Psycho-Babble Medication Thread 693568

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Re: experts say...ditch schizophrenia label

Posted by xbunny on October 10, 2006, at 20:00:49

In reply to experts say...ditch schizophrenia label, posted by med_empowered on October 10, 2006, at 12:57:35

> its about time.

I disagree, I think the time isnt right yet, until more is understood about the different illnesses they hope to disambiguate from the umbrella term of schizophrenia then inventing new names for schizophrenia achieves nothing. They would be swapping one term for something they cant really pin down for multiple names which are equally difficult to pin down. I think this would actually be more damaging as then specific treatment plans for each new illness would be invented and sufferers would be fitted as best as possible into thier new supposably more accurate illness definition with even less regard to individual symptoms than before. By being deliberately vague the psychiatrist is forced to treat what he sees rather than not think and just follow some flowchart. Maybe in the future we will know enough about schizophrenia illnesses to be able to make an effective guide for the diagnosis and treatment of patients but nothing I have seen suggests we are in anyway close to that and until then I feel it should remain a very personalized approach. As for the arguement that the very name schizophrenia results in stigmatization and that changing it to something else will lessen this sounds even more ridiculous to me. The result will be that the new name(s) become stigmatizing. Changing the name wont lessen ignorance about schizophrenia and those who suffer from it however education might.
I read that one of the previously proposed new names for schizophrenia was dopamine deficiency syndrome. Im sure we all can see how ludicrous that suggestion is but I think it gives us a good insight into the mindset of our leading psychiatrists and their rigid adherence to biobabble.

Bunny

 

Re: experts say...ditch schizophrenia label

Posted by alexandra_k on October 10, 2006, at 20:21:12

In reply to Re: experts say...ditch schizophrenia label alexandra_k, posted by Squiggles on October 10, 2006, at 16:18:05

Categorical vs Dimensional Approaches to Nosology

The DSM is categorical. There are a number of different categories (disorders) like 'Bi-Polar' and 'Schizophrenia' and 'Borderline Personality Disorder'. They are 'all or none' in the sense that one either has that condition (meets the criteria) or one does not.

It has been suggested that the DSM would be more useful for research and treatment if it moved from a categorical approach to a dimensional approach. There are different ways the dimensional approach could go. Here is one suggestion.

The symptoms that feature in the DSM could be listed. The clinician assesses whether the symptom is present in the individual, and notes (where appropriate) whether the symptom is mild or moderate or severe. This better reflects the notion that some symptoms are had by other members of the population, it is just the DEGREE that they are present that is problematic.

Currently... What tend to happen... Is that once someone has been given a categorical diagnosis clinician's have a tendency to ASSUME rather than ASSESS whether the person meets the other symptoms associated with the diagnosis or not. They call this 'a useful heuristic' but it is only useful if accurate and it is inaccurate more often than accurate because there is often more variation in symptoms between people of the same category than there is variation in symptoms between people of different categories.

One would be better able to assess progress over time. Whether symptoms lessen in severity or aren't present anymore. Whether new symptoms emerge.

If they did that for a while... They might start noticing that certain symptoms do occur clustered together. That would be a significant empirical finding. If we found that then the way would be paved to enumerate REAL diagnostic categories that carve nature at its joints and these diagnostic categories are much more likely to be useful for research and treatment purposes.

Medication seems to work on symptoms rather than diagnostic categories anyway. Instead of looking for the medication that helps the most people with schizophrenia they are likely to have more luck looking for the medication that helps the most people with a certain symptom like delusion.

The same is likely to go for neurology. The same is likely to go for genetics.

The possible downside is that if we listed all the symptoms that are present in the DSM and the clinician had to specifically consider all of them... How long would diagnosing take? I think it could be made manageable but... It is often said that even though the current approach suggests mental illness is all or none clinician's aren't so naieve. But whether or not this is the case the system is inadequate.

> I think therapy is always helpful, in
> comforting a person who falls into these
> strange states, in themselves frightening
> and difficult to cope with.

They have had fairly good success with treating delusions with CBT as well...

> These states are biological
> but the nomenclature makes them sound like a
> particular *cognitive* disease, when they may
> be biological diseases (e.g. endocrinological
> or physiological disorders)...

But therapy works precisely by making neurological / biological alterations in the brain...

