 2013 - 11:44 AM.

[Tom_]

I'm going to ask you a bunch of questions, answer as many as you can please. You will proberly feel uncomptable answering a few if you really don't want to, don't feel any presure what so ever to.

How do you sleep? To little? To much? Broken? How long has this been going on for if its a problem?
what time roughtly would you say you fall asleep? wake up?
How old are you?
Male or Female?
Was there any major psychological truama in your past (you don't need to tell me what it was) such as; abuse by parents or family members (mental, physical or sexual), sexual or physical assult, bullying...was it long term or a once or twice off event?
Have you ever tried to kill yourself, delibarately harm yourself or threaten to?
Do you feel 'empty'?
Are you reckless such as spending more money than you should? Abuse drugs (if so what drugs)? Drive to fast? Bindge eat?
Do you have any pain problems or chronic physical health problems etc?
Have you ever been told you have unusual or weird believes that nobody else seems to agree with? Such as aliens reading your mind, people putting thoughts or controlling thoughts in your head?
Do you dress or behave a lot differently to most people in public?
Do you ever become very exicted and happy/irritable for more than 2 days? Things you might do include spending a lot of money, sleeping for less time than ususal, being very physically active, thinking about sex a lot and getting angry with people when they aren't also as exited?
Have you had a fairly recent check up with a doctor who preformed bloods? How did they turn out?
Do your moods change a lot? What kind of moods do you have? Happy, Sad, Angry, Anxious, excited, Bored
Do the intrusive thoughts cause you a lot of anxiety?
Do you like yourself? Hate yourself?...
Why were you admitted to psychiatric wards? Suicide attempt? risk to others? couldn't look after yourself?
Have you ever had psychotherapy? If so what kind? Did it help?
Have you had any improvement of medications? Can you list all of the ones you have tried? (no problem if you can't) Have you tried mood stabilzers?
What have you been diagnosied with (all health problems from lung disease to depression that are currently effecting you)?
Have you ever been knocked out? If so did your problems start within six months of them in the absence of any major stressors?
Have you ever been charged with more than one non-trivial criminal offence (ignore stuff like jaywalking :L)?
Do you know roughly what your IQ is?

Sorry lot of questions - need to rule out a lot of possibilites. There is a good chance I will have a few but hopefully a lot less after you have answered these.

What ever treatment I'm going to suggest its going to include biological, psychosoical and behavioual interventions. You absoultely will not recover from major mental health problems with just medications alone. They might help you make the changes you need to but they will not do all the work for you.

Edited by Tom_, 06 May 2013 - 07:56 PM.

[Godot]

Sounds like psychodynamic psychotherapy would be helpful.

[Tom_]

Why would that be?

[Godot]

In my experience, it's helpful for this type of issue.

[Tom_]

We don't know what 'type' of issue it is. Do we?

[nowayout]

I haven't been hearing voices, but when I'm near a noise source (like bathroom ventilation) I hear a noise other than the noise from that source.

I don't know about the rest, but I think this is normal and probably not cause for alarm. The brain can "fill in" white noise by making things up. Sometimes at night driving my car on the freeway, I can imagine music in the sound of the wind and engine, especially if I am coming home from a club that played music.

[Godot]

We don't know what 'type' of issue it is. Do we?

Seems like we have a pretty good description: intrusive, foreign thoughts of a blaming nature, and uncontrollable, dystonic impulses of a destructive nature.

These are psychotic-type symptoms, an assessment that seems to be reflected in the meds he's been tried on. There's a general paranoid flavor to the descriptions offered.

Psychotherapy is indicated, and cognitive-behavioral therapy doesn't have much to offer for these types of disorders.

[BioFreak]

Just wondering:

1. did any of these medications / supplements make your condition WORSE?
2. Or does your symptomatic simply not react to any of these substances?
3. Did any show an improvement, but not enough?

Would be great if you could order all you have tried in one of these three categories. Then we could have something to give us a hint.

[Tom_]

Psychotic thoughts and experiences are meant to be ego-sytonic and most psychotherapists recommend that psychodynamic therapy not be used for psychotic disorders (not something I always agree with).

I have to agree some of the writing is pretty jumbled up and make little sense to me but that could be first/second language problems, difficulty expressing an unusual experience or any number of things not related to psychosis.

Lets not forget the percentage of auditory hallucinations in schizophrenia/psychotic disorder is very high; in the 90%s and the OP isn't mentioning any.

I think it could be in no order (all likely to have comorbidities)

OCD
Type B personality disorder (borderline most likely)
attenuated psychosis

less likely to include/not a primary problem in no order
some kind of dissociative disorder
depressive disorder
schizophenria
PTSD

Which would also explain the use of antipsychotics.

