Psycho-Babble Medication Thread 422741

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Sheesh, tell us how you really feel... :-) (nm) » Shalom34Israel

Posted by gardenergirl on December 1, 2004, at 22:15:10

In reply to Re: The artificial nature of psychiatric diagnosis, posted by Shalom34Israel on December 1, 2004, at 19:43:03

 

Re: The artificial nature of psychiatric diagnosis » Shalom34Israel

Posted by Kristel on December 2, 2004, at 1:46:59

In reply to Re: The artificial nature of psychiatric diagnosis, posted by Shalom34Israel on December 1, 2004, at 19:43:03

Huh?! Are you kidding me now? Do you really think that a fMRI machine or something similar to it would see your thoughts?!!!

If that wouldhappen it might be i 100 years!

Yes such tech might be useful for the diagnosis of neurological disorders such as ADHD or epilepsy. But not psychiatric disorders that have to do mostly with thoughts.

I work with fMRIs and PETs and I see how inprecise they can be at times. They only show which parts of the brain are more activitated than other. But that advancement would happen and make them being able to see thoughts, sound like science fiction!

DSM is absolutely necessary. I hope you guys have not got a "desired diagnosis" that don't meet the criteria in DDM and thus upset.

Take care!

 

Re: So, Ed, do you have an opinion here? » Shalom34Israel

Posted by Kristel on December 2, 2004, at 2:01:32

In reply to Re: So, Ed, do you have an opinion here?, posted by Shalom34Israel on December 1, 2004, at 21:21:38

I can't understand how you justify that?!!!!!

They are ppl there out there that would really suuffer if their problems get reduced to neuroloical disorders.

Many patients in psychiatry have "deffective thouhgts" and psychiatry have the responsibilty to deal with that.

Would be really funny if a patient goes to a neurologist about say depresson and the neurologist starts talking about "medial frontal lobe" or "anterioir hypothalamus" " or "septohippocampal complex"... In fact, as far as today, this has no clinical significance. A day might come when we would start to set chips into the brain but for now this sounds like science fiction! What about developing crazy chips? nazi chips? crime chips? or some freak would take a depression chip and hack it into "popular guy" chip? WeLL, ALL THIS SOUNDS LIKE SCIENCE FICTION TO ME, and might bring disasters to humanity!!!!! And I think many scientists would agree that this is really far away. PLEASE REMEMBBER THAT EVEN THE MECHANISMS BY WHICH ANTI DEPRESSANTS HELP DEPRESSION ARE STILL UNKNOWN. We know about uptake and so on, but how this leads improvement.. we know about changes in the synapse (down and up regualtion is one hypothesis) but yet how this really works, anyone's guess.

> >
> >
> > YOU may not find any solace in having a diagnostic code written after your name, but there are many people in this world who do find it a relief.
>
> I dont mind at all having a diagnostic code written after my name as long as it is accurate and correct. In fact, I WANT one. I want to be diagnosed correctly, with an individualized diagnosis. I want everything individualized. I dont like this "one size fits all" canned approach that psychiatry has.
>
> The problem is that the DSM is way too generalized and not an accurate enough way to diagnose people and get it right the first time around. Being placed on the wrong class of psychiatry drug can tear a person's brain down faster than anything. Examples; a bipolar person initially misdiagnosed with unipolar major depression or anxiety and placed on an SSRI without a mood stabilizer. They go manic and end up hospitalized. That shouldnt happen...psychiatrists should be able to predict better what the reactions to their meds will be.
>
> Psychiatry is fifty years behind the times and its time for it to be tossed out completely. It is a waste of time, money and has a bad name. It should be formally merged into Neurology and should cease to exist as a separate branch of medicine.
>
> Shalom
>

 

Re: The artificial nature of psychiatric diagnosis

Posted by ladyofthelamp on December 2, 2004, at 4:37:50

In reply to Re: The artificial nature of psychiatric diagnosis » Shalom34Israel, posted by Kristel on December 2, 2004, at 1:46:59

