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Ask Dr. DombeckAsk Dr. Dombeck:
Psychotherapy and Mental Health Questions

Is Paranoia A Destiny?

Wed, Jun 14th 2000

I am 32 years of age and a resident of the UK. I have been receiving mental health treatment for three years now after a two month stay in hospital with major depression which occurred shortly after starting a university course in a new city. I have received three additional diagnoses, what my psychiatrist describes as 'a very severe form of depression' by which I think he means dysthymia, a 'non-specific psychosis' and paranoid personality traits. I take 400mg per day of nefazodone and two mg per day of Stelazine, which I am hoping to change to a newer and stronger anti-psychotic with fewer side effects if I can (a help line recommended quetiapine.) I see a psychiatric nurse about once a month and my psychiatrist about once every three months for a very short session. I also meditate and sometimes practice relaxation techniques. I generally suffer worst in the evenings from paranoia and anxiety, and I find I lack a sense of direction in my life, am confused about my sexuality and sometimes I feel I am a bit impulsive. Before I was diagnosed I found person centered counseling very useful provided the counselor is experienced and self aware.

I have several questions about my condition, which I hope you will not mind answering. The first is about the prognosis for my condition. From your site and others it seems that there is little that can be done as far as paranoid personality traits are concerned and that these usually either get worse or reach a certain level of severity and then stay there. Also from the little information I have gained from medical abstracts it seems that paranoia is often associated with violence, suicide and stalking behaviors. I find this very worrying as I do not want to be this sort of person, or am I taking this too seriously? What are the best treatments for my condition, if any? Are drugs the only realistic option? Secondly, I wonder about having so many diagnoses. The National Schizophrenia Fellowship here in the UK suggested seeking a second opinion and recommended a psychiatrist who could do this, not to go against my existing doctor but as a one off thing to clarify matters. I would like to do this but I am not sure how my psychiatrist will take it, and there may be funding issues too. Do you think this is a good idea, or have I just not accepted the diagnoses that I have been given?

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