[Turnbuckle]

Lets not forget the percentage of auditory hallucinations in schizophrenia/psychotic disorder is very high; in the 90%s and the OP isn't mentioning any.

Schizophrenia is certainly a possibility, and a trial with niacin might be in order. Here is a report from one user on a forum who seems to be going in the opposite direction of the OP, thanks to niacin--

Hi, I am 27 and have had been hearing voices off and on (but fairly consistently) for the past few years. I used to have bipolar symptoms starting at 19, but the symptoms began to become more like schizophrenia after a few years. I also recently stumbled upon the dr. hoffer niacin therapy. I slowly have been raising the niacin dose and am up to 1.5grams a day and the voices seem to have gone. I still get them a little, but they now seem to be more like thoughts than voices.

Hoffer recommends you slowly raise the intake to 3 grams a day. One of his books on niacin for schizophrenia--
http://www.amazon.co...r/dp/0879839104

[Heh]

I'm going to ask you a bunch of questions, answer as many as you can please. You will proberly feel uncomptable answering a few if you really don't want to, don't feel any presure what so ever to.

How do you sleep? To little? To much? Broken? How long has this been going on for if its a problem?
what time roughtly would you say you fall asleep? wake up?
How old are you?
Male or Female?
Was there any major psychological truama in your past (you don't need to tell me what it was) such as; abuse by parents or family members (mental, physical or sexual), sexual or physical assult, bullying...was it long term or a once or twice off event?
Have you ever tried to kill yourself, delibarately harm yourself or threaten to?
Do you feel 'empty'?
Are you reckless such as spending more money than you should? Abuse drugs (if so what drugs)? Drive to fast? Bindge eat?
Do you have any pain problems or chronic physical health problems etc?
Have you ever been told you have unusual or weird believes that nobody else seems to agree with? Such as aliens reading your mind, people putting thoughts or controlling thoughts in your head?
Do you dress or behave a lot differently to most people in public?
Do you ever become very exicted and happy/irritable for more than 2 days? Things you might do include spending a lot of money, sleeping for less time than ususal, being very physically active, thinking about sex a lot and getting angry with people when they aren't also as exited?
Have you had a fairly recent check up with a doctor who preformed bloods? How did they turn out?
Do your moods change a lot? What kind of moods do you have? Happy, Sad, Angry, Anxious, excited, Bored
Do the intrusive thoughts cause you a lot of anxiety?
Do you like yourself? Hate yourself?...
Why were you admitted to psychiatric wards? Suicide attempt? risk to others? couldn't look after yourself?
Have you ever had psychotherapy? If so what kind? Did it help?
Have you had any improvement of medications? Can you list all of the ones you have tried? (no problem if you can't) Have you tried mood stabilzers?
What have you been diagnosied with (all health problems from lung disease to depression that are currently effecting you)?
Have you ever been knocked out? If so did your problems start within six months of them in the absence of any major stressors?
Have you ever been charged with more than one non-trivial criminal offence (ignore stuff like jaywalking :L)?
Do you know roughly what your IQ is?

Sorry lot of questions - need to rule out a lot of possibilites. There is a good chance I will have a few but hopefully a lot less after you have answered these.

What ever treatment I'm going to suggest its going to include biological, psychosoical and behavioual interventions. You absoultely will not recover from major mental health problems with just medications alone. They might help you make the changes you need to but they will not do all the work for you.

How do you sleep? To little? To much? Broken? How long has this been going on for if its a problem?
I don't sleep very well. Difficulty getting to sleep, and waking up multiple times per night. This has been happening since late 2011, but has gotten worse recently.

what time roughtly would you say you fall asleep? wake up?
Recently

How old are you?
27

Male or Female?
Male

Was there any major psychological truama in your past (you don't need to tell me what it was) such as; abuse by parents or family members (mental, physical or sexual), sexual or physical assult, bullying...was it long term or a once or twice off event?
No, but this began in late 2010 after being harassed on the job for months. And due to how similar what I'm experiencing is to what they did to me on the job, I suspected that they were the ones that caused this problem.

Have you ever tried to kill yourself, delibarately harm yourself or threaten to?
No.

Do you feel 'empty'?
No.

Are you reckless such as spending more money than you should? Abuse drugs (if so what drugs)? Drive to fast? Bindge eat?
Yes, spending more money, and that's mainly due to the intrusive thoughts and an overwhelming feeling to just buy this thing or that thing.