In my humble opinion,lots of people may be 'happy'with their diagnosis because it gets the right words on a form,either for sick benefit or in the USA for insurance,but what if you are given a label at a time in your life where things are difficult.I am thinking of the positively damning title of personality disorder in its many guises.In mt teen years that is 'probably' what i was thought to have as i was angry,depressed and very difficult.I now have reams of notes on me that are innapropriate to say the least but the stigma just wont go away.If you wanted to label me now i expect i would be Bipolar with the anxiety state that accompanies my somewhat odd behaviour from time to time.Yes i do have an anxious personality and mild agoraphobia when i am ill but i am also outgoing and overly social to the point of getting myself into 'scrapes'.But suprise suprise i can never shake off my past history which incidentaly was only in my mid teens.This information haunts me but it never goes away.I also believe 'personality disorder' is more often given to females, and men who exhibit similar symptoms are given a different and less damning diagnosis...Best wishes to everyone.

 

Re: The artificial nature of psychiatric diagnosis

Posted by ed_uk on December 2, 2004, at 6:55:09

In reply to Re: The artificial nature of psychiatric diagnosis, posted by ladyofthelamp on December 2, 2004, at 4:37:50

Hello,

I notice that a lot of people have brought up the issue of insurance. Here in the UK this is less relevent because people are treated on the National Health Service. Everyone pays for the NHS through taxes. Psych patients do not pay for their care on the NHS. I get the impression that in the US the DSM is valuable more on a financial level than on a personal level!

It's interesting to note that a lot of people seem to use their DSM diagnosis (eg. ADHD) as an explanation for their problems eg. I didn't succeed at school because I had ADHD. In reality, a DSM diagnosis doesn't really explain anything because each diagnosis is little more than a list of symptoms. Saying 'I didn't succeed because I had ADHD' is no more helpful than simply saying 'I didn't succeed because I found it difficult to concentrate in class'. A DSM label does *not* explain the cause of a persons problems, nor does it tell us whether a person has any responsibility for their own problems. Yesterday, I went on a site about ADHD. A parent said 'I felt responsible for my child's failure at school until he was diagnosed with ADHD'. I found this a very interesting point because the DSM makes no attempt to explain the cause of an individual persons symptoms. It certainly doesn't attempt to tell us whether a parent is responsible!

I often feel that patients are being misled into thinking that their DSM diagnosis is a specific neurological disease. Patients diagnosed with DSM dosorders such as bipolar disorder may well be suffering from neurological problems but it is important not to forget that the DSM diagnosis itself is not neurological is nature. Each diagnosis is based on subjectively measured symptoms and not on the direct measurement of neurological function. To give an example..........In the future, some of the people who are currently diagnosed with bipolar disorder may be found to be suffering from specific genetic diseases but others will not. A genetic problem which may be present in one individual who has received a DSM diagnosis of bipolar disorder may be very different to the genetic problem in another person who has received the same DSM diagnosis. This is the inevitable result of using diagnostic categories which are not based on physiological measurements (such as a blood test or an MRI.) DSM psychiatric diagnoses must not be seen as specific conditions. The DSM should be seen for what it is, an inadequate attempt to divide mental health problems into discrete categories.

So you might ask... if we don't use the DSM how should a diagnosis be made? I am not suggesting that the DSM be abandonned. I think the DSM has a useful place in clinical trials of drugs and may also be useful in other circumstances. It is vital, however, to recognise the DSM for what it is and not to overestimate its value.

A diagnosis of MDD tells us very little. It should not be regarded as an explanation for a persons distress. It does not tell us the cause, it does not tell us which treatment would be best, it does not take a persons psychosocial circumstances into account, nor does it describe the nature of any biological abnormailty which may or may not be present.

In clinical practice, a simple list of a persons problems/symptoms would be more useful and more truthful than a DSM diagnosis. So many times I hear people say things like 'Now I've been diagnosed with major depression I know what my problem is, my doctor says I've got a chemical imbalance'. Well, such a patient may have a chemical imbalance but her doctor certainly doesn't know whether that is the case. Synaptic levels of monoamines are not measured in a psychiatric consultation. In is important that psychiatric theory is recognised as thoery, and not misleadingly presented as fact.

Regards,
Ed.

 

Re: The artificial nature of psychiatric diagnosis » ed_uk

Posted by Larry Hoover on December 2, 2004, at 8:02:43

In reply to Re: The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 12:30:28

> I feel that people are angry with me. Am I being paranoid?
>
> Ed.

