r/AskPsychiatry

Why do killers of the Paranoid Schizophrenic variety know who to target? Im thinking of the likes of Suttcliffe, Napper etc.

If they are detached from reality & delusional why do they have the cunning to attack women, old people etc.? If they are that detached or psychotic why dont we hear about them attacking say groups of men. Or walking into a weightlifting gym or a Boxing club in order to carry out their attacks.

They seem to be sufficiently attached to reality when it comes to choosing a victim.

Am i misunderstanding the nature of Paranoid Schizophrenia? Im not trying to cast doubt on the diagnosis. I just genuinley dont understand

Hello, I would like to know if it was possible to undergo a lobotomy with clear consent.

Could some clinics in Europe (preferably in France or Czechia) perform such surgeries? If yes, which are they, do they need any prior psychological consulting, and how much would it cost?

Just in case, this post isn't bait and is 100% serious. I just want to undergo a lobotomy in a safe and professional way.

I am a 22 year old PhD student who initiated a leave of absence a few weeks ago because of the onset of my first significant depressive episode. My other diagnoses (ASD, ADHD, anxiety) I've had my whole life so developing a whole new set of symptoms was very scary. It was the first time I could no longer keep up with school. I came home to a different state and needed a new psychiatrist who takes my insurance.

I found someone at a major hospital near me and had an hour long intake. At the end of the intake, he told me I needed a higher level of care because he couldn't be contacted after hours and because he "only meets with patients once every 3 months or so." (His schedule is wide open by the way and he treats ADHD and those meds needs a new RX every month). He did not refer me to another physician nor did he refill my meds after billing my insurance. He said my only option was to go to the hospital's crisis center which is similar to an emergency room and be referred to a doctor through them. I replied that I am not in crisis, and I definitely wasn't. (I drove myself to the appointment, my symptoms had improved since leaving school, and I even started a part time job).

The crisis center social worker was shocked and appalled. She called his office but he refused to get on the phone. There is a 3 month waiting list to get a psychiatrist through the outpatient program so they assigned me a temporary NP. This doctor who denied me care is very aware of the situation since he did all his training at the hospital with the three month waiting list.

Do I have any recourse in this situation? I don't want this to happen to other patients. It seems that I was discriminated against based on the complex nature of my issues given that passive SI is a very common symptom of depression and is not a safety concern.

I was having health anxiety after I hurt my back and it spiraled into me being anxious about every health related thing I felt and caused sadness, spiraling and a lot of obsessive and ruminating thoughts about those things. Felt like I needed to fix every health and know what it was. From stress I think I got a vestibular migraine (vertigo) which caused my anxiety to spiral even more, low dose nortriptyline fixed this and then weaned off. Consistently was having health anxiety but then I was put on Zoloft for a year at 50 mg and it worked great and I felt back to normal. Suddenly it stopped working and a dose increase didn’t work. I felt worse than when I started the med, anxious and really upset and down, crying soo much dread and so uncomfortable in emotional pain and waves of panic that arises for no reason. No event caused it.

Cut to the next 6 years: Trying different ssris, SNRIS (both made things worse) and, Remeron (irritability) buspar, Wellbutrin also didnt work (made me way too panicked uncomfortable), sometimes I would Get a brief lift for a day or two when trying some and but then would end up feeling worse. I also would get a brief lift when stopping sometimes I think maybe because of rebound on chemicals in the brain when I stopped but that also was short lived. After going through so many meds without success for 3 years I took a break for a year and felt a little better since the meds were making me worse and bringing me on a emotional roller coaster but I am still worse than when I started Zoloft, anxious about nothing, having crying outbursts a lot, overly emotional and easily emotional triggered and very sensitive to any stress and am now obsessed with getting better and it’s overtaken my life and given me health OCD basically.

I also saw a functional medicine doctor who did a lot of blood tests and there was nothing off and I got the genesight test which basically said SSRIS were never a great option for me but didnt help solve anything. So after the year break and nothing wrong I wanted to try meds again what was in the green section, I tried Viibryd which gave me a brief lift for a day or two at the beginning but then by week 4 made me more panicked and Pristiq which didn’t do much after 5.5 weeks. So now I am doing for TMS but am worried because my symptoms arent typical depression and seems more like nervous system dysregulation.

I’ve had increased panic since beginning TMS. After second session had a couple hours of euphoria feeling happy and energized before spiraling into increased panic the rest of the weekend. Dialed back the depression and just doing anxiety now but not sure whether or not to continue or what to do because it seems my body is VERY resistant to change and sends me into fight or flight whenever i try to push it into a better place. Please help if there are any ideas.