Do you have any pain problems or chronic physical health problems etc?
Random pain all over at random times. No chronic health problems.

Have you ever been told you have unusual or weird believes that nobody else seems to agree with? Such as aliens reading your mind, people putting thoughts or controlling thoughts in your head?
No, but I do think someone caused this to happen to me, and/or is doing it to me.

Do you dress or behave a lot differently to most people in public?
No.

Do you ever become very exicted and happy/irritable for more than 2 days? Things you might do include spending a lot of money, sleeping for less time than ususal, being very physically active, thinking about sex a lot and getting angry with people when they aren't also as exited?
No.

Have you had a fairly recent check up with a doctor who preformed bloods? How did they turn out?
Yes. Low RBC, but I know why (Niacin at 1-3g/day).

Do your moods change a lot? What kind of moods do you have? Happy, Sad, Angry, Anxious, excited, Bored
No. I usually feel miserable.

Do the intrusive thoughts cause you a lot of anxiety?
No, they are just annoying and debilitating, but there may be added anxiety. They did at the beginning when I thought everyone was hearing these stupid thoughts and would think I was actually thinking/believing them.

Do you like yourself? Hate yourself?...
Like.

Why were you admitted to psychiatric wards? Suicide attempt? risk to others? couldn't look after yourself?
Yes, 3 times. No suicide, risk to others, or inability to look at myself.

Have you ever had psychotherapy? If so what kind? Did it help?
Not sure, but I've seen Psychiatrists.

Have you had any improvement of medications? Can you list all of the ones you have tried? (no problem if you can't) Have you tried mood stabilzers?
No. Zyprexa and Abilify worked initially (a few days), but then stopped. I've tried the natural supplements Lithium Orotate (helpful for those with Bipolar) and Pantothenic Acid to stabilize mood. And also the anti-psychotics. I listed the relevant ones in my first post.

What have you been diagnosied with (all health problems from lung disease to depression that are currently effecting you)?
Nothing. Each visit to the Psych Ward resulted in a diagnosis of Psychosis NOS. They were trying to decide (the last time I was in) whether I had Bipolar or Schizophrenia, but I don't agree with either diagnosis.

Have you ever been knocked out? If so did your problems start within six months of them in the absence of any major stressors?
No.

Have you ever been charged with more than one non-trivial criminal offence (ignore stuff like jaywalking :L)?
No.

Do you know roughly what your IQ is?
130-135.

Just wondering:

1. did any of these medications / supplements make your condition WORSE?
2. Or does your symptomatic simply not react to any of these substances?
3. Did any show an improvement, but not enough?

Would be great if you could order all you have tried in one of these three categories. Then we could have something to give us a hint.

1. did any of these medications / supplements make your condition WORSE?
No.

2. Or does your symptomatic simply not react to any of these substances?
Generally, no reaction whatsoever. Or side-effects (like inability to sit still, or fall asleep).

3. Did any show an improvement, but not enough?
Zyprexa and Abilify worked for a few days.

Lets not forget the percentage of auditory hallucinations in schizophrenia/psychotic disorder is very high; in the 90%s and the OP isn't mentioning any.

Schizophrenia is certainly a possibility, and a trial with niacin might be in order. Here is a report from one user on a forum who seems to be going in the opposite direction of the OP, thanks to niacin--

Hi, I am 27 and have had been hearing voices off and on (but fairly consistently) for the past few years. I used to have bipolar symptoms starting at 19, but the symptoms began to become more like schizophrenia after a few years. I also recently stumbled upon the dr. hoffer niacin therapy. I slowly have been raising the niacin dose and am up to 1.5grams a day and the voices seem to have gone. I still get them a little, but they now seem to be more like thoughts than voices.

Hoffer recommends you slowly raise the intake to 3 grams a day. One of his books on niacin for schizophrenia--
http://www.amazon.co...r/dp/0879839104

I have tried niacin, and plan to continue taking it when I get the chance. It had no effect on me other than raising my liver enzyme and uric acid levels. I solved that problem by adding vitamin B5 at 1/3rd the niacin dosage.

Edited by Joel, 07 May 2013 - 03:54 PM.

[Turnbuckle]

I have tried niacin, and plan to continue taking it when I get the chance. It had no effect on me other than raising my liver enzyme and uric acid levels. I solved that problem by adding vitamin B5 at 1/3rd the niacin dosage.

How long did you take B3? It can take a while to work, and you may have to take it for years for maintenance. (I take a couple of grams a day for cholesterol, along with Pepcid to stop the acid.)

