Schizophrenia: Key Questions and Insights for Patients - Psychiatry

Comprehensive questions about schizophrenia?

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Dear Dr.
Wu,
Thank you for taking the time to read this.
I will first provide a brief overview of my medical history, followed by a list of questions regarding my condition.
In March of the year before last, while living alone, I experienced my first episode of auditory hallucinations.
The voices were giving me commands, asking me to do things like isolate myself from others, keep the lights and faucets on 24 hours a day, and other trivial yet absurd tasks.
This lasted for about a month.
As a religious person, I believed these commands were messages from the Buddha (which I now find quite ridiculous).
After a month, the voices stopped, and I returned to my normal life, not thinking much about them afterward.
The second episode of auditory hallucinations occurred from late last year to early this year, also lasting about a month.
Again, the voices were perceived as commands from the Buddha.
I followed these commands with some skepticism until my sister found me and asked, "If this is the Buddha, would He instruct you to do these things?" This question jolted me awake, and I began to examine my actions through Buddhist teachings, realizing I had strayed from the right path, which prompted me to seek medical help.
The doctor diagnosed me with schizophrenia.
From January of last year until now, I have seen three doctors.
I stopped seeing the first doctor because the medication was too strong and caused severe side effects.
I switched from the second doctor because my family felt it was ineffective.
The third doctor has been my current physician since August of last year.

Between May and July of last year, I did not experience auditory hallucinations, but I had strange thoughts.
I began to believe that everything I experienced through my five senses—sights, sounds, smells, tactile sensations, information on my computer, teachings from various monks, and even people on the street—was somehow directed at me, suggesting that they were conveying messages related to the previous commands from the Buddha.
This caused me significant distress and fear, leading me to distrust everyone while maintaining a facade of peace with my family.

I felt as though I was in danger, and I seriously considered that rather than being silenced, I might as well end my life (not in a self-destructive sense).
I recalled instances in Buddhism where an Arhat chose to end their life to liberate their consciousness from a deteriorating body.
I continuously assessed my spiritual practice, reaffirming that I was just an ordinary person (I did make gestures of self-harm but ultimately refrained).
I also researched the consequences of suicide (actual suffering and karmic repercussions) and concluded, through rational evaluation, that I should never take my life in this lifetime or any future lifetimes, as it would be too tragic and not worth it.
I realized I cherished life even more as an ordinary person.
In August of last year, I began seeing the third doctor.
Initially, I was still skeptical, believing there were indeed commands from the Buddha (or that I was cursed by someone), so I did not take my medication regularly.
In October, after two months of self-observation and continuous reflection, my previously firm beliefs began to loosen (that everything was about me and that everyone was watching me, wanting to take my life).
I started to take my medication regularly and now completely view my past experiences as absurd, hoping for a swift recovery.
During my last follow-up, the doctor noted that I seemed more stable and provided me with a continuous prescription.
However, I mentioned to the doctor that I was experiencing recurring anxiety, leading the doctor to revert to monthly follow-ups and increase my medication dosage.
My anxiety is primarily concentrated in my neck and upper back, often appearing without reason.
It manifests as a tight, flowing sensation that distracts me, making it difficult to focus (I have to consciously and carefully adjust my attention).
It resembles the feeling of embarrassment or humiliation that most people experience when they are publicly shamed.
This anxiety often recurs throughout the day (I haven't tracked how many times), affecting my ability to continue tasks or read.
In moments of struggle, I frequently abandon what I'm doing and lie down, coexisting with that feeling (which feels like a form of avoidance).
Currently, my greatest distress comes from this inexplicable anxiety.
I no longer experience auditory hallucinations or feel that everything is about me, but when I think about real-life issues, such as my future path, I do feel anxious.
However, I clearly recognize that this anxiety is psychologically induced (there is a distinction between the two).

I am currently taking Ativan 0.5 mg/tab (twice a day) and Abilify 10 mg/tab (once a day, 1.5 tablets each time).
Here are my questions:
1.
The doctor mentioned that schizophrenia has a broad spectrum, and I fall into a milder category.
What type of schizophrenia do I have?
2.
If we were to rate schizophrenia from mild (1) to severe (10), what would my score be?
3.
How can one assess the negative symptom of poverty of speech? (Currently, I cannot determine if it is due to self-isolation from society for too long, leading to a lack of common topics with others, or if it is genuinely poverty of speech, as I feel my ability to express myself in writing and speech is not as fluent as before.)
4.
I often plan many things to do, but when the aforementioned anxiety arises, it feels as if there is a string pulling me back from taking action, making it difficult to motivate myself.
I often end up lying down for the entire day.
How can I overcome this cycle of anxiety and lethargy?
5.
Is my anxiety a form of negative symptom, and will it disappear with long-term medication treatment, returning me to a state without anxiety?
6.
Is it possible for negative symptoms to completely disappear?
7.
I plan to ordain in the future.
If I consistently cooperate with my doctor regarding medication and find ways to overcome negative symptoms, and if I remain stable for two years without any positive symptoms, will the doctor allow me to discontinue medication? Would this be considered a medical recovery? Additionally, are negative symptoms also a criterion for recovery?
8.
Is the current healthcare system fully interconnected, so that all my medical records are accessible to doctors whenever they swipe my health insurance card?
9.
In the future, if I need to undergo a medical examination for work and do not proactively disclose my history of schizophrenia, will this omission be illegal?
10.
Besides regular medication, adherence to medical advice, and a supportive environment, can relying on positive inner energy and practicing relaxation techniques serve as another form of self-healing when facing adversity? After discontinuing medication in the future, can this method become an effective factor for maintaining mental and physical stability?
Thank you, Dr.
Wu, for taking the time to read this lengthy message.
I look forward to your response.
Wishing you peace and well-being.

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Xi Wang, 40~49 year old female. Ask Date: 2020/01/06