I'm not angry in the slightest, speaking for myself.

Lar

 

Re: The artificial nature of psychiatric diagnosis » ed_uk

Posted by Larry Hoover on December 2, 2004, at 8:31:05

In reply to Re: The artificial nature of psychiatric diagnosis, posted by ed_uk on December 2, 2004, at 6:55:09

> A diagnosis of MDD tells us very little. It should not be regarded as an explanation for a persons distress. It does not tell us the cause, it does not tell us which treatment would be best, it does not take a persons psychosocial circumstances into account, nor does it describe the nature of any biological abnormailty which may or may not be present.
>
> In clinical practice, a simple list of a persons problems/symptoms would be more useful and more truthful than a DSM diagnosis. So many times I hear people say things like 'Now I've been diagnosed with major depression I know what my problem is, my doctor says I've got a chemical imbalance'. Well, such a patient may have a chemical imbalance but her doctor certainly doesn't know whether that is the case. Synaptic levels of monoamines are not measured in a psychiatric consultation. In is important that psychiatric theory is recognised as thoery, and not misleadingly presented as fact.
>
> Regards,
> Ed.

I've made similar points many times. MDD is a symptom cluster, not a disease. What brought this symptom cluster to the fore in patient A may be totally unrelated to the causes in patient B, whether on a symptom by symptom comparison, or as a whole.

Where it really falls apart, IMHO, is in attempts to match treatment to diagnosis, rather that by symptoms. A subject ought not to be treated because of a diagnosis of MDD, but because of specific presenting symptoms.

In drug trials for e.g. an antidepressant used against MDD, there is no evidence to suggest that the subjects even are suffering from the same underlying problem. It is similar, but responders and non-responders may be distinguished, perhaps, not by diagnosis itself, but instead, by underlying physiological disturbance.

If you collected together a group of cars that won't start, and came at them with battery booster cables, perhaps some would have an excellent response to that treatment, and off they go. Others, though, e.g. those which are out of fuel, will not have a similar response. The failing in this "experiment" is by inappropriately collecting together cars with dissimilar deficiencies under an overly broad "diagnosis". I believe we have a similar problem in mental health. Too many people who are out of gas getting booster cables.

Lar

 

Re: The artificial nature of psychiatric diagnosis

Posted by SLS on December 2, 2004, at 10:27:07

In reply to The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 8:57:15

I think the DSM is an incredibly detailed piece of work that has made the diagnoses and treatment of mental illness much more exacting than it was previously. It is a very impressive book. While not perfect, it does work. It is a statistical evaluation of what has been observed empiracally. It makes no claims to describing etiologies. It leaves that to research ongoing. Let's see what the DSM V has to offer.


- Scott

 

Larry - EXCELLENT analogy!! (nm)

Posted by dazedandconfused on December 2, 2004, at 12:06:20

In reply to Re: The artificial nature of psychiatric diagnosis » ed_uk, posted by Larry Hoover on December 2, 2004, at 8:31:05

 

Re: The artificial nature of psychiatric diagnosis

Posted by ed_uk on December 2, 2004, at 15:29:52

In reply to Re: The artificial nature of psychiatric diagnosis » ed_uk, posted by Larry Hoover on December 2, 2004, at 8:02:43

To Larry, Scott and everyone else,

I do believe that the DSM has its uses. I am not suggesting that we get rid of it! I do feel, however, that it is misunderstood by patients and professionals alike. In some cases it may do more harm than good. Each diagnosis describes a cluster of symptoms which often occur together, yet each diagnosis is not a specific disease. We could construct many other DSM diagnoses based on clusters of symptoms which tend to occur together. The DSM is only really useful to those who appreciate its inadequacies, many people do not. Misuse of the DSM may harm both individual patients and psychiatric research alike. Larry gave an excellent summary of some of the problems which we face.

Regards,
Ed.

 

Re: To Sailor: diagnosis

Posted by ed_uk on December 2, 2004, at 15:54:17

In reply to Re: The artificial nature of psychiatric diagnosis, posted by ladyofthelamp on December 2, 2004, at 4:37:50

Hi!

Thank you for your post. :-)

I've often noticed than when I have known a person for 5 minutes, their problems seem to fit perfectly into a DSM category, but after I've known that person for 5 hours they don't fit the diagnosis at all! The more you learn about a person, the more individual and complicated their problems become.