 

Re: experts say...ditch schizophrenia label alexandra_k

Posted by Squiggles on October 10, 2006, at 20:40:10

In reply to Re: experts say...ditch schizophrenia label, posted by alexandra_k on October 10, 2006, at 20:21:12


> But therapy works precisely by making neurological / biological alterations in the brain...
>

I think this is very helpful (esp. treating
the symptoms part). I like the whole approach.
I disagree only with the last sentence.

Squiggles

 

Re: experts say...ditch schizophrenia label

Posted by Phillipa on October 10, 2006, at 21:22:14

In reply to Re: experts say...ditch schizophrenia label alexandra_k, posted by Squiggles on October 10, 2006, at 20:40:10

Schizophrenics suffer so. No one understands their fears, seeing or hearing things, or inability to go out. I correspond with one. So sad. He's a great kind person but no one wants to be his friend cause to others he acts strange. Well if you said your TV gave you secret messages maybe you would be afraid of this person too. It takes special people to work with them. I myself loved it. So gratifying when their meds kicked in and the symptoms went away. Then Alex you could do therapy with them as now they trusted you in most cases. Love Phillipa

 

Re: experts say...ditch schizophrenia label med_empowered

Posted by sleepygirl on October 10, 2006, at 21:23:58

In reply to experts say...ditch schizophrenia label, posted by med_empowered on October 10, 2006, at 12:57:35

interesting...really interesting

a focus more on "symptoms" rather than diagnosis makes good sense to me

not that the diagnosis isn't a "valid" one, but SOOOO much overlap of symptoms between the disorders exists!
we don't understand enough yet do we?

 

Re: experts say...ditch schizophrenia label

Posted by laima on October 10, 2006, at 21:57:53

In reply to Re: experts say...ditch schizophrenia label med_empowered, posted by sleepygirl on October 10, 2006, at 21:23:58


The BBC article made it roughly sound like a big part of the the concern was that people with so many diverse problems with so many diverse causes were being lumped together as "same"- therefore getting "same"kinds of treatments instead of more finely tuned ones- they weren't saying that these people were not suffering. It made some sense. (Remember once upon a time we were all "neurotics"-or worse?) Here. I'll paste it in for ease of access:

Schizophrenia term use 'invalid'

The term schizophrenia should be abolished, experts have said.
They claim the category falsely groups a wide range of symptoms and encourages over-reliance on anti-psychotic drugs rather than psychological intervention.

The academics also said the label stigmatised people as being violent, dangerous and untreatable.

But other scientists said the term should not be scrapped without finding another means of classifying patients with psychosis.

I think the concept is scientifically meaningless, clinically unhelpful and ultimately has been damaging to patients-
Richard Bentall. Schizophrenia represents a complex mental health disorder. Symptoms vary from person to person, but include delusions, hallucinations and disordered perceptions of reality.

It is estimated that one in 100 people will develop schizophrenia at some point in their lifetime.

But experts, speaking on the eve of World Mental Health Day, are calling for the term to be scrapped.

Richard Bentall, professor of experimental clinical psychology, from the University of Manchester, said: "We do not doubt there are people who have distressing experiences such as hearing voices or paranoid fears.

"But the concept of schizophrenia is scientifically meaningless. It groups together a whole range of different problems under one label - the assumption is that all of these people with all of these different problems have the same brain disease."

He said this can misinform treatment, and has encouraged the widespread use of "drastic biomedical interventions" as the first-line of treatment, rather than psychological help.

Although drugs were useful for some patients, too often they were given at extremely high doses and had some dangerous side-effects.

Professor Bentall said: "Overall, I think the concept is scientifically meaningless, clinically unhelpful and ultimately has been damaging to patients."

Stigmatising patients

Paul Hammersley, also of the University of Manchester, who is involved with the Campaign to Abolish the Schizophrenia Label (Castle), wants the term dropped.

He said: "It is associated with violence, dangerousness, unpredictability, inability to recover, constant illness, constant need for medication and an inability to work. I cannot emphasise enough how stigmatising this label is."

But the academics could not give a definitive answer to what should replace the term schizophrenia if it was eliminated.

They pointed to Japan, where the category schizophrenia was replaced with "integrated disorder" in 2004, as a possible model.

And Professor Bentall suggested patients should be treated on the basis of individual symptoms, as opposed to an overarching category.


We should be careful not to throw the baby out with the bath water
Professor Til Wykes
Robin Murray, professor of psychiatry at the Institute of Psychiatry, London, said most psychiatrists accepted term schizophrenia was imperfect but warned that were it discarded another method of classification must be devised.