[Heh]

I have tried niacin, and plan to continue taking it when I get the chance. It had no effect on me other than raising my liver enzyme and uric acid levels. I solved that problem by adding vitamin B5 at 1/3rd the niacin dosage.

How long did you take B3? It can take a while to work, and you may have to take it for years for maintenance. (I take a couple of grams a day for cholesterol, along with Pepcid to stop the acid.)

I started last Sept, but my taking of it has been sporadic. Usually one month at a time. I had done the research on niacin, and after reading the rave reviews had high hopes that it would work. I was shocked that it did nothing to alleviate this problem.

[Godot]

Joel - You said this problem is quite debilitating for you. What are some of the things you would be able to do if the problem resolved?

[docTorpedo]

I doubt supplementing will be very effective. You got to work with your thoughts.
Youtube can provide methods of relief. This channel has some useful stuff about OCD:
http://www.youtube.c...abrain?feature=

Edited by docTorpedo, 07 May 2013 - 06:07 PM.

[Tom_]

Was there any major psychological truama in your past (you don't need to tell me what it was) such as; abuse by parents or family members (mental, physical or sexual), sexual or physical assult, bullying...was it long term or a once or twice off event?
No, but this began in late 2010 after being harassed on the job for months. And due to how similar what I'm experiencing is to what they did to me on the job, I suspected that they were the ones that caused this problem.

Can I ask you how they harassed you?

Do you have any pain problems or chronic physical health problems etc?
Random pain all over at random times. No chronic health problems.

Can you expand on the pains you feel, stabbing, burning, crushing? How bad? 10 would be the breaking of a leg or kidney stones. To get an idea pinch the skin between your index finger and thumb with your nails. That's about a 6. How long do the pains last?


Have you ever been told you have unusual or weird believes that nobody else seems to agree with? Such as aliens reading your mind, people putting thoughts or controlling thoughts in your head?
No, but I do think someone caused this to happen to me, and/or is doing it to me.

By caused, how did they cause this to happen to you?

Few more questions.

Have you considered or made plans for suicide or considered deliberately harming yourself?
Are you in work, university or other long term thing?

[Heh]

Joel - You said this problem is quite debilitating for you. What are some of the things you would be able to do if the problem resolved?

Work, for one-- whether full-time or on my own startup. Be as clever and innovative as I normally am. Resolve the other issues in my life. Move on. Be happy. Move out of my mother's apartment (had to move back in after this started). Girlfriend (in no position to date anyone). Etc.

Was there any major psychological truama in your past (you don't need to tell me what it was) such as; abuse by parents or family members (mental, physical or sexual), sexual or physical assult, bullying...was it long term or a once or twice off event?
No, but this began in late 2010 after being harassed on the job for months. And due to how similar what I'm experiencing is to what they did to me on the job, I suspected that they were the ones that caused this problem.

Can I ask you how they harassed you?

Do you have any pain problems or chronic physical health problems etc?
Random pain all over at random times. No chronic health problems.

Can you expand on the pains you feel, stabbing, burning, crushing? How bad? 10 would be the breaking of a leg or kidney stones. To get an idea pinch the skin between your index finger and thumb with your nails. That's about a 6. How long do the pains last?


Have you ever been told you have unusual or weird believes that nobody else seems to agree with? Such as aliens reading your mind, people putting thoughts or controlling thoughts in your head?
No, but I do think someone caused this to happen to me, and/or is doing it to me.

By caused, how did they cause this to happen to you?

Few more questions.

Have you considered or made plans for suicide or considered deliberately harming yourself?
Are you in work, university or other long term thing?

Can I ask you how they harassed you?
Followed me around. Constantly monitored me. Constantly commented (verbally) on the code I was writing as I was writing it and at just the right time to cause me to lose track of what I was doing. The comments were always negative, but it was the timing that got on my nerves. As I said, they'd always make the comment at just the right time to cause me to lose my place and forget what I was doing. Constant implicit accusations of wrong-doing. Constantly (and maybe implicitly) insulted my intelligence, as though I was supposed to give a sh*t what they think. Nothing worked by itself, but overtime it wore me down, as I was already in a bad place.

Can you expand on the pains you feel, stabbing, burning, crushing? How bad? 10 would be the breaking of a leg or kidney stones. To get an idea pinch the skin between your index finger and thumb with your nails. That's about a 6. How long do the pains last?
It's an uncomfortable sensation all over my back (like someone is poking a bunch of nerves firing off many literal knee-jerk reactions at once), or down my left leg/arm (hasn't happened in a while). Also, and most frequently, there is a poking uncomfortable sensation near my anus and a tightness or tenseness in my stomach area.