Personally, I've received scores of different DSM diagnoses. Describing me as an anxious, obsessional neurotic would provide almost as much information!

Regards,
Ed.

 

Re: The artificial nature of psychiatric diagnosis

Posted by simcha on December 2, 2004, at 23:29:44

In reply to The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 8:57:15

As a student in my psychopharmacology class the professor has told us that the establishment has basically said that the DSM-IVTR is obsolete.

They will have a DSM-V coming out in about a few years.

Then, we in the USA are one of the few countries that relies on the DSM system. The neuro-psychologists are lobbying, very powerfully, for using ICD-10 codes instead of DSM diagnosis to put us in line with most countries. ICD-10 is about symptomology and treating symptoms. It will put many psycho-analysts out of business.

However, we will still need psychiatrists, neuropsychiatrists, and psychotherapists because someone will need to treat the symptoms. The current scans do not prove much. Even Dr. Amen's research is being called into question... I suggest you go to quackwatch.org to look him up.

In the next ten years we will see radical changes in how mental illness is seen, diagnosed, and treated. Most likely a multidisciplinary approach will be embraced.

Psychotherapy actually changes brain chemistry. This is because we have found that experience creates new neural pathways and new neurons. When you do psychotherapy well you help the client re-wire their brian so that it functions in a way that is more functional. Of course, not all conditions respond to psychotherapy.

Psychopharmicology is important for those symptoms that cannot be helped by psychotherapy. Also psychopharms can help kickstart people into a different brain pattern that will help them to re-align their brians through psychotherapy.

This is the current thinking in forward thinking schools like mine...

Simcha

 

Re: The artificial nature of psychiatric diagnosis

Posted by sunny10 on December 3, 2004, at 11:38:38

In reply to Re: The artificial nature of psychiatric diagnosis, posted by simcha on December 2, 2004, at 23:29:44

I already have a label- it's my name. What I NEED is for someone to make me feel better.

To further Larry's analogy, whether or not you tell a car that it needs a need battery- you have to actually FIX the problem in order to make the car run.

Just because some dr gives me a label (which, by the way is scoffed at and replaced by the next dr who thinks HE knows better), doesn't make me feel better.

And, frankly, I don't care whether my problem stems from nurture or nature- I want it to go away...

So there you have it from the patient's (or car's) point of view...

 

Re: DSM versus ICD

Posted by ed_uk on December 3, 2004, at 14:59:21

In reply to Re: The artificial nature of psychiatric diagnosis, posted by sunny10 on December 3, 2004, at 11:38:38

What do people think?

Ed.

 

Re: DSM versus ICD

Posted by simcha on December 3, 2004, at 16:24:25

In reply to Re: DSM versus ICD, posted by ed_uk on December 3, 2004, at 14:59:21

I prefer the ICD. Now I'll make my case...

This applies to the USA:

The DSM classifications get used by insurance companies, governmental agencies, other mental health professionals to pigeon-hole clients in nice neat boxes. Once these clients are pigeon-holed, depending on the condition, they may or may not help the client to the extent that they actually need.

For example, if you get a diagnosis of Bipolar Disorder and you want to get private medical insurance because you've been layed-off of a job and you have run out of COBRA, you will not get the insurance or you will be charged at least $2000 per month, which basically amounts to not getting insurance... Also it is on your insurance record for 10-years. So, no insurance company, unless you get another job, will cover your Bipolar Disorder.

Personality Disorders are another difficult part of the DSM. A person labelled with a Personality Disorder will not get insurance. Most clinicians will deny treatment for Personality Disorders because they are seen as "untreatable."

By the way, look in the DSM-IVTR for the diagnosis of Bipolar. It only requires one manic episode for receiving the diagnosis of Bipolar. It does not call for a pattern or cycle of depressive episodes, euthymic, episodes, and manic episodes. Also, the specifiers for Bipolar I are time-based. They are based on the most recent event like a manic or depressive episode. Ask psychologists and psychiatrists if there is any utility to this part of the coding for the diagnosis. None of them will be able to tell you the value of knowing the state at which the person was diagnosed as Bipolar I at the time he or she was diagnosed as such.

