Posted by medlib on April 13, 2000, at 21:10:58
In reply to Re: DSM diagnosis...., posted by JohnL on April 13, 2000, at 4:30:01
JohnL--I always enjoy your posts; you bring literate thoughtfulness to whatever you address.
Re diagnoses: It is the function of *all* medical diagnoses simply to specify *what* is happening *where*. Most dxs have more than one potentially causative agent and nearly all have more than one treatment option.
For example, the pneumonia I was just recently hospitalized for just means (as I'm sure you know) inflammation of the lung; it could have been viral, bacterial, tubercular, or even fungal. Even knowing that it was bacterial didn't limit treatment choices much--in fact, it took 4 different antibiotics to beat back the "bug". As in psych meds, some of the most effective agents have the worst side effects. (Vancomycin did a good job of lowering my white count, unfortunately, it did an equally good job lowering my red count to the point of anemia.) I'm allergic to most of the ABs that work best for this dx, so you could say that individual variability strongly affected treatment choice.
My point? Don't expect too much of a dx label--it's no more than a first-pass catagorization. Does it have *any* value? That depends. Some symptoms require the same immediate treatment regardless of dx--my SOB needed oxygen tx, whether it was caused by hemorrhage, heart attack, or pneumonia. But you could say that the dx label "pneumonia" saved me from more invasive tx for other potential problems with similar symptoms. A psych equivalent might be a full-blown panic reaction. I would think it would require a fast-acting anxiolytic, regardless of whether it was part of a schizophrenic hallucination, a bipolar mania, or a phobic escalation. But what you would do next would depend on a dx label.
To me, the biggest difference btw. mental and other physical illnesses is the lack of cheap (relatively) diagnostic tests or procedures that can pinpoint the cause *after* a dx label is determined, as blood and C&S tests do for pneumonia, for example. Of course, it isn't always possible to specify "why"; but, for most other diseases, more specific tests can at least eliminate some "not whys". It's a sad commentary on the state of the "art" that psych practitioners have to use treatment to infer cause (practically speaking, and most of the time).
What an incredibly lengthy way to say that diagnostic labels matter, but their utility is limited. Sorry to be so wordy--medlib
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> > I am a student trying to find an expert, all axis diagnosis for the actor/ Robert Downey Jr. Anyone have any ideas? Thank You.
>
> Regardless of who the patient is, I find DSM diagnosis to be a very futile strategy. That's because regardless of the diagnosis, the underlying causes vary dramatically and are treated by at least ten different general approaches for the exact same diagnosis. And there is a lot of overlap as well. An anxiety medication may be the magic ingredient to cure someone's diagnosis of depression, where antidepressants didn't work. And vica versa. Just one of dozens of examples. Could go on and on with endless examples.
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> Let's assume for example we believe we have a concrete iron-clad diagnosis of bipolar depression. OK. But how useful is that? The cause could be low serotonin; low norepinephrine; low dopamine; elevated dopamine; elevated norepinephrine; GABA deficient; chemical instability; electrical instability; norepinephrine/dopamine failure; thyroid; hormones; blend of more than one. Which is it? Only through the trial and error process of different drugs can we gather clues as to what is going on. Knowing that a person has bipolar depression (just one example) is nearly useless, because it doesn't provide any clue as to the cause of the problem. I believe putting a label on the condition is rather futile. I mean sure, a diagnosis of bipolar depression would have a higher probability of responding to a serotonin medication and/or a mood stabilizing medication than other choices, but really not much more than a 50/50 chance. Flip a coin. Only trial and error will tell.
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> I believe the same reasoning applies to every other possible DSM diagnosis. What the person suffers from is almost irrelevent. All that matters is what treatment will get them well. DSM diagnosis provides little scientific guidance in that respect. We can put a label on the person's symptoms if we want to, but we are no closer to treating the person than we were without a label. It may be a medication outside of that DSM diagnosis that cures the person, not one we would normally expect. And ones we normally expect to work fail time and again. It all depends on the cause of the problem, not the name of the problem.
poster:medlib
thread:29662
URL: http://www.dr-bob.org/babble/20000411/msgs/29908.html