So I (15M), have lots of troubles with my dads wife (I don’t feel like she deserves any other label besides that) but she throws a pissy fit and spews out a ton of insane nonsense any time she’s upset about something about how she’s gonna leave my dad and then forces him into a situation where he has to choose between me or her. The most recent example of this was today. We were having a perfectly good time (which is extremely rare) and I asked my dad if he would start preparing my room so I could trial staying the night with him (I haven’t lived with him since the fourth grade and I just thought maybe if I spent more time with him other than the couple hours I spend with him on Monday’s and Tuesday’s that our relationship would improve) so after I bring that up, we arrive at the grocery store and she seems perfectly fine and we split up and my dad says we’ll meet up so then I have to use the loo and when I get out he’s telling me about how she’s saying she’s leaving him and all that because apparently he didn’t tell her anything about that (mind you this isn’t even close to being kicked into gear it was just a suggestion) so anyhow, she was super inconsistent and said multiple different things like she was gonna file a transfer request for work and somehow pay for the house or something and also she was taking all her belongings to the dump (that’s not very helpful if you ask me) and how she was walking home (this is a real big thing she does every time she throws her little temper tantrums) anyways to sum things up she just freaks out every time stuff doesn’t go her way, she dresses so inappropriately for her age (she’s like 43 and she wears unicorn shirts and rainbow Skechers) and one of the craziest things she’s ever said is when me and my dad found out she has a degree in psychology (terrible major for someone who clearly doesn’t have their life together) and she says she makes more money being the manager at dominos than she would’ve if she would’ve been a therapist. How she came to that conclusion? She applied for one job at a large clinic that’s infamous for treating staff and patients like horseshit. Anyone have an idea why she’s like this? She seems really immature and possessive to me.

is random but im a highschooler and im interested in psychiatry as a future career but im so confused to what are doctors talking about whenever they mention being on "call" like what does it mean? i google it but i never find a clear answer like it's a common sense thing so no one writes down what it is (english is not my first language and ive only been in the US sinceni started highschool so have that in mind) so what is it? does it just mean "make sure to be nearby in case we need you for any emergencies" because thats what ive understood so far.

Hello! I (19F) have been diagnosed with Major Depressive Disorder since late 2023, and a friend, along with some family members, has expressed concern about the amount of medication I currently take daily (See below). Can I ask if anyone has had any bad experience taking the same medications/combinations as mine? I'm willing to answer any questions in the comments if ever. Thank you!

1. Quetiapine Fumarate (QTIPINE) – 25 mg tablet
   • Take ½ tablet at bedtime as needed for insomnia/anxiety.
   • May repeat every 15 minutes if needed.
   • Maximum: 3 whole tablets per day.
2. Vortioxetine Hydrobromide (BRINTELLIX) – 15 mg tablet
   • Take 2 tablets once daily.
3. Clomipramine Hydrochloride (CLOFRANIL) – 25 mg tablet :
   • Take 1 tablet after dinner.
   • Check blood pressure before and after taking the medicine.
4. Phosphatidylcholine + Taurine + Gotu Kola (NEUROTAIN PLUS / PLAIN) – capsule
   • Take 1 capsule once daily.
5. Fluoxetine Hydrochloride (PRODIN) – 20 mg capsule
   • Take 1 capsule 4 times daily
   • or divide doses in another way (example: 1-1-2).
6. Lurasidone (LURASITOR) – 40 mg tablet
   • Take 1 tablet once daily.

Bonjour,

Mon coloc Ayan t eu un unique épisode maniaque avec caractéristiques psychotiques il y a plus d’un an. Récemment, je me suis aperçu qu’il ne prenait plus ses médicaments. Il me dit avoir arrêté son traitement il y a 9 mois d’un coup, sans le dire à personne. Quil s’est auto surveillé, a analyser ses humeurs durant tout ce temps, conscient du risque qu’il prenait, mais que ce médicament le bousillait trop. Il était prêt à le reprendre de lui même si il se sentait repartir.
Mais de ce que je lis, le sevrage, sur un arrêt brutal d’olanzapine a 20mg est violent. Il dit ne pas avoir eu de sevrage et s’être senti rapidement mieux et à nouveau lui même après l’arrêt du traitement. Il est totalement stable depuis plus d’un an, travaille, vie sociale, sport, bonne hygiène de vie, sommeil stable, etc.
Je me demande si c’est possible qu’il ai vraiment arrêté son médicament depuis autant de temps, ou si il est probable qu’il l’ai arrêté depuis peu, peut être juste qques semaines, et, un peu pour montrer qu’il « maîtrise » dise que cela fait presque 1 an sans médicament et que c’est ok, qu’il n’a pas de rechute. Je ne veux pas le fliquer j’essaie juste d’appréhender au mieux cette situation car je tiens beaucoup à lui. Qu’en pensez vous ? Merci de m’avoir lu