So, with the ICD, you have no labels. You only have symptomology. In treatment, in practicality, clinicians are treating symptomology with medication and therapy. You can even use depth-orentied psychotherapy with the goal of treating symptoms.

So, the ICD codes have more use to the clinician because it is more specific. We can see the host of symptoms that the client is presenting. Bipolar I gives me only a general map as to what is possible that my client might be experiencing. The ICD sypmtom codes tell me exactly what the client has to deal with at the moment. You can also track the ICD codes during the course of treatment to predict prognosis better than simply having a DSM dx.

Also, moreover, US medical insurance companies will fight using ICD codes for diagnosing mental symptomology. This is because by US law, they must TREAT ALL ACTUAL SYMPTOMS. Therefore this makes exlusions impossible. Eventually this might force the insurance monster in this country to release its strangle-hold on medical care. It might actually lead to universal health care of some form in this country and bring us up to the rest of the first world in standard of care.

The DSM system fails we clinicians all the time. It blocks us from treating some poeple who need treatment because some DSM codes are covered and some are not. Thus the client cannot come up with the funds to pay for treatment. This is completely unjust and most first world countries find this to be yet another reason to look down on the USA.

So, I'm all for the ICD codes. And I hope the neuropsychologists win so that I might be able to give better treatment to my future clients as a Marriage and Family Therapist.

Simcha

 

Re: DSM versus ICD » simcha

Posted by ed_uk on December 5, 2004, at 3:34:25

In reply to Re: DSM versus ICD, posted by simcha on December 3, 2004, at 16:24:25

Hello......

Thank you simcha for your informative post. Does anyone else have any opinions on the ICD?

Regards,
Ed.

 

Re: Other methods of classification eg. CCMD

Posted by ed_uk on December 5, 2004, at 5:32:15

In reply to Re: DSM versus ICD » simcha, posted by ed_uk on December 5, 2004, at 3:34:25

Does anyone have any knowledge of other classification systems such as...........

The Chinese Classification of Mental Disorders (CCMD)

The French Classification for Child and Adolescent Mental Disorders

The Latin American Guide for Psychiatric Diagnosis

There's also a Japanese system but I've forgotten what it's called....... but I do know that it includes the diagnosis of Taijin Kyofusho 'a Japanese form of social anxiety centered around concern for offending others with inappropriate behavior or offensive appearance'. Anyone here suffer from that?

It's interesting to look at how culture can influence the expression of mental health problems eg. social anxiety in the West tends to revolve around the self rather than other people.

Ed.

 

Re: Other methods of classification eg. CCMD

Posted by simcha on December 5, 2004, at 15:29:34

In reply to Re: Other methods of classification eg. CCMD, posted by ed_uk on December 5, 2004, at 5:32:15

Yes, Diagnosis is very cultural. That's another reason to adopt the ICD... It would be classifying symptoms rather than pathologizing say... offensive dress...

Each culture has it's own issues with therapy.

For instance, it is rare to see an Asian client who has been raise in an Asian culture to come in for therapy here in the West. It seems to have to do with their particular concept of shame and that the family helps people with their problems. We westerners tend to be more individualistic and the Asians (in a gross generalization) tend to be more collectivistic.

So, it just makes sense that different cultures would classify mental illness differently or even see things as mental illnesses that other cultures would not.

Simcha

 

Re: BP II

Posted by ed_uk on December 5, 2004, at 18:15:40

In reply to Re: Other methods of classification eg. CCMD, posted by simcha on December 5, 2004, at 15:29:34

Everyone seems to be getting diagnosed with bipolar II at the moment. Do you think that this is a step forward or a step in the wrong direction?

Ed.

 

Re: BP II

Posted by simcha on December 5, 2004, at 23:32:31

In reply to Re: BP II, posted by ed_uk on December 5, 2004, at 18:15:40

I think that BPII will disappear in the DSM IV. Most professionals who are currently working on the DSM IV are uncomfortable with the dx. What exactly is a hypomanic episode? How do you evaluate that?

