Schizoaffectiveness disorder dx should I forget about medicine and move on?

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DR. Tran

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I was recently diagnosed with schizoaffectiveness disorder. I am very stable on medication with no symptoms. Should I still pursue my dream of going to medical school or should I forget it and move on to something like computer science? I am feeling very normal and symptom free on meds. I am just afraid that the residency process will bring symptoms back on. Also, what will my practicing life be like?

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I have to be honest, hearing about this makes me cringe. I had a student with a similar diagnosis once who stopped taking his meds, and failed out.

Keep in mind that medical school is a furnace, and I've seen it break even healthy students. The #1 reason my school loses students to withdrawal, dismissal or LOA is to unresolved mental health issues.

Make sure your psychiatrist is on board with this first.
 
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There are plenty of people with mental health disorders that are in medicine. If you are well controlled and you have coping mechanisms in place for breakthrough symptoms, you should be okay pursuing a career in medicine. Be aware that there is a lot of stress involved in medical school and beyond, so make sure you are able to handle the increased stress.

Like Goro implied, you are on those meds likely for life. Do not take a chance and try to get off of them in the middle of school. I also agree that your psychiatrist should be on board. S/he will have a unique perspective in that they know your disorder and know the stresses of medical school. Definitely your best resource!
 
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Honestly, I wouldn't recommend it. Individuals with Schizoaffective are at increased risk of suicide. One of the resident suicides at Loma Linda University was someone on the depressive episode of their Bipolar. Try to live a less stressful life. Someone correct me if I'm wrong, but if you end up in a ward after an episode, you could lose your medical license due to being unfit. I wouldn't play around with this diagnosis and a life in medicine.
 
Thank you. I'm so confused as what to do so I appreciate the advice. I feel completely normal right now on 5mg of abilify. But I question if I will have a relasp during training especially during residency. If I do and manage to get it back under control I guess that's not too big of a deal. Can you have a permanent episode and stay hallucinating? My psychiatrist told me most likely not if I stay on meds. He also told me sleep deprivation is a major issue, but does not give me clear advice on what I should do. I pull an all nighter here or there for class etc but no relapse in sx so far. I'm pretty good with taking meds.
 
Honestly, I wouldn't recommend it. Individuals with Schizoaffective are at increased risk of suicide. One of the resident suicides at Loma Linda University was someone on the depressive episode of their Bipolar. Try to live a less stressful life. Someone correct me if I'm wrong, but if you end up in a ward after an episode, you could lose your medical license due to being unfit. I wouldn't play around with this diagnosis and a life in medicine.
And yet, we usually don't talk about the incredibly high numbers of med students and practicing physicians with mental health diagnoses who are doing just fine. Which means that we reinforce this BS idea that you need perfect mental health to survive in medicine (you don't) and perpetuate the stigma that keeps anyone from admitting how common it is in the first place. And so the cycle goes on.

OP: don't ask SDN about this. Don't ask your med school friends who are caught up in the middle of it and can't see beyond "med school = stress don't do it". Don't ask admissions folks unless you want them to make that decision for you.

Talk to your psychiatrist and see what their concerns/recommendations are. And make sure that you honestly, legitimately, ask yourself what you think will be your own particular challenges in med school and residency and beyond, how you'll handle them, what your fallbacks will be when something slips (because something always does, even if you don't have an ongoing condition), and whether you are ready to handle the grind. If you're at all concerned, do something now that challenges you, to see if you're ready. I went wayyyy harder than necessary during my postbacc for exactly that reason; I wasn't going to start med school until I had proven to myself that I could handle time pressure and stress and whatnot without losing all organization or my mental health. Was it a risk? Yeah, I could have buckled in my postbacc and not gotten into med school. But at that point, doing well under the amount of pressure I chose in my postbacc was my own personal prerequisite for attending med school, so if I failed, it didn't matter what the admissions folks thought.

Best of luck to you.
 
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And yet, we usually don't talk about the incredibly high numbers of med students and practicing physicians with mental health diagnoses who are doing just fine. Which means that we reinforce this BS idea that you need perfect mental health to survive in medicine (you don't) and perpetuate the stigma that keeps anyone from admitting how common it is in the first place. And so the cycle goes on.

OP: don't ask SDN about this. Don't ask your med school friends who are caught up in the middle of it and can't see beyond "med school = stress don't do it". Don't ask admissions folks unless you want them to make that decision for you.