He said: "If we don't have some way of distinguishing between patients, then those with bipolar disorder or obsessional disorder would be mixed up with those currently diagnosed as having schizophrenia and might receive treatments wholly inappropriate for them.

"Most psychiatrists would still agree that the term schizophrenia is a useful, if provisional, concept. My personal preference would be to replace the unpleasant term schizophrenia with dopamine dysregulation disorder which more accurately reflects what is happening in the brain when someone is psychotic. "

Til Wykes, professor of clinical psychology and rehabilitation at the Institute Of Psychiatry, said: "We should be careful not to throw the baby out with the bath water, as despite its limitations, a diagnosis can help people access much needed services.

"What all of us have to remember is that these are people with a diagnosis of schizophrenia, not 'the schizophrenic'."

Marjorie Wallace, chief executive of the mental health charity SANE, said: "While we recognise that the term 'schizophrenia' can act as a stigmatising label, without identifying this condition as a serious illness how can there be any hope of researching it and providing better treatments?

"Simply replacing the term with another is unlikely to add to our understanding of this complex condition."

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/6033013.stm

Published: 2006/10/09 13:09:42 GMT

BBC MMVI

 

Re: experts say...ditch schizophrenia label sleepygirl

Posted by laima on October 10, 2006, at 22:00:43

In reply to Re: experts say...ditch schizophrenia label med_empowered, posted by sleepygirl on October 10, 2006, at 21:23:58

Actually, it almost seems they could do something like that about "depression", maybe? So many kinds, causes...different subtypes responding to different treatments and all?

 

Re: experts say...ditch schizophrenia label

Posted by alexandra_k on October 10, 2006, at 22:20:49

In reply to Re: experts say...ditch schizophrenia label alexandra_k, posted by Squiggles on October 10, 2006, at 20:40:10

> > But therapy works precisely by making neurological / biological alterations in the brain...

> I disagree only with the last sentence.

Is that the above sentance?
Er... If therapy doesn't help by changing the neurology... Then how does it work? Does flying spaghetti monster move his noodly appendage thus leading to a miraculous alteration in mind stuff? The only way to change behaviour is to change the brain. There are many ways to change the brain, however. Experience, social environment, therapy, learning, medication, surgery... Just consider learning how to do something. The repetition leads to neural changes. Consider remembering something, the experience led to neural changes.


> The BBC article made it roughly sound like a big part of the the concern was that people with so many diverse problems with so many diverse causes were being lumped together as "same"- therefore getting "same"kinds of treatments instead of more finely tuned ones.

Yes, that is a problem. Lets say that they say '80% of people with dx xxx get better with treatment yyy you have dx xxx therefore we shall give you treatment yyy'. But... It turns out that you are more similar (with your symptoms) to people with dx zzz... Treatment yyy doesn't work for you... People conclude you are chronic... The perils of inadequate diagnostic categories. It is an impediment to research. Trying to figure out what all people with schizophrenia have in common when they don't have anything in common...

> The term schizophrenia should be abolished, experts have said. They claim the category falsely groups a wide range of symptoms and encourages over-reliance on anti-psychotic drugs rather than psychological intervention.

Yeah. Because in other societies... They don't medicate the way western societies do instead they have social intervention and... A whole bunch of people get better. Are we really better off with all our drugs? Hard to say... Maybe the people who get better with social intervention are the people who aren't being helped so much with drugs... Maybe the people who are helped by drugs are the ones who wouldn't really benefit from social intervention alone... Unfortunately drug companies don't really fund studies on social intervention unless it is to undermine it...

> The academics also said the label stigmatised people as being violent, dangerous and untreatable.

Yes. And that isn't so good for people with the dx. Can lead to the 'looping kind' effect (which is to say 'everyone tells me I'm chronic so I may as well stop planning for a decent life and just accept my likely fate')

> But other scientists said the term should not be scrapped without finding another means of classifying patients with psychosis.

There is one.
Delusions - yup. severe.
Hallucinations - yup. severe.
Formal thought disorder - no.
Catatonia - no.
They can tally the sympoms...

> I think the concept is scientifically meaningless, clinically unhelpful and ultimately has been damaging to patients - Richard Bentall. Schizophrenia represents a complex mental health disorder. Symptoms vary from person to person, but include delusions, hallucinations and disordered perceptions of reality.

Yes. Bentall is an interesting figure...

> "But the concept of schizophrenia is scientifically meaningless. It groups together a whole range of different problems under one label - the assumption is that all of these people with all of these different problems have the same brain disease." He said this can misinform treatment, and has encouraged the widespread use of "drastic biomedical interventions" as the first-line of treatment, rather than psychological help.

