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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Isa on April 11, 2000, at 19:17:54
I am a student trying to find an expert, all axis diagnosis for the actor/ Robert Downey Jr. Anyone have any ideas? Thank You.
Posted by Mark H. on April 11, 2000, at 20:29:01
In reply to DSM diagnosis...., posted by Isa on April 11, 2000, at 19:17:54
When in doubt, stroke your chin, raise an eyebrow slightly, purse your lips and say "borderline personality disorder" in a way that makes it unclear whether you intended it as a definitive diagnosis or a question to be debated. If it's debated, then to whatever anyone else says, you just reply, "Of course." If no one says anything, then BPD it is! Next patient?
Posted by boB on April 12, 2000, at 11:26:14
In reply to Re: DSM diagnosis...., posted by Mark H. on April 11, 2000, at 20:29:01
you forgot the part about collecting a $250,000 income for your self serving effort. Why would anyone want to diagnose Downey if they are not going to treat him? Are not DSM's diagnoses oriented toward clinicians and their patients to help develop treatment plans?
Posted by KarenB on April 12, 2000, at 11:47:03
In reply to Re: DSM diagnosis...., posted by boB on April 12, 2000, at 11:26:14
> you forgot the part about collecting a $250,000 income for your self serving effort. Why would anyone want to diagnose Downey if they are not going to treat him? Are not DSM's diagnoses oriented toward clinicians and their patients to help develop treatment plans?
BoB: I'll treat him - I think he's cute.:)
Does anyone know enough about his personal life or symptoms to make an assessment? Then again, limitations like that never stopped MY doctors.
Karen
Posted by Cass on April 12, 2000, at 14:57:19
In reply to Re: DSM diagnosis...., posted by KarenB on April 12, 2000, at 11:47:03
How can someone in the psychiatric field believe they can make an accurate diagnosis of someone they have never spoken to before?
Posted by JohnL on April 13, 2000, at 4:30:01
In reply to DSM diagnosis...., posted by Isa on April 11, 2000, at 19:17:54
> 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.
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.
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.
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.
>
> 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.
>
> 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.
Posted by boB on April 16, 2000, at 21:42:50
In reply to Re: DSM diagnosis?/JohnL, posted by medlib on April 13, 2000, at 21:10:58
I just had a thought on this diagnose-the-movie-star thing. Uhhh, once I.. ... I mean a friend of mine found the door unlocked at the office of a university psychologist. I .... I mean my friend sure learned a lot in that office, not so much about any individual but about the practical aspects of clinical psychology, and how records are kept.
Well, I know the proposal of black-bag jobs and trade-craft is very inappropriate in an academic setting, but it does allow one to observe without interfering, and might be the best shot at getting an expert diagnosis of someone who is not asking that you diagnose them.
This is the end of the thread.
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