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Re: Bipolar Spectrum: Very long but very accurate. » SLS

Posted by Larry Hoover on September 7, 2008, at 11:26:56

In reply to Re: Bipolar Spectrum: Very long but very accurate. » Larry Hoover, posted by SLS on September 6, 2008, at 17:46:56

> I was surprised at how accurate the descriptions of categories were as depicted in the summary article. They match very well what I have seen in myself and others with bipolar disorders. I disagree with the concept of treating symptoms without regard to defining the identity of the disorder being treated. Depression arising from hypothyroidism will not be well treated as a symptom by using antidepressants.

Allow me to clarify....I didn't intend to suggest that differential diagnosis has no value, but that the patient brings specific symptoms forward for treatment. The doctor decides that they cluster according to some diagnostic schema, but there tends to be a missing step.....taking that schema and determining which symptoms most trouble the patient, as a guide to treatment. If e.g. insomnia is the most troubling symptom of a putative BPII patient, providing treatment that fails to address that symptom will fail the patient, regardless of what other clustered symptoms are ameliorated by the selected treatment.

> I first presented with an ultra rapid cycling presentation of depression in the absence of hypomania or mania. I believe that my bipolarity would have been identified much earlier had my treatment team operated under the premise that any type of true ultra rapid cyclicity of mood state should indicate bipolarity. The absence of a bipolar diagnosis allowed the usage of antidepressants without the concomitant use of mood stabilizers; a treatment that eventually led me to a psychotic mania as the result of antidepressant treatment. The rest of the story is too long to describe here. However, let me say that I would never have appeared on Psycho-Babble had my doctor treated a disorder rather than a series of symptoms.

Scott, I would say that your experience is a perfect example of what I am suggesting remains a weakness of the mental illness treatment paradigm. Your caregiver(s) cherry-picked depressed mood symptom(s) and ignored other presenting symptom(s), the ultrarapid cycle. I do agree (and never questioned) that this diagnostic schema for bipolar spectrum is a vast improvement, but it too must be applied with the same caveats as I'm suggesting don't often occur. For this specific patient, what symptoms cluster within a category, and what symptoms are outside of it? What symptoms trouble this individual the most? Although more tightly circumscribed than early schemas might allow, even a specific diagnosis like "ultra-rapid cycling bipolar type II with mixed states" does not mean that appropriate treatment will be the same for each subject found to correspond therewith. In other words, a greater number of smaller cubbyholes is progress, but the symptoms are what matter to the patient.

Medical schools teach, and most doctors perhaps unwittingly follow, that once diagnosis is made, treatment is selected to fit the dx. In the case of mental illness, the patients' focus on sx, and the doctors' on dx, leads to a disconnect that led to serious problems for you, and me.

Lar

 

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poster:Larry Hoover thread:850483
URL: http://www.dr-bob.org/babble/20080903/msgs/850775.html