I have a friend who suspects they are gifted and AuDHD (both undiagnosed), and after years of trying therapy and admitting that those sessions have become rant sessions instead of anything therapeutic. This time they asked for recommendations from their psychiatrist and said they need someone who are used to dealing with very smart patients, because they would like someone who would challenge their unhealthy thinking patterns. So my question is to psychiatrists on this feed: 1) can my friend come across as full of themselves when saying this to a psychiatrist? 2) is their assessment that counsellors and psychologists who are not used to treating gifted patients often get “out-talked” by a patient very good at intellectualising their problems? And 3) do psychiatrists treat their gifted and/or neurodivergent patients differently than neurotypical patients

I'm not in a good situation. I don't know what else to do.

About 6 months ago I was seeing a therapist in the happiest period of my life. Nothing could harm me and I was invencible. Except for my job.

I began seeing a therapist. I think I knew on some level something was off.

I'm a bisexual male. The therapist asked me how come she could not "see" my sexuality from looking at me and what I thought about people who did "show" their sexuality. This was an ignorant question and I was kind of annoyed at it.

But I answered that I thought they were brave. We continued the session and later she circled back to it.

When she mentioned that I said they were brave I was instantly overwhelmed with anxiety and thoughts "I'm trans, I'm trans." This became obsessive and I immediately abandoned that therapist and started feeling things I had never felt before.

It's fucking terrifying and I'm angry at my happiness being taken from me. I now spend almost every waking minute thinking about this. I did have moments where I felt relief which was when I read about OCD and some OCD patterns and did see some of my thought patterns in there.

I do think there's a level of OCD to these feelings and thoughts, for example recently I was convinced my liver hurt because I drank too much during a long weekend and I scheduled a doctors appointment right away, only to be told by the doctor that livers can't hurt. I was convinced I had cirrhosis or at least fatty liver.

But at the same time there's definetly something else there as well, I never liked my own name and I've been feeling weird about things that were never a topic for me.

And the thing is I really don't want any kind of gender affirming care. I was fine with being a guy all my life or at even neutral about it.

Now my quality of life has severely dropped and I feel incredibly alone I also feel like shit a lot of the time.

In my country gender affirming care would be social suicide and my social connections are the most important thing I have. I kind of feel like my life has been taken away from me.

I don't want hormones or treatments or anything. I just want this all to go away and for me to have some peace of mind.

Realistically what can I do? Because everything I read everywhere seems to lead people to transitions and gender affirming care. Which I do NOT want at ALL and I especially don't want it to be presented as the first/only option for me.

I will admit I spend a long time reading forums about detransitioning. It gives me some sort of relief because it's like I can still come back even If I transition? I don't know anything I'm lost and scared.

And the options between feeling like this forever or imploding my entire life has been incredibly disruptive.

I've went through hospitalisations for self harm and the theme is the same, at each time that my self harm escalates I have a very strong desire to perforate internal organs. I've attempted at doing this a few times by inserting sewing needles into my abdomen, digging an abdominal wound and stabbing myself with scissors. In those moments, it's like nothing else matters, not life, not the future, not the people that I love, not my own health.

The psychiatrists' think it might be psychosis because when I was put on olanzapine, I completely stopped wanting to harm myself. For reasons I won't elaborate on, I went off it for a week and the urges came back in full force. Now, I'm sectioned again. But I'm still confused.

Can psychosis be odd compulsions to hurt oneself badly?

If ADHD is associated with low dopamine, and mania and psychosis are associated with high dopamine, how can someone have all of the above? I am diagnosed with combined type ADHD and the bipolar type of schizoaffective disorder. I can’t take stimulants because they make me manic and psychotic, but on the flip side, my antipsychotics and mood stabilizers don’t worsen my ADHD.

Hi I was diagnosed with BPD traits , mixed anxiety and depressive disorder. I started off with Sertraline which just made me feel angry, then went to Citalopram 40mg and Aripiprazole 5mg to venlafaxine 112.5mg / Aripiprazole 5mg now and honestly I just feel deflated, Venlafaxine makes me feel more anxious and irritated, I’m not getting as much sleep, and sometimes my thoughts and feelings don’t feel like mine. I have serious impulse control issues. I only changed because I felt flat after a while on these meds. I have a meeting with my psychiatrist soon who’ll change my meds and discuss my case with others but what’s next, can anyone help me? I just feel really lost and hopeless now. My moods are all over the place, I’m having more unwanted intrusive thoughts and I feel so stuck. I just want to feel okay

My brother (32M) got married last year in April. Last month, our grandmother passed away at home, and ever since then his behavior has changed so drastically that none of us recognize him anymore.