So true.

> Professor Bentall suggested patients should be treated on the basis of individual symptoms, as opposed to an overarching category.

Yes. Dimensional approach instead of categorical.

> "If we don't have some way of distinguishing between patients, then those with bipolar disorder or obsessional disorder would be mixed up with those currently diagnosed as having schizophrenia and might receive treatments wholly inappropriate for them.

B*llshit they have different symptoms.

> "Most psychiatrists would still agree that the term schizophrenia is a useful, if provisional, concept...

But they would be wrong...

It is just... Easier to diagnose rather than assessing symptoms. Lazy psychiatry... No other way to say that.

> Til Wykes, professor of clinical psychology and rehabilitation at the Institute Of Psychiatry, said: "We should be careful not to throw the baby out with the bath water, as despite its limitations, a diagnosis can help people access much needed services.

That is only one aim of classification... There are three aims:
1) Ease of diagnosis and communicability.
2) To facilitate research
3) Treatment

It is unfortunate they all get lumped together.

The DSM shouldn't be catered for the health insurance companies, however, or it means it is dictated to by political agenda instead of science. Wakefield criticises the DSM as being overinclusive as it is. Thats because of health insurance. Wakefield says we should distinguish between mental disorder (caused by malfunction within the individual) and 'problems in living' which might well be worthy of treatment and yet do not constitute mental disorder. For example... There is a learning disorder category in the current DSM. Wakefield says that if someone meets criteria for learning disorder because they have inner malfunction which renders them unable to read then they have a mental disorder. If they meet criteria because they have never been shown how to read, on the other hand, then this does not constitute mental disorder though it does constitute a 'problem in living' that should be treated.

> "While we recognise that the term 'schizophrenia' can act as a stigmatising label, without identifying this condition as a serious illness how can there be any hope of researching it and providing better treatments?

What is 'it'? That is precisely the problem. There is no such thing as schizophrenia. There are people who have a number of symptoms like delusion and hallucination etc and those symptoms should be treated, however.

> "Simply replacing the term with another is unlikely to add to our understanding of this complex condition."

Indeed. Trouble is it isn't a single condition...

 

Re: experts say...ditch schizophrenia label

Posted by alexandra_k on October 10, 2006, at 22:30:58

In reply to Re: experts say...ditch schizophrenia label sleepygirl, posted by laima on October 10, 2006, at 22:00:43

Natural Kinds.

Water is H2O.

Turned out that all samples of water had an underlying essence in common and that essence was H2O. That means the term 'water' picks out an interesting category in nature. Because all samples of 'water' have an underlying essence in common you can make interesting generalisations about the behaviour of water. It is a scientifically useful category.

Greenstone is either Jadite or Nephrite.

Turned out that all samples of Greenstone don't have an underlying essence in common. Rather... There were two different things (with two different underlying essences) that fell under the concept 'greenstone'. So... Greenstone isn't a natural kind. Some samples of Greenstone are Jadite (with its underlying essence) and some samples of Greenstone are Nephrite (with its underlying essence). There aren't very many scientifically interesting generalisations you can make about Greenstone because Greenstone isn't a natural kind. We say that the term 'Greenstone' has 'split reference'.

We could of course have decided that Jadite was the essential nature of Greenstone and we were simply wrong in considering Nephrite to be Greenstone. It would seem to be an arbitrary decision to consider Jadite to be the essence rather than Nephrite, however. Another thing we could say is that Greenstone has the following disjunctive essence in common: 'Greenstone' is 'either Jadite OR Nephrite'. One could do this... But the trouble is that Jadite behaves interestingly differently from Nephrite so to classify the essence of Greenstone as disjunctive is an impediment to the progress of science.

Ditto with the majority of psychiatric categories...

No underlying essences in common...
Our categories are more like 'Greenstone' than 'H2O'.
So...
Better categories are needed.

I'm a fan of the symptom approach.

Trouble is that the same issue arises on the level of symptoms...

It seems likely that delusions that arise in response to cerebral injury are importantly different from delusions that arise in a context of psychosis, for example. Well... That is okay. Methinks the DSM should be working to classify symptoms on the basis of cause (aetiology) anyways. Clades have worked out pretty well for Biology (for example)...