By caused, how did they cause this to happen to you?
I don't know. The two situations are just so strongly related and connected that it's hard to believe they weren't directly involved in causing this to happen to me.

[Tom_]

You have given me no good reason to suspect you are actively psychotic and I doubt you have ever been. I wouldn't describe you however as totally free from psychotic like thinking. You could well be more paranoid than one would normally expect, there is no obvious cognitive deterioration (would you disagree? do you feel less intelligent or able to think than you once could? and certainly no incoherence. These outbursts of violence could have a psychotic element to them although again its hard to tell. You are much older than one would expect for a male to develop a psychotic disorder although about the right age for Bi-polar. You however have given no indication what so ever of Bi-polar disorder. I forgot to ask, is there any history of mental illness in your family and what type/s?

I think you have significant obsessive and depressive symptoms. This could be the famous OCD/psychosis (in your case subclinical) disorder I have heard so much about yet never met anyone who is experiencing it.

Medications should take a part in your treatment but they are certainly not going to be a cure all.

You need quality psychotherapy (I'm going to disagree with Godot and recommend Cognitive behavioral therapy). Mindfulness should also make an important part of your psychotheraputic treatment - in regards to anger and unusual feelings, this is something you can practice by yourself (by researching it), in a group (there is likely to be a mindfulness group near you) or as part of cognitive therapy (mindfulness based cognitive therapy).

Behavioral & occupational treatments should take a part in your treatment as well. Exercise is important 3-5 times a week resistance or cardio, doesn't make a massive difference. If that's to much to start with, start with one session a week and build up from there. You also need to be around people as much as possible. You need to do stuff. What - is really up to you. Whether its with a local mental health charity either helping to raise funds or by taking advantage of a service they offer or by going out with friends. Try to occupy your time with something other than browsing the internet or...(I don't know what you should do) a significant portion of this time should be devoted to socializing (I realize this might be quite hard so again take it slow if you need to).

Medication wise, the B vits treatment for schizophrenia as far as I am concerned is a load of hocus pocus. I've not read any convincing evidence for it what so ever. Nor is there any obvious theoretical reason why it should work.

Treatment of obsessive and depressive symptoms should start with an SSRI. I would recommend paroxetine which is the most efficacious in OCD. If this doesn't work normally I would recommend a swap to another SSRI. In this case I'm going to recommend a swap straight to Clomipramine if you are willing to endure some pretty nasty side effects (not usually anywhere near as bad as the antipsychotics) otherwise Venlafaxine and then Clomipramine.

After the failure of Clomipramine I would recommend Amitriptyline (which is very effective at controlling aggression and anger). You could after this decide to try and combine an SSRI with a Tricyclic antidepressant.

I also recommend you use an antipsychotic. You have tried a fair few without success. One you didn't mention was Quetiapine although I am unwilling to recommend such a sedating combination. For that reason I'm going to recommend Amisulpride.

With the antidepressants you should take it for four weeks before deciding it is not having any effect and trial it for 12 weeks if it has had some effect but not made you totally better.

The antipsychotics should be trialed for at least 3 weeks before deciding they aren't making any difference and 6 weeks if they are making some difference but not enough.

Edited by Tom_, 07 May 2013 - 10:16 PM.

[Godot]

In my personal opinion, Joel, everything you've described points to a psychogenic origin to your problems. You had a pre-existing vulnerability to a particular type of criticism or scrutiny, and it got triggered and flared up your paranoia. You need to work with a therapist who can help you understand how came to have that vulnerability, repair the psychological injury you've sustained, and help you build up strength in the correct areas of social and emotional functioning so that you will become more resilient to that type of stress in the future.

CBT might help relieve symptoms in the short term, but does a poor job of resolving vulnerability to the development of future symptoms. You need to address the cause, not the symptoms. And symptoms are the only things CBT and meds are going to address.

[Tom_]

Any self respecting psychiatrist or clinical psychologist will tell you that a brain produces a persons psyche and that is the ONLY reason anyone would ever prescribe a medication. Meds and 'medical interventions' WILL relieve symptoms and in some cases, especially Bi-polar type 1, classical major depressive disorder with melancholic and delusional features, Seasonal affective disorders and certain subsets of Paranoid Schizophrenia be the only needed treatment.

In disorders that seem to be more the result of adverse environment with genetic factors as a secondary cause medication becomes important will not treat a disorder to remission.

Behavioral and occupational interventions remain a constant throughout any disorder.