It started with him suddenly bringing up “childhood trauma” caused by our mother. He says she was extremely strict, a perfectionist, controlling, and that she slapped him as a child. My SIL tries very hard to calmly listen and support him. Once she gently said that in older generations many parents used physical punishment because they themselves didn’t know better and were raised similarly. He immediately snapped at her, accusing her of dismissing and invalidating his experiences and saying there’s no point comparing generations.

The hardest part is that my mother has actually been trying so much to make things right. She has apologized to him multiple times, tried to listen, tried to support him, and keeps blaming herself for his current condition. She genuinely regrets being strict when he was younger and feels completely responsible for what’s happening now. But no matter how calmly or lovingly she responds, something suddenly switches in him.

He will refuse to talk to her for days, then suddenly start acting normal and speaking to her again, and then within hours switch back into anger and hostility. One incident that shocked us was when he asked my mom whether he should go pick up my SIL. My mother casually asked what happened because usually he doesn’t go himself, and he suddenly shouted “chup” (shut up) at her loudly and aggressively.

He has become extremely suspicious and paranoid about everyone around him. He keeps talking to my father about how he has “started reading people” and can tell what they truly feel. He insisted my father is secretly sad, even when my father reassured him he’s completely fine. My brother says he can now “see through faces” and know who is truthful and who is lying.

He has also become intensely spiritual in a way that feels alarming rather than normal. He constantly listens to Shiv songs and chants like “Namami Shamishan” on full volume for 12-14 hours. He says he’s talking directly to God and that God is revealing truths to him. He frequently consumes bhang leaves (cannabis) these days as well.

A few days ago he went to a cremation ground and stayed there alone for hours. After that, he started saying that two souls are following him.

Yesterday he got an axe sharpened and casually said, “I have to slit someone’s throat.” That terrified all of us. He keeps accusing my grandfather of being a liar and saying God will demand answers from him. He told my grandfather, “You don’t need to explain anything to me, you’ll have to answer to God yourself.” He also says our entire house is “full of liars” and for two days refused to eat food at home because of it.

What’s strange is that he himself lies constantly, more than anyone else in the family, but right now he’s obsessed with accusing everyone else of dishonesty and hidden intentions.

He keeps asking his wife whose side she’s on. He repeatedly tells her they need to leave this house and move somewhere else immediately. My SIL has been trying to calm him down and not encourage these fears, so as a compromise they decided to move into a small storeroom upstairs instead of fully leaving the house.

Today he went to our village where my grandfather currently is to look after the farm, which he does every few days. But now he’s hiding inside a room there saying if he comes out, my grandfather will have him killed on the way back. He genuinely seems convinced people are after him.

The scariest part is how suddenly all of this escalated after our grandmother passed away. Before this, he was not like this. He could be stubborn, emotional, or difficult sometimes, but never paranoid, delusional, spiritually obsessed like this, aggressive, or disconnected from reality.

None of us know what to do anymore. We can’t tell if this is grief, drugs, unresolved trauma, psychosis, or some kind of mental breakdown. We’re especially scared because he’s talking violently, believes people are plotting against him, thinks souls are following him, and says God is speaking directly to him.

Has anyone experienced something similar with a family member after a major loss? What are we even supposed to do in a situation like this?

- wanting to be a patient

- wanting to be hurt in the hospital

hello 19m here, so my psychiatrist says he think i might have bipolar and said that he will put me on vraylar for a month to test if i do have it or not, I don't know but this sounds to me wrong somehow can someone please confirm to me if this is standard practice or not and should i comply ? he has been the best psychiatrist i ever saw (i have been to 10+ in 3 years) but i am lowkey scared of trying a new medication, thanks

Hey everyone. I live in Central Mexico, not in a touristy or near the border area. I've been able to buy Bupropion/Anfebutamona up until recently. Farmacia Similares-Dr. Simi just told me that they will no longer be carrying it due to some restrictions from the Mexican government starting in July. Looks like I will need to switch to something else. Open to ideas even c@nn@bis if needed. Anyone have any luck switching to a different antidepressant that won't kill my libido or make me gain 30lbs?