 

OCD as an example Squiggles

Posted by alexandra_k on October 10, 2006, at 23:02:16

In reply to Re: experts say...ditch schizophrenia label alexandra_k, posted by Squiggles on October 10, 2006, at 20:40:10

'The first example comes from a neuroimagine study of the treatment of obsessive-compulsive disorder (OCD). Both cognitive-behavioural psychotherapy and medications are known to be effective treatments for OCD. In this study, patients' cerebral glucose metabolism was imaged by means of positron emission tomography (PET) scans before and after treatment (Schwartz, Stoessel, Baxter, Martin, & Phelps, 1996). Some patients were treated with psychotherapy and others with medication. Regardless of the type of treatment, patients who responded favorably to treatment showed metabolic changes in the same brain structures. What may seem surprising about this result is that (1) psychotherapy changes brain metabolism, and (2) psychotherapy and medication affect the same neural systems. But unless we are dualists, we know that psychotherapy has to change brain function to change behaviour. Because altered activity of certain brain structures (e.g., the basal ganglia) produces the symptoms of OCD, a successful treatment must alter the activity of these critical brain structures. Undoubtedly, the exact process by which psychotherapy and medication produce this similar effect are different. Medication directly alters neurotransmitter levels and hence the activity of certain structures. Psychotherapy teaches strategies for managing obsessive thoughts and compulsive behaviours. But to work, these strategies must somehow affect brain function.

"The Development of Psychopathology" p. 12

A few things to think about:

1) Do medications exclusively target the problematic brain function or are their effects more widespread (i.e., affecting systems that don't need to be targeted)?
2) Are the negative side effects of therapy more extensive than medication or vice versa?

 

Re: experts say...ditch schizophrenia label xbunny

Posted by SLS on October 10, 2006, at 23:07:09

In reply to Re: experts say...ditch schizophrenia label, posted by xbunny on October 10, 2006, at 20:00:49

> I disagree, I think the time isnt right yet, until more is understood about the different illnesses they hope to disambiguate from the umbrella term of schizophrenia then inventing new names for schizophrenia achieves nothing. They would be swapping one term for something they cant really pin down for multiple names which are equally difficult to pin down. I think this would actually be more damaging as then specific treatment plans for each new illness would be invented and sufferers would be fitted as best as possible into thier new supposably more accurate illness definition with even less regard to individual symptoms than before. By being deliberately vague the psychiatrist is forced to treat what he sees rather than not think and just follow some flowchart. Maybe in the future we will know enough about schizophrenia illnesses to be able to make an effective guide for the diagnosis and treatment of patients but nothing I have seen suggests we are in anyway close to that and until then I feel it should remain a very personalized approach. As for the arguement that the very name schizophrenia results in stigmatization and that changing it to something else will lessen this sounds even more ridiculous to me. The result will be that the new name(s) become stigmatizing. Changing the name wont lessen ignorance about schizophrenia and those who suffer from it however education might.
> I read that one of the previously proposed new names for schizophrenia was dopamine deficiency syndrome. Im sure we all can see how ludicrous that suggestion is but I think it gives us a good insight into the mindset of our leading psychiatrists and their rigid adherence to biobabble.

Very well said.

I think we are looking at several separate illnesses here within the diagnostic catergories comprising schizophrenia. I believe these are discrete diagnosable entities; the individual cases within which have similar characteristics and respond similarly to similar treatments. Continued research will ultimately resolve the details and produce biological and psychometric tests to segregate out the various illnesses that might be currently portrayed by the single diagnosis of schizophrenia. Although to the credit of the establishment, the identification of the various subtypes makes for a recognition of different illnesses.


- Scott

 

Re: experts say...ditch schizophrenia label

Posted by alexandra_k on October 10, 2006, at 23:30:48

In reply to Re: experts say...ditch schizophrenia label xbunny, posted by SLS on October 10, 2006, at 23:07:09

> I believe these are discrete diagnosable entities; the individual cases within which have similar characteristics and respond similarly to similar treatments.

In virtue of sharing the same symptoms?
It might be that symptom plus etiology of the symptom is the basic unit of psychopathology.
Kind of like the little lego building blocks of psychopathology and different people have different combinations of blocks...
Medications might be targeted to the blocks (symptoms)
So people take a combination of meds that is taylored to their individual blocks.
Of course it might turn out that some combinations of blocks are always found together... And further research might tell us why that is so... But we need to find correlations first...

> Although to the credit of the establishment, the identification of the various subtypes makes for a recognition of different illnesses.