Any self respecting psychiatrist or clinical psychologist will ALSO explain to you that cognitive and behavioral psychology give a much more scientifically verified, clearly defined and better clinical response than does psycho-dynamic therapy. They might also mention that other than behavioral therapy which could be regarded as a different class off intervention the vast majority of improvement is seen by having a good rapport with the therapist rather than the effectiveness of the therapy. However cognitive therapy remains the only therapy to date that can claim a treatment response roughly equal to antidepressant or antipsychotics not to mention it is also usually much shorter term. The only other therapy of realistically comparable efficacy across a range of disorders (but with less of an evidence base) is CAT or cognitive analytical therapy.

[Godot]

The misconception that psychodynamic therapy does not have empirical support is unfortunately very common.

http://psycnet.apa.o...ls/amp/65/2/98/

The efficacy of psychodynamic psychotherapy.
Shedler, Jonathan
American Psychologist, Vol 65(2), Feb-Mar 2010, 98-109. doi: 10.1037/a0018378

Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as “empirically supported” and “evidence based.” In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings.

[Edit: I have the full paper somewhere, if you'd like to see it.]

Edited by Godot, 08 May 2013 - 02:29 PM.

[moleface]

It's difficult to pin this sort of problem down as a "brain disease" per se. Even the brain chemistry that's associated with these sorts of modes of thought can't necessarily be referred to as the root cause, even though the prescription drugs will definitely help dampen obsessive thought loops or OCD.

My severe OCD symptoms are a good example of this -

For the last half decade or so, I've experienced obsessive self-critical thought loops that would start up literally within the first minute of being awake and then wouldn't go away for even one second until I finally managed to fall asleep at night. I literally couldn't even watch television shows or read books anymore. Normally this condition leaves me almost completely nonfunctional, to the point where my irrational worries and harsh self-cricicisms "play" over anything I try to focus on.

But through lots of intense, difficult, outright painful self reflection over the last year, I've delved deep into my psyche and forced myself to very logically pick apart every irrational obtrusive fear, every self-hating thought, and to come up with solutions that allow me to feel that these issues have received some degree of resolution for me, at least to the point where I accept that I may have deep flaws but I also realize that I'm holding myself to too high of a standard. And once I did this (over the course of about six months, where I'd literally do this and ONLY this with all my free time), I found that my thought loops had gradually GONE AWAY. So obviously there was a "chemical problem" with my brain in the sense that my brain was manifesting the biochemical mechanisms that underly severe OCD, but the root cause of this brain condition was my own psyche and the ridiculously lofty standards I was holding myself to.

As far as supplements go, you might want to look up some info on the recent clinical trials of NAC for obsessive compulsive disorder. I started 2400mg a day about a year ago and actually experienced what felt like a 25% reduction in my thought loops.

Sorry you're dealing with this.

[Tom_]

I'm sure you will either not read them, or read them as 'they are equally effective'. The studies are either showing lack of responses from psychotherapy in general or the superiority of CBT/occupational/social skills training. The general results of the studies suggest a lack of evidence for psychodynamic therapies and even at times for CBT. one or two are just showing psychotherapy actually is only changing the brain and supports my nice little reductionist view of the world. I also figured I'd be nice and fair and include a the few studies I could find against my opinion.

While I really can't be bothered finding the evidence for it you might also be interested in knowing that the only long term treatment that doesn't cause dangerous side effects for insomnia is CBT.

http://www.hta.ac.uk...umm/summ535.htm
http://www.ncbi.nlm....lth/PMH0041583/
http://www.ncbi.nlm....les/PMC2632545/
http://www.ncbi.nlm....pubmed/11288607
http://web151.s02.sr...hsenring_06.pdf
http://www.ncbi.nlm....pubmed/23644038
http://www.ncbi.nlm....pubmed/23643675
http://www.ncbi.nlm....pubmed/23646178
http://www.ncbi.nlm....pubmed/23639303
http://www.ncbi.nlm....pubmed/23647281
http://www.ncbi.nlm....pubmed/23505980
http://www.ncbi.nlm....pubmed/23512628
http://www.ncbi.nlm....pubmed/22895952

The only disorders in which I am willing to except the possibility of equal efficacy of psycho-dynamic therapies to CBT is type B personality disorders (without further evidence). Mindfulness and Dialectical behavioral therapy which is CBT based (although still very different) is however regarded as the most effective psychotherapy in these disorders. I'm talking about short term improvement, cost efficiency, long term outcome...

Anorexia has also shown a slightly more favorable outcome to CAT and Maudsley Family Therapy. However there is still significantly more evidence for CBT type treatments.

