Really low self esteem

[justmehere]

My issues stem from sometime back when I had issues with people coughing. I would find that when someone would cough in my direction I would feel put down or that the person coughing is trying to put me down. Experienced this often at my workplace which resulted in a serious issue me everytime. I would loose confidence and my face would drop in an unsightful facial expression.

I have been working with a therapist who has spent maybe a few sessions on helping me with this issue. The therapy has helped but not entirely. However I have other issues as well which prevent me from wanting to talk face to face with someone whether in a grocery store or at a social situation. My confidence and self esteem is so low that my face shows my low self esteem when I talk. This embarasses me and I find that it makes the other person uncomfortable as well. I also feel untrustworthy following a situation at my previous place of work and find that I am in a hyper vigilance state that makes me always feel on edge and am always scanning the immediate area
to see if I am being watched by others and get very tense if I am. I am unable to work because I lack concentration and confidence badly and the state of hyper vigilance. .

I should say also that I am not able to work because of my lack of confidence and low self esteem and same goes for going back to school to finish my degree. I believe that my lack of confidence and feeling untrustworthy really is hampering my chances of being able to work again and get on with my life.

I am taking 3-25mg of Seroquel which helps me fall asleep at night and no other medications right now.

Any help or suggestions would be appreciated.

[Dr. Adams]

You describe symptoms of a (persecutory) delusional disorder. Since the belief system is irrational, it is not likely that "therapy" is going to resolve this, but appropriate medication may help you organize your thinking.

[justmehere]

Thank you Dr. Adams.

Can you possibly suggest some types of medications that might be appropriate for my situation ? I will then take up these meds with my family doctor. Unfortunately I am unable to find a physciatrist here where I live.

[Dr. Adams]

Your family doctor can research these agents (typically neuroleptics) and discuss this with you, or he may prefer to refer you to a neurologist. You can also search for "delusional disorder medication."

This appears at the Cleveland Clinic website:

"The primary medications used to attempt to treat delusional disorder are called anti-psychotics. Medications include the following:

Conventional anti-psychotics , also called neuroleptics, have been used to treat mental disorders since the mid-1950s. These medicines work by blocking dopamine receptors in the brain. Dopamine is a neurotransmitter believed to be involved in the development of delusions. Conventional anti-psychotics include chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidon (Haldol), thiothixene (Navane), trifluoperazine (Stelazine), perphenazine (Trilafon) and thioridazine (Mellaril).
Newer medications — called atypical anti-psychotic drugs — appear to be more effective in treating the symptoms of delusional disorder. These medications work by blocking dopamine and serotonin receptors in the brain. Serotonin is another neurotransmitter believed to be involved in delusional disorder. These drugs include risperidone (Risperdol), clozapine (Clozaril), quetiapine (Seroquel), ziprasidone (Geodon) and olanzapine (Zyprexa).
Other medications that might be used to treat delusional disorder include tranquilizers and anti-depressants. Tranquilizers might be used if the person has a very high level of anxiety and/or problems sleeping. Anti-depressants might be used to treat depression, which often occurs in people with delusional disorder."

[justmehere]

Many thanks Dr. Adams.

[justmehere]

Dr. Adams can you tell me since I am currently taking Seroquel and have been for 4-5 years and the dosage which I am taking does not help with the irrational thoughts will I require a multitude of the newer and more effective medications that you have mentioned ? I have also tried Risperdol and Zyprexa both separately not together and have not noticed any help with my thought process.

Thanking you

[Dr. Adams]

You should discuss your experiences with the individual prescribing for you. You can also research the drug when used with your symptoms. No one online should be directing your health care. The internet is solely for informational purposes.

[justmehere]

Thanks again Dr. Adams.

I need to ask another question. When I am in hyper vigilance mode or feel that I am being watched or being observed I have trouble concentrating on what I am doing. So if I am reading a book I find myself reading too fast and skipping words and missing out on the meaning of the sentence resulting in having to reread the sentence. Would this be a case of racing thoughts or some thing else ?

Thanking you

[Dr. Adams]

There are many psychological factors that interfere with attention and concentration, not the least of which is depression. Distractibility can be caused by influx of thoughts, preoccupation with other concerns or simply that what you are doing/reading is uninteresting.

[justmehere]

Dr. Adams can you tell me whether being delusional is the same as being paranoid ? Also I have noticed that being in the public does not create any high level of anxiety for me which is good.

[Dr. Adams]

"Delusional" means false belief. They can be grandiose or persecutory (etc) which are paranoid. But they can also have other structure that merely makes them a false belief system. Schizophrenic individuals may have delusions that are not paranoid.