Trouble is... There can be about as much variation between patients of the same subtype as there is between patients with different diagnoses... The sub-types don't seem to be natural kinds either...

But then the same problem emerges on the symptom level... Thats why people are starting to talk about symptoms plus etiology.

(So delusions caused by cerebral trauma might be different to delusions associated with psychosis, for example).

The idea would be to do some statistical magic with looking at particular symptoms (and severity) and the effects of medications and therapies and the like... Trouble with the current scheme of things is that patients are studied in virtue of their diagnostic category instead of their symptoms. So... There isn't all that much data on symptoms and symptoms that are correlated and on the effects of meds on particular symptoms or symptom combinations or therapy on particular symptoms or symptom combinations. Instead... People insist on trying to find what all people with schizophrenia or a parituclar subtype of schizophrenia have in common when we have known for a while now that they simply don't have anything interesting in common.

Like trying to do chemistry with the kind 'yellow metal'

 

Re: experts say...ditch schizophrenia label

Posted by xbunny on October 11, 2006, at 5:08:29

In reply to Re: experts say...ditch schizophrenia label xbunny, posted by SLS on October 10, 2006, at 23:07:09

> Continued research will ultimately resolve the details and produce biological and psychometric tests to segregate out the various illnesses that might be currently portrayed by the single diagnosis of schizophrenia. Although to the credit of the establishment, the identification of the various subtypes makes for a recognition of different illnesses.

I think it will be interesting to see whether the breakdown of schizophrenia like illnesses will be drug driven or observationally driven. I think what should happen is that at some point in the future we will discover drug X effects only some group of schizophrenia sufferers but much more effectively. This is in turn will lead researchers to investigate this group more closely and disambiguate its symptoms from the cloud of schizophrenia and a new disorder will be born. This approach I feel is better than an observational approach which says suffers X appears to like sufferer Y therefore they have the same subtype as there is little evidence other than the superficial that this is so and more importantly there is no accurate treatment for the new subtype. In fact I think it could be damaging as researchers will end up in a loop whereby they think they identify one subtype but fail to find a treatment which accurately fits it and ultimately after wasting time it will result in the disposal of the subtype and the loop will continue pointlessly.
This is the trap schizophrenia researchers will fall into if they attempt to divide schizophrenia at this current time.

Bunny

 

Re: experts say...ditch schizophrenia label

Posted by SLS on October 11, 2006, at 5:28:55

In reply to Re: experts say...ditch schizophrenia label, posted by alexandra_k on October 10, 2006, at 23:30:48

> The sub-types don't seem to be natural kinds either...

According to whom? I would disagree with that statement. That they are is rather obvious in my opinion.

> There can be about as much variation between patients of the same subtype as there is between patients with different diagnoses

Symptoms do not exist in a vacuum as they vary. They tend to occur in clusters and segregate themselves in manners that are identifiable to a disorder much like are fingerprints to an individual. That's why current diagnostic schemes have been working so far to the degree that they have - which has been remarkable as far as I am concerned given the subjective nature of observation and interpretation in behavioral or psychological illnesses. It has been this fortunate segregation of symptoms, features, and characteristics that has allowed for differential diagnosis at a time when biological tests are not available and psychometric examinations are still being explored.


- Scott

 

Re: experts say...ditch schizophrenia label alexandra_k

Posted by Squiggles on October 11, 2006, at 7:39:31

In reply to Re: experts say...ditch schizophrenia label, posted by alexandra_k on October 10, 2006, at 22:20:49

> > > But therapy works precisely by making neurological / biological alterations in the brain...
>
> > I disagree only with the last sentence.
>
> Is that the above sentance?

Yes.


> Er... If therapy doesn't help by changing the neurology... Then how does it work? Does flying spaghetti monster move his noodly appendage thus leading to a miraculous alteration in mind stuff?

Are you being sarcastic? lol

I don't think that therapy changes neurology
in the same way that drugs do; for one thing
it is a transient change in mood while you are
benefitting from the conversation; for another it
requires the memory of the conversation to bring
back the ideas that made you feel secure about
your condition-- a question of will. That's not
how drugs work; whether you will the mood or cognitive state to change, it changes. Basically, i think that therapy is palliative. That does not mean i disagree with its practice. Meds are stronger for an unalterable psychotic state.
If there weren't a neurological problem in psychotic states, then there would be no need for a solution.