Hi everybody, I have been having heated discussions in the long haulers subreddit and I would like to hear your opinion. I have messaged the mods of this subreddit already, on how dangerous this is but please read this yourself:

https://www.reddit.com/r/covidlonghaulers/comments/1tdvyk4/vagus_nerve_dysfunction_after_covid19/

https://www.reddit.com/r/covidlonghaulers/comments/1teb7e1/my_wife_is_being_labeled_as_insane_and_being_sent/

The comment section is full of people telling them to refuse treatment and that their condition is way worse than they think. They get mad at me for suggesting that these are anxiety symptoms and how they should see a doctor/psychiatrist rather than AI and redditors who are fearmongering.

I think the subreddit long haulers is dangerous to people with anxiety. What do you think?

Over the last couple of years (between 2-3) I have been struggling a lot with depression. I had finally broke and started up therapy again because I was at a point where I was missing work frequently, not completing tasks, and overall suffering severely from anhedonia. This was not at all the person who I used to be. I used to be someone that could never sit still, was always finding something to do, always getting into new hobbies and projects, etc. now I find myself stuck in bed or on the couch scrolling through my phone and struggling to do anything as it just requires too much effort.

I have been on Effexor since I was 19 (I’m 26F) for panic disorder, cPTSD, and generalized anxiety. It has done wonders for my anxiety to the point I almost missed having anxiety. I thought that maybe being on my medication so long that it had began to “numb” me… since I had never had depression before. So I talked with my doctor and had them decrease my dose (I had been on the max dose for years) in hopes that I’d get some of my “Spunk” back that the anxiety gave me. About a year went by and no change. My doctor thought that maybe we could add an additional anti depressant medication and so he tried Lexapro. That medication caused severe suicidal thoughts and constant crying. I immediately stoped it and asked about trying Trintellix because I heard lots of good things about it. He respected my wishes and sent out a script but insurance ended up saying no. At that point he thought I’d be best if a saw a professional…

So this last year and a half I was sent to a psychiatrist where I was diagnosed with major depressive disorder and was sent on a path to find an additional medication to help. Due to my reaction to lexapro she thought I’d be best to combat my symptoms with an antipsychotic instead because sometimes two antidepressants together can increase chances of suicidal thoughts? So I was first started on aripiprazole and it worked for the first couple of weeks. I felt good but around week 5/6 I started having severe panic attacks again (which was under control for years) and developed restless leg syndrome. I was stopped on it and moved to Risperidone. This medication caused extreme hunger to the point it felt like an addiction (food was ALL I thought about) and I was a bit more tired on it. Few weeks go by and we decided to stop this because it wasn’t helping. She then recommended Vraylar and sent out a script… then the insurance sad no. At this point I was defeated with all the time put into this and with insurance saying no to two medications at this point. So I stopped seeing her and took my health into my own hands again.

I switched health providers and was set out to see if there was an additional cause to my “depression”. I have also been struggling with weight the last 5-6 years. I had gained 60 pounds in 4 months and have been trouble shaking it. I had always had issues GAINING weight so I was thinking maybe there is something metabolic going on and thyroid runs rampant in my blood line. Bloodwork on hormones, metabolic, etc all back NORMAL. Back to square one.

Doctor recommended I increase my Effexor again and see if that helps. I agreed but wasn’t hopeful. I thought maybe it’s something I am doing wrong. I was depressed in my job and had no life goals. So maybe that was the fix? I quite my job and pursued schooling again. This was January of 2026. Slowly but surely I felt great. I was making moves in life again, meeting people, motivated. I started a calorie deficit and had lost 10 pounds. Life was GOOD. Doctor was convinced it was the increase in Effexor. I was convinced it was the change in lifestyle. Maybe it was both. But here I am again. The last few months have slowly gotten worse. I stopped my calorie deficit a few weeks ago, started laying around more, stopped walking, and my bad thoughts are crowding my head again. I’m starting to think that the Effexor has once again worn off in its antidepressant abilities.

I don’t even know anymore. I was so happy with getting by without needing another medication. I’m exhausted thinking about starting the process up again. I feel like they aren’t working and when they do it’s short lived. Could there be something the doctors are all missing? The two symptoms that are really bothersome for me is this deep feeling of loneliness and anhedonia. I know one of the primary doctors briefly threw out the words BP2 but wasn’t super convinced. I had thought I had BPD but my last therapist didn’t really think so or at least didn’t think a diagnosis would help… I’m starting to think maybe I’m slightly autistic and that’s why I having difficulty with friends and feel such deep loneliness but I think I’m just grasping for some explanation for why I feel this way and why nothing is working. It’s really hard for me to grasp when I have went years of my life being the complete opposite of what I am now and have so much (I have a house, supporting family, pets, a career, a degree, school, and a loving partner of 9 years)… the only thing missing is s solid friendship…. So WHY am I like this and why are the meds not working? Any thoughts would be greatly appreciated.