Simcha

 

Re: DSM versus ICD

Posted by SLS on December 6, 2004, at 0:55:59

In reply to Re: DSM versus ICD, posted by simcha on December 3, 2004, at 16:24:25

> I prefer the ICD. Now I'll make my case...
>
> This applies to the USA:
>
> The DSM classifications get used by insurance companies, governmental agencies, other mental health professionals to pigeon-hole clients in nice neat boxes. Once these clients are pigeon-holed, depending on the condition, they may or may not help the client to the extent that they actually need.

But isn't this really a defect in the way a diagnostic system is used rather than in the system itself?


- Scott

 

Re: Bipolar II

Posted by ed_uk on December 6, 2004, at 5:48:28

In reply to Re: DSM versus ICD, posted by SLS on December 6, 2004, at 0:55:59

Bipolar II seems to be a 'fashionable' diagnosis among psychiatrists at the moment. I think it may be overdiagnosed, especially in people who suffer from chronic depression but have unusual reactions to antidepressants. The problem with the current 'expansion' of the bipolar spectrum is that the term bipolar is at risk of becoming meaningless. The concept of manic-depression used to be quite specific and many people who are currently diagnosed as bipolar would be excluded. Some people see the 'expansion' of bipolar disorder as an advance, I'm not so sure.... the boundaries of bipolar disorder seem to be getting increasingly vague to the extent that if somone tells you that they are bipolar, it doesn't tell you that much.

I think Elizabeth put it well in 2002...

'I still think that bipolar II is probably overdiagnosed, though. I never have a clear idea what people mean when they say, "I have bipolar II disorder." The definition has become vague, the boundaries blurred. Even bipolar I gets confusing when you're talking about mixed episodes, rapid-cycling, comorbid disorders, etc. I'm sure you've noticed how the concept of bipolar disorder has become diluted in recent years.'


Regards,
Ed.

 

Re: Bipolar II

Posted by SLS on December 6, 2004, at 8:28:06

In reply to Re: Bipolar II, posted by ed_uk on December 6, 2004, at 5:48:28

Bipolar II might be misdiagnosed often due to its current fashionability, but it makes it no less a syndrome with well defined boundaries and probably a distinct physiological etiology. I think the differential responses to lithium and valproate help make a case for this. The DSM IV is specific as to what constitutes bipolar II, and describes hypomania as follows:


Hypomanic Episode

A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.

During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

inflated self-esteem or grandiosity

decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

more talkative than usual or pressure to keep talking

flight of ideas or subjective experience that thoughts are racing
distractibility (i.e., attention too easily drawn to unimportant or
irrelevant external stimuli)

increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

The disturbance in mood and the change in functioning are observable by others.

The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder


- Scott

 

Re: Distinct Physiological entity

Posted by ed_uk on December 6, 2004, at 8:52:50

In reply to Re: Bipolar II, posted by SLS on December 6, 2004, at 8:28:06

Hi Scott,

To me, it seems highly improbable that any diagnosis which is based on subjectively measured symptoms will ever be demonstrated to be a distinct physiological entity. Rather, a group of people who's symptoms are consistent with the same DSM diagnosis are likely to have numerous different pathologies- both biological and psychosocial in nature.

Regards,
Ed.

 

Re: Distinct Physiological entity » ed_uk

Posted by SLS on December 6, 2004, at 9:43:31

In reply to Re: Distinct Physiological entity, posted by ed_uk on December 6, 2004, at 8:52:50

Hi Ed.

> To me, it seems highly improbable that any diagnosis which is based on subjectively measured symptoms will ever be demonstrated to be a distinct physiological entity. Rather, a group of people who's symptoms are consistent with the same DSM diagnosis are likely to have numerous different pathologies- both biological and psychosocial in nature.

I respectfully disagree. I think whatever physiological heterogeneity there is within bipolar disorder, idiosycratic to the individual, is minor and due to the great plasticity of the human brain. There are enough phenotypic variables such that differential responses to medications for the same illness are inevitable. This is true of many other illnesses as well, including Parkinsons and Alzheimers, disorders with well known and identifiable physiological pathologies.

Clinical diagnosis of somatic illness very often relies upon signs and symptoms reported by the patient that are subjective and must be interpreted by the physician. There are so many idiopathic syndromes for which no etiology has been identified and few, if any physical tests exist. Medicine in these circumstances remains an art and relies on the subjective observations and clinical interpretations of the physician. Gulf War syndrome might be an example of this.


- Scott



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