Squiggles

 

Re: experts say...ditch schizophrenia label laima

Posted by Squiggles on October 11, 2006, at 7:48:12

In reply to Re: experts say...ditch schizophrenia label, posted by laima on October 10, 2006, at 21:57:53

>
> Story from BBC NEWS:
> http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/6033013.stm
>
> Published: 2006/10/09 13:09:42 GMT
>
> BBC MMVI

Interesting -- maybe we should go back to
the different flavours of dementias;

Squiggles

 

Re: experts say...ditch schizophrenia label alexandra_k

Posted by Squiggles on October 11, 2006, at 8:02:16

In reply to Re: experts say...ditch schizophrenia label, posted by alexandra_k on October 10, 2006, at 22:30:58

....


> Ditto with the majority of psychiatric categories...
>
> No underlying essences in common...
> Our categories are more like 'Greenstone' than 'H2O'.
> So...
> Better categories are needed.
>
> I'm a fan of the symptom approach.
>
> Trouble is that the same issue arises on the level of symptoms...
>
> It seems likely that delusions that arise in response to cerebral injury are importantly different from delusions that arise in a context of psychosis, for example. Well... That is okay. Methinks the DSM should be working to classify symptoms on the basis of cause (aetiology) anyways. Clades have worked out pretty well for Biology (for example)...


I agree with you (if i understand this
correctly) that it is a matter of practical
convention that doctors categorize mental
illnesses. The names end up being the
thing-- but whether there is a real physical
disorder in the brain that always corresponds
to that name, is another matter. I think
this is the reason for all the MRI shots trying
to say -- here is schizophrenia, here is bipolar
disorder, etc. But that may be just one of the angles of the picture if you like. What if the psychotic process is not a particular disorder of a neuron (like myeletic degeneration, or lesions, or tumour) but rather a chemical process, and
an erratic one at that... i don't think the MRI would pick that up. Working down from the category than up from the symptoms may lead to more mistakes. Hypotheses are like that.

Squiggles

 

Re: OCD as an example alexandra_k

Posted by Squiggles on October 11, 2006, at 8:14:44

In reply to OCD as an example Squiggles, posted by alexandra_k on October 10, 2006, at 23:02:16

I think this article is an exception to the rule.
It takes some pretty strong brain-washing methods to change brain states through therapy. Also,
this article is about OCD-- try therapy on a
manic in the middle of extreme anxiety and agitation and i'll bet you that a benzo is worth one thousand kind words.

Squiggles

 

Re: experts say...ditch schizophrenia label xbunny

Posted by Squiggles on October 11, 2006, at 8:33:34

In reply to Re: experts say...ditch schizophrenia label, posted by xbunny on October 11, 2006, at 5:08:29

I'm supporting the scrapping of the schizophrenia
categorizing, not because i don't believe there
are similar clusters of symptoms to be found in
delusional psychoses of this type.

Rather, it is a desperate measure in the present state of ignorance in neuropsychiatry. Until the function of the brain which gives rise to the shifting climates of thinking and feeling that we call normal, is understood, described and predicted, we have to stumble in the darkness, and listen to the patient's complaints. So, an observational approach is more reliable than a diagnostic according to diagnosic tools that we don't have. There is endocrinology, and MRIs --
maybe those can be helpful in some cases. Etiology is so hard.

Until medicine cracks this frontier, we have some mostly bad drugs to treat some of these symptoms. These drugs are made on the basis of neurological hypotheses about what causes depression and hallucinations. In a sense they are experimental. As far as the patient is concerned and how he copes with these drugs, heroin would be a more sensible drug to give, as it covers so many psychotic states, with relatively less harm. Cheaper too.

Squiggles

 

Re: experts say...ditch schizophrenia label Squiggles

Posted by xbunny on October 11, 2006, at 9:35:10

In reply to Re: experts say...ditch schizophrenia label xbunny, posted by Squiggles on October 11, 2006, at 8:33:34

> I'm supporting the scrapping of the schizophrenia
> categorizing, not because i don't believe there
> are similar clusters of symptoms to be found in
> delusional psychoses of this type.
>
> Rather, it is a desperate measure in the present state of ignorance in neuropsychiatry. Until the function of the brain which gives rise to the shifting climates of thinking and feeling that we call normal, is understood, described and predicted, we have to stumble in the darkness, and listen to the patient's complaints. So, an observational approach is more reliable than a diagnostic according to diagnosic tools that we don't have. There is endocrinology, and MRIs --
> maybe those can be helpful in some cases. Etiology is so hard.