Talk to your psychiatrist and see what their concerns/recommendations are. And make sure that you honestly, legitimately, ask yourself what you think will be your own particular challenges in med school and residency and beyond, how you'll handle them, what your fallbacks will be when something slips (because something always does, even if you don't have an ongoing condition), and whether you are ready to handle the grind. .

Agree with the above. The only person (other than yourself) that you should be asking about this is your psychiatrist.

If you feel symptom free/that your symptoms are well managed on your medications then I think that is good (but my opinion shouldn't matter much). You need to get your psychiatrist's blessing and have a plan/person in place should your symptoms break through your meds so you can get them adjusted asap. You also need to be realistic with yourself and acknowledge that there will be many, many stressful times ahead in school, residency, and beyond.

I wish you the best.
 
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I like @mehc012's point but I think it's worth checking in again with why you want to be a doctor. I like what I'm learning in med school and I'm excited to progress and actually be a physician but at the end of the day, I don't expect it to be anything more than a job. A fulfilling and interesting one, but nothing more. Some people feel more strongly about it then that. Not that if you're like me you shouldnt do it, but it affects the decision and what alternatives you have.

Hope everything goes well!
 
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I know a girl with an Bipolar Type 1/Borderline who needed medication starting since end of high school/beginning of college per her report. During orientation we already recognized red flags like healed cutting marks, she would go off on tangents and share way too intimate details with us about her hospitalizations, and would be extremely sexual at certain moments. She was a good person at heart as most of us are and she was also responsible for herself. One thing I think she did right was follow with a psychiatrist and therapist very regularly and made it part of her routine. She ultimately dropped out but she did not really fail classes or have a manic episode or get hospitalized. When she was near her personal breaking point in first year she consulted his psychiatrist/therapist and left quietly and went on with her life and is now happily in a long term relationship with minimal debt, a decent paying job, and an active social life.

It would be irresponsible not to say that SDN isn’t the place to make this determination, but that being said, if you’re the type of person who is takes responsibility for your mental health, there should be no reason for why you should not at least attempt medical school.
 
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And yet, we usually don't talk about the incredibly high numbers of med students and practicing physicians with mental health diagnoses who are doing just fine. Which means that we reinforce this BS idea that you need perfect mental health to survive in medicine (you don't) and perpetuate the stigma that keeps anyone from admitting how common it is in the first place. And so the cycle goes on.
There are many, but how many of them are schizoaffective (psychosis + mood disorder) or have another mental health condition that includes psychosis? Imagine one psychotic break endangering patients. It's incredibly naive (maybe outright stupid) to not take this kind of diagnosis seriously and pretend it's the same as someone with OCD, Depression, Anxiety, etc.
 
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There are many, but how many of them are schizoaffective (psychosis + mood disorder) or have another mental health condition that includes psychosis? Imagine one psychotic break endangering patients. It's incredibly naive (maybe outright stupid) to not take this kind of diagnosis seriously and pretend it's the same as someone with OCD, Depression, Anxiety, etc.
Thanks, I'm aware of what schizoaffective disorder is. I'm pretty sure that their psychiatrist is also aware of what schizoaffective disorder is, as well as what med school is. Your post also went beyond schizoaffective and started discussing med students with bipolar, and essentially any group with increased rates of suicide.

That may very well not have been your intent. Nonetheless, that is how it came across and so that is what I was responding to. Not to mention that I would likely have brought up this aspect regardless of preexisting posts in the thread; yours just happened to be a convenient example of the all-too-common attitude, intentional or not, that people with mental health issues just aren't cut out for med school. Call me stupid all you want; I'm not going to keep up the facade that most med students don't struggle with this crap, and I'm going to defer the judgements on what's appropriate for an individual with a mental illness to...their mental health professional.
 
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Thanks, I'm aware of what schizoaffective disorder is. I'm pretty sure that their psychiatrist is also aware of what schizoaffective disorder is, as well as what med school is. Your post also went beyond schizoaffective and started discussing med students with bipolar, and essentially any group with increased rates of suicide.

That may very well not have been your intent. Nonetheless, that is how it came across and so that is what I was responding to. Not to mention that I would likely have brought up this aspect regardless of preexisting posts in the thread; yours just happened to be a convenient example of the all-too-common attitude, intentional or not, that people with mental health issues just aren't cut out for med school. Call me stupid all you want; I'm not going to keep up the facade that most med students don't struggle with this crap, and I'm going to defer the judgements on what's appropriate for an individual with a mental illness to...their mental health professional.
I'm surprised you know because you didn't seem to grasp the severity. Have you even rotated in psych yet? I gave the example of how someone with Bipolar 1 committed suicide as to illustrate that mental health is not a joke and the consequences have been seen in medicine, but at no point did I say anything about everyone with mental health. If you read too much into my comment, hopefully this one clarifies it once and for all.
 
