Issues of nosology (ATTN: Raziel) and meds!

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So I saw my psychiatrist today. I've been under a lot of stress lately with trying to get everything right for sex reassignment surgery and I had been having to take my full dose of clonazepam and even some Benadryl to help sleep. He thinks I've been having some troubles with obsessiveness as well, so he's upped my clonazepam dose to 1 mg BID and given me paroxetine. He says that the clonazepam should help counter any agitation caused by the paroxetine (as my experience with fluoxetine shows SSRI's can make me agitated). So we're working on that. I'm working on dealing with lodging and travel expenses, as those aren't generally covered by insurance and all the uncertainty over it has greatly stressed me out.

I also discussed some psychotic-like experiences and my psychotic episode at 14. He seems pretty sure I'm not on the schizophrenia spectrum, just on the autism spectrum, but I do wonder if there isn't an issue of nosology here. I do note I have a lot of the self-disorders mentioned in the EASE and in the opinion of a schizophrenia researcher who has published research in the peer-reviewed literature, a large number of self-disorders in an apparently autistic person actually points more to a schizophrenia spectrum condition. That would explain the psychosis at 14, kinda, but it's apparent that psychiatry is a mess when it comes to nosology and I get the sense that none of us have any idea of what to expect in the future.

Maybe because I'm getting 30 years old, my vulnerability for any more psychosis is coming to an end, but it's also possible that this stress that I'm going through with trying to get SRS and trying to adapt to things might trigger something. I remember deliberately cutting corners and underachieving as a teenager and young adult to avoid stress. I would skip class, not do homework, take lots of time off work, not push for the latest greatest jobs or anything like that, because during times where I did try to do it all, I ended up only exhausted. I also maintained very strict structures and routines, always making sure to give myself plenty of free time to indulge in my restricted interests. Of course, the consequence is that I underachieved in work and school, not meeting my full potential, because the stress just gets to me. I wonder, Had I pushed myself, would I have developed psychosis?

When I was a teenager, after that psychotic episode, I swore off all illegal psychoactive drugs ("Not for me!," I said). The psychotic episode at 14 proved to me that there was something not quite right in my head and that adding to the stress and the trouble could just make things blow up.

So, let's say I get my surgery and I start removing some of that structure (as my current structure is largely geared toward getting that), and then let's say I go to teach English in Japan. Could the stress and the culture shock (despite understanding a good part of the language), the open-ended workdays (which I hear are very common in the Japanese workforce, including in eikaiwa; by open-ended, I mean, you don't know when your workday will end as you employer might want you to stay long after your shift for other stuff), and being away from any support trigger an episode of psychosis? Maybe the reason I've been able to avoid another psychotic episode has been my ability to cut corners, reduce workload, keep for myself lots of free time, maintain family support, etc., and once those factors go away the decompensation may resume.

Or maybe I'm now too old. Who knows, right?

People might say I'm being obsessive, and it is true; I did some pretty effed up crud when I was psychotic that I don't want to repeat. But I am also legitimately interested in this, like it's become one of my restricted interests, so I will keep studying and let things come as they may.