I am a 31-year-old woman who has been diagnosed with clinical depression in the past. Within the past two years I've had increasingly strong beliefs that people are reading my thoughts, that they're conspiring against me, and that when I'm "alone" I'm being observed. I don't hallucinate or hear things. I occasionally have feelings of electrical shocks going through my body. The mental health care caseworker I am seeing says a schizoaffective disorder diagnosis would not apply to me because I don't have hallucinations or hear things, and he says I don't look schizoaffective. A friend of mine has talked to two mental health care professionals about my situation, and they both agreed schizoaffective sounded possible and that antipsychotic drugs might help me. I would like to find a way to function positively in the world; the suspicions are making it very frustrating. Is it possible to be in a stage of schizoaffective disorder even though I don't see or hear things? -- Kelli

Make that three mental health care professionals who think schizoaffective disorder might be a possible diagnosis and that antipsychotic drugs might help you.

Your mental health care caseworker may be very good at case management, but I seriously doubt he's trained or licensed to diagnose mental or emotional disorders. In the state in which I practice (Tennessee), the typical mental health care caseworkers are unlicensed individuals with bachelor's degrees. Some may be working on master's degrees in social work or related fields. But social workers are not trained or licensed to diagnose mental and emotional disorders -- only psychiatrists and psychologists, or people working under their direct supervision, are qualified to do that.

Yes, you -- or anyone else -- could have schizoaffective disorder without having hallucinations (seeing or hearing things that aren't really there). People can even have schizophrenia, including the paranoid type, without experiencing hallucinations. (There are other criteria that they would have to meet, however, that I won't go into now.)

Some people with clinical depression also develop psychotic features such as delusions. As a result, it's often difficult to differentiate schizoaffective disorder from the condition called major depression with psychotic features.

Bottom line -- you need to see a licensed psychiatrist who can evaluate you, make the appropriate diagnosis, and prescribe different medication, such as an antipsychotic, if he or she thinks that would help. While a psychologist could perform the evaluation and make the diagnosis as well, he or she would not be able to prescribe medication for you. Currently, only a licensed physician, such as a psychiatrist, or a nurse practitioner under a physician's supervision can do that.

If you are already on medication prescribed by a psychiatrist, please contact him or her and request an evaluation for possible schizoaffective disorder and to discuss whether antipsychotic medication could help you. Be sure to tell him about the beliefs and somatic (bodily) sensations you are experiencing. If your caseworker needs to arrange such an evaluation and he continues to say you can't have schizoaffective disorder because you don't hallucinate, tell him to look up the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the "bible" of psychiatric diagnosis. Better yet, remind him that your psychiatrist or psychologist is the one who's supposed to make the diagnosis.