I'm quite happy to do this all day. I'm enjoying it and likely pissing you all off but hey, whats the internet for. I also genuinely have the evidence to back up my opinion (I won't say I 'believe' it to be true - personal believe should have nothing to do with this debate). I won't say Psychodynamic and psychoanalytic therapies have no place but they certainly need to prove they do have one.

Edit: P.s I have another 25 +/- 2 ready to be pasted in but removed them due to size of post.

Edited by Tom_, 08 May 2013 - 03:16 PM.

[Heh]

In my personal opinion, Joel, everything you've described points to a psychogenic origin to your problems. You had a pre-existing vulnerability to a particular type of criticism or scrutiny, and it got triggered and flared up your paranoia. You need to work with a therapist who can help you understand how came to have that vulnerability, repair the psychological injury you've sustained, and help you build up strength in the correct areas of social and emotional functioning so that you will become more resilient to that type of stress in the future.

CBT might help relieve symptoms in the short term, but does a poor job of resolving vulnerability to the development of future symptoms. You need to address the cause, not the symptoms. And symptoms are the only things CBT and meds are going to address.

I've spent a lot of time thinking about it, and it is unlikely that I'm weak enough to have "snapped" at the hands of this BS. I just noticed that after I left that company that the things they were harassing me with and accusing me of didn't stop. Actually, the signs that strongly suggested I was being watched didn't stop (started seeing strange postings [and I still do] to Hacker News, and the people around me began to act even stranger). Then a month or two later, I woke up one day and these intrusive thoughts magically started. There was a short build up to them beginning, and since then they haven't gone away.

Everyone claims that this is all my own doing, and that no one is watching me, but I don't really care anymore. I know what I went through. I don't know if I'm being watched now, but the company I worked at definitely meddled farther into my life than they should have.

I've also, though I already knew better, spent a lot of time going through and refuting every single accusation made against me. Some are dumber than others. For example, they continually say I'm white (though I'm African American), and there's nothing to prove there. I'm just clearly an African American. And yet the obsessive accusation from these intrusive thoughts just continue. And are just as debilitating as the others. Again, it could be anything that's repeated, and what's repeated rarely makes sense. It's the fact that it's repeating constantly, and that something seems to drag my attention from what I'm doing to constantly go back and forth with the BS being said that's causing problems.

Also, to address your point, I should make it clear that my situation was more like being kicked while I was down. It took years of constant BS to pull me down to the level that I'd even acknowledge what they were doing to me, and once I was free of that situation, I went right back to normal. Minus the problems I've brought up in this thread. I'm not superman, but I certainly have a strong mental system for rejecting BS. The problem is, when I reject that BS now, or dismiss a stupid thought, it doesn't go away as it normally would/should, and the stupid thoughts are being generated much more frequently (constantly).

I've been to Psychiatrists, and I now doubt they'll be able to help. All I end up doing is repeating myself constantly, and being told things I already know, or being told nothing at all ("just accept it, this is the way it is" and GIVE UP, GIVE UP is all I hear, but that is something I can't do. I refuse to accept that this was my doing, and I absolutely refuse to just live with it. I want this problem gone).

I've also asked around online, and all I hear are the same things, most of which I've already gotten desperate enough to try, but without much success (the anti-psychotic medication being the major one. I absolutely hate that I'm taking these anti-psychotics. And then to top it all off, they aren't working).

Edited by Joel, 08 May 2013 - 03:34 PM.

[Tom_]

I have to say the more you say about what happened the more unlikely it seems. Don't misunderstand me, I'm not saying this did or didn't happen and I don't think arguing about it is going to help you or me. I wasn't there and I doubt I could gather enough information over the internet to make a judgement. Weird and bad shit does happen - all to often, just be mindful that this could also be partly or totally due to delusions. I cannot see the point of a company trying to say you are white when you aren't. That again doesn't mean there wasn't a reason they might try to do it (as an example some kind of tax break or to appease a company director).

I often find myself arguing that something is true when everyone else disagrees with me. That should ALWAYS be a point at which you pause and think "have I got this all wrong". It shouldn't be a point when you dig in and disagree with everyone all the harder or a point when you fold over and agree with someone. Make a rational judgement. Look at the evidence. If you can't trust yourself not to be bias in a matter ask someone you trust to give you an opinion and evaluate theirs instead.

Neither me nor Godot (I'm pretty sure I speak for both of us) think you are 'weak' or anything else of the sort. Although it seems we fundamentally disagree the pathogenesis of mental disorder. (I'm right btw - I joke I'm just pretty sure I'm right as I assume he is)

One of the things you do need to do is stop putting effort into fighting the company on any matter that doesn't directly cause you economic harm. You might be entirely in the right and they are all bastards but continuing to fight them is only going to cause your head more problems and then they really do win.

