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Re: Schizophrenia/ Neuropathology

Posted by Levi on August 14, 1998, at 1:02:38

In reply to Re: Schizophrenia/ Neuropathology , posted by Toby on August 13, 1998, at 16:23:23

More thoughts? You bet...
I have found the diagnosis of schizoaffective (hmm..) to be quite puzzling. I view it as a sort of "dumping ground" for patients who warrant a full affective diagnosis and also cannot be excluded from the schizophrenia spectrum. I've come across many different opinions - one which I don't seem to agree with - is that SCAF is "between" bipolar (perhaps w/f psychotic features...) and schizophrenia. The patient seems to be both, but at the same time not exclusively an element of one diagnosis. I think, i.e. it is my opinion that the "between" thing is just a misunderstanding on behalf of the mysterious "duality" that is presented - why did the DSMIV seperate this and not include it as a subtype of schiz - because people kept "missing" theses two diagnoses or because people kept having these two diagnoses (affective+shiz symptoms). It seems a mask that the DSM claims that the patient has to have a..."two week vacation" from mood disruption. My Doc has emphasized, and I'm sure you do, that the diagnosis is not so as important as the symptoms (which are inevitably going to lead one to one or another diagnosis anyway). But the Doc treats the symptoms. My Doc has said his definition - he has stated that person A is more on the schiz side, and person B is more on the affective (low, high, mixed) side, etc. He has also stated that his definition of 295.7 is Shiz+affective. But why? Schizophrenia will almost always induce, say, post-episodic depression, and the suicide rate speaks for itself. Schizophrenia is not exclusively "no" affect but "inappropriate" affect, or any affect at all is present. So why extract 295.7 from shiz? I do know that the thought disorder is related to dopaminergic action in areas...and that depression is wrapped up with other neurotrans..etc. The kreaplin dichotemy obviously is true in that it is the case that thought and mood are different areas of the brain - obviously they "affect' eachother. But is this dichotomy still acceptable? Will 295.7 evolve into something else, stay as it is, or go back to an earlier model? Sure, there's a ton of cases where mood and thought go awry, but this seems to debunk the kreaplien distinction. Not warrant it - or maybe 295.7 is an expression of the error of the dichotomy? What will become of this? What about schizo-obsessive! Or shizapanica! Or schizo-add. In these, schiz would be primary, and the other diagnoses would be secondary - i.e. they would not be the number given to the wonderful insurance companies. But "affective" - this really warrants its own correlation, as if reg. shiz don't get depressed? The DsM makes it clear that there must be mood-incongruent symptoms, delusions,etc. What's the deal?




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