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So true schizoaffective disorder is nothing to brush over. I’m with Goro on this one. You can have all the help from your psychiatrist and medicine in the world. It won’t change the fact that actual Med School won’t give a damn and will still come at you with all the stress and demands it does for everyone else. At the end of the day to graduate you gotta take the same tests, have the same skill sets and be socially engaged just like your peers.
 
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I'm surprised you know because you didn't seem to grasp the severity. Have you even rotated in psych yet? I gave the example of how someone with Bipolar 1 committed suicide as to illustrate that mental health is not a joke and the consequences have been seen in medicine, but at no point did I say anything about everyone with mental health. If you read too much into my comment, hopefully this one clarifies it once and for all.
You've said nothing clarifying, but you have solidified that you'd be miserable to have a discussion about this with, so let's leave it there.

Now we can get back to the regularly scheduled "med school is the most stressful thing ever you won't make it" circlejerk that half of the threads on SDN eventually devolve into.
 
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I have to be honest, hearing about this makes me cringe. I had a student with a similar diagnosis once who stopped taking his meds, and failed out.

Keep in mind that medical school is a furnace, and I've seen it break even healthy students. The #1 reason my school loses students to withdrawal, dismissal or LOA is to unresolved mental health issues.

Make sure your psychiatrist is on board with this first.

^^
This, as someone who has a sibling with schizoaffective, I end up seeing how bad it can be from different angles. It varies person to person. Med school is hard by itself, like Goro said.

Like I told someone with immunosuppressive drugs: talk to your doctors and find something that you CAN do, as a back up. Mental illness, like any other disease or illness, can change over time. Its not always stagnant. Things can be good, or can get worse. Just make sure you are prepared if you can't.
 
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^^
This, as someone who has a sibling with schizoaffective, I end up seeing how bad it can be from different angles. It varies person to person. Med school is hard by itself, like Goro said.

Like I told someone with immunosuppressive drugs: talk to your doctors and find something that you CAN do, as a back up. Mental illness, like any other disease or illness, can change over time. Its not always stagnant. Things can be good, or can get worse. Just make sure you are prepared if you can't.
( referring to the bolded)
Is that serious enough that it would make someone doubt if they can go to Med school? Immune suppressive drugs aren't the same thing as being immune compromised.

( I'm not trying to be argumentative , I'm really just curious).
 
( referring to the bolded)
Is that serious enough that it would make someone doubt if they can go to Med school? Immune suppressive drugs aren't the same thing as being immune compromised.

( I'm not trying to be argumentative , I'm really just curious).

It really depends on how long and what they're used for. Most of those immunosuppressive drug DO compromise you. You can (and most people will have) get sick easier. Because they either suppress the entire immune system or remove a component that is necessary. (Like Biologics)

If you do go to med school, having those drugs itself is very difficult. You can essentially catch even minor diseases and get sicker than other people would normally. That...can be dangerous depending on the reason you're on it. (In that thread, the individual would habitually go to the hospital because they were on immunosuppressive drugs since they had an organ donated and kept getting sick from various illnesses )

Immunosuppression can and has led to being compromised. That's why you get those warnings, actually. If you listen to the humira commercials or the entyvio commercials, they do warn you about compromising your immune system. Working with patients in that manner is dangerous for you. Thats also why they check you for diseases prior to getting those drugs, to.
 
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Thank you. I'm so confused as what to do so I appreciate the advice. I feel completely normal right now on 5mg of abilify. But I question if I will have a relasp during training especially during residency. If I do and manage to get it back under control I guess that's not too big of a deal. Can you have a permanent episode and stay hallucinating? My psychiatrist told me most likely not if I stay on meds. He also told me sleep deprivation is a major issue, but does not give me clear advice on what I should do. I pull an all nighter here or there for class etc but no relapse in sx so far. I'm pretty good with taking meds.

I think a permanent episode is unlikely, especially with meds (I work in mental health, but I’m not an expert by any means), and your psychiatrist is right that sleep deprivation (especially chronic) can be a trigger for mood episodes. I absolutely don’t think you should rule out med school because of a mental health dx, but you’ll need to ask yourself if you can commit to self-care and balance that with your studies. Self-care is important for any student, but the consequences of a lapse in self-care if you’re struggling with mental health issues can take a larger toll. Maybe being “pretty good” with taking your medications is working for you now, but why risk leaving anything up to chance once the pressure is really on as a med student.
 
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