There is one thing I don't understand that you are saying. You talk about these obsessive accusations in your head but how do they relate to what you believe (I say believe because I cannot prove or disprove whether they did or didn't - not because I'm disagreeing with you(this is the type of thought process you need to learn and which CBT is most apt to teach)) company did to you?

Edited by Tom_, 08 May 2013 - 03:41 PM.

[Godot]

Joel - We all have strengths and weaknesses. In a situation that overwhelms our coping strategies, even someone with a very strong character can start to look borderline or even psychotic. As you said, you were going through a lot of stress before this incident with your employer, and stress is actually sensitizing. So, at a certain point, the stress overcame your healthier and more developed psychological defenses and started this chain of obsession.


Tom - The studies you listed seem to work against your thesis.

http://www.ncbi.nlm....ubmed/23646178/ - suggests that psychotherapy, even in its early stages, initiates physiological changes in the brain. This removes the rationale for medication therapy, and raises questions about what effects meds might have on natural neural remodeling processes brought about by psychotherapy.

Your meta-analyses on CBT vs Psychodynamic therapy all show equal effectiveness in the short term, and, as the Shedler article I posted notes, patients given psychodynamic therapy continue to improve after treatment and have better long-term outcomes.

Of course, any tx vs tx study in this field is going to be flawed, because therapist effects are difficult to account for. Psychotherapy takes more skill and cunning than researchers are often willing to admit.

A couple of studies you posted seem irrelevant to this discussion (e.g. why offer a study showing that therapeutic relationship is important in CBT? And what has DBT for BPD got to do with anything?)

Edited by Godot, 08 May 2013 - 03:59 PM.

[Tom_]

I'm also going to change my diagnosis slightly. I think you have symptoms of depression and ocd which should be treated but rather than prodromal psychosis I'll say there is a good possibility you have a persecutory delusional disorder. This is a disorder I would NEVER say someone has over the internet but I am happy to suspect its a possibility. I'll explain why.

A delusional disorder is:

A. Nonbizarre delusions (i.e., involving situations that occur in real life, such as being followed, poisoned, infected, loved at a distance, or deceived by spouse or lover, or having a disease) of at least 1 month's duration.

Your story is not impossible by ANY means. Its perfectly possible that a company would dick on an employee.

B. Criterion A for Schizophrenia has never been met. Note: Tactile and olfactory hallucinations may be present in Delusional Disorder if they are related to the delusional theme.

You are clearly not schizophrenic, there is no thought disorder, no obvious hallucinations or regular heavy illusions you seem rational and 'normal'.

C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre.

You do have a mood disorder but thats due to what ever the fuck is happening.

D. If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods.

check - mood disorder started afterwards.

Clinical signs include average to above average intelligence (tick), previous normal functioning (tick), onset between days and months (tick), recurrent affective disorders due (tick).


These are the signs of a delusion.

• The patient expresses an idea or belief with unusual persistence or force. No - you don't meet this
• That idea appears to exert an undue influence on the patient's life, and the way of life is often altered to an inexplicable extent. Yes - clearly.
• Despite his/her profound conviction, there is often a quality of secretiveness or suspicion when the patient is questioned about it. I don't know, I'm not face to face with you and it would be understandable if you didn't want to discuss it with some strange armchair psychologist
• The individual tends to be humorless and oversensitive, especially about the belief. Can't tell
• There is a quality of centrality: no matter how unlikely it is that these strange things are happening to him, the patient accepts them relatively unquestioningly. Yes although it has the benefit of not being massively unlikely.
• An attempt to contradict the belief is likely to arouse an inappropriately strong emotional reaction, often with irritability and hostility. I'm assuming so.
• The belief is, at the least, unlikely, and out of keeping with the patient's social, cultural and religious background. Could well be.
• The patient is emotionally over-invested in the idea and it overwhelms other elements of their psyche. That sounds like a load of psychological babble but yes.
• The delusion, if acted out, often leads to behaviors which are abnormal and/or out of character, although perhaps understandable in the light of the delusional beliefs. You have been out of character.
• Individuals who know the patient observe that the belief and behavior are uncharacteristic and alien. You checked that box.

This would also explain a very poor treatment response to antipsychotics which is documented repeatedly in delusional disorder. Pimozide might be slightly more effective.

Again I want to stress, the only people that can make this diagnosis are clinical psychologists and psychiatrists WITH THE WHOLE STORY. I could be astoundingly wrong. This is an hard disorder to diagnose in comparison to say major depression or schizophrenia.