I find you hard to follow, but your agreeing with me right? Your saying there is no really accurate diagnosis tools so therefore it would be meaningless to attempt to apply subcategories when we dont have the right ways to notice them? If thats what you mean I think your absolutely right.
I think your slightly disagreeing with me because I am advocating that _in the future_ one way of categorizing schizophrenia will be to investigate how different groups react to different drugs, thats fair enough. The way I see it, once we have the drug we are one step closer to infering a) how it might work (and hence other drugs too) and b) what the subtype of schizophrenia we are dealing with is. This is a net gain for all schizophrenia.


>
> Until medicine cracks this frontier, we have some mostly bad drugs to treat some of these symptoms. These drugs are made on the basis of neurological hypotheses about what causes depression and hallucinations. In a sense they are experimental. As far as the patient is concerned and how he copes with these drugs, heroin would be a more sensible drug to give, as it covers so many psychotic states, with relatively less harm. Cheaper too.

Not sure if Im with you there, but it may well be my ignorance. I have never heard that heroin was an effective antipsychotic. In the other points I agree with you, the current drugs are far to inexact and the mechanism by which they work are still to vague to draw many conclusions. I disagree though that they are 'bad drugs' they are the best we have and I think better than nothing. I also think at least we are on the right track, researchers _are_ trying new drugs and forming new hypotheses about both how the drugs work and how they interact with the illness, this is good stuff. I agree its experimental its abit like trying to determine how a computer works by replacing components with ones which your not quite sure about either. Unfortunately we dont yet have suitable logic probes nor a manual! I certainly can conceive a day when we will have exact hypotheses about the way the brain works which fit actual results, but until that day I think its quite acceptable to experiment.

Bunny

 

Re: experts say...ditch schizophrenia label xbunny

Posted by Squiggles on October 11, 2006, at 10:19:13

In reply to Re: experts say...ditch schizophrenia label Squiggles, posted by xbunny on October 11, 2006, at 9:35:10

> > I'm supporting the scrapping of the schizophrenia
> > categorizing, not because i don't believe there
> > are similar clusters of symptoms to be found in
> > delusional psychoses of this type.
> >
> > Rather, it is a desperate measure in the present state of ignorance in neuropsychiatry. Until the function of the brain which gives rise to the shifting climates of thinking and feeling that we call normal, is understood, described and predicted, we have to stumble in the darkness, and listen to the patient's complaints. So, an observational approach is more reliable than a diagnostic according to diagnosic tools that we don't have. There is endocrinology, and MRIs --
> > maybe those can be helpful in some cases. Etiology is so hard.
>
> I find you hard to follow, but your agreeing with me right? Your saying there is no really accurate diagnosis tools so therefore it would be meaningless to attempt to apply subcategories when we dont have the right ways to notice them? If thats what you mean I think your absolutely right.
> I think your slightly disagreeing with me because I am advocating that _in the future_ one way of categorizing schizophrenia will be to investigate how different groups react to different drugs, thats fair enough. The way I see it, once we have the drug we are one step closer to infering a) how it might work (and hence other drugs too) and b) what the subtype of schizophrenia we are dealing with is. This is a net gain for all schizophrenia.
>


Yes, basically, i agree with you --
Sorry, if i am not clear -- i notice my sentences
ramble above.. i am presently on an antibiotic making a bit fuzzy; diagnoses are not accurate-- they are general guides to what kind of treatment would be appropriate. As for drugs working or not working and therefore meriting the title of diagnostic tools -- maybe; it has been seen that different drugs may work on the same disorder. Some drugs are magic bullets i think - in my case -- lithium.

Yes, basically, i agree with you --
>
> >
> > Until medicine cracks this frontier, we have some mostly bad drugs to treat some of these symptoms. These drugs are made on the basis of neurological hypotheses about what causes depression and hallucinations. In a sense they are experimental. As far as the patient is concerned and how he copes with these drugs, heroin would be a more sensible drug to give, as it covers so many psychotic states, with relatively less harm. Cheaper too.
>
> Not sure if Im with you there, but it may well be my ignorance. I have never heard that heroin was an effective antipsychotic. In the other points I agree with you, the current drugs are far to inexact and the mechanism by which they work are still to vague to draw many conclusions. I disagree though that they are 'bad drugs' they are the best we have and I think better than nothing. I also think at least we are on the right track, researchers _are_ trying new drugs and forming new hypotheses about both how the drugs work and how they interact with the illness, this is good stuff. I agree its experimental its abit like trying to determine how a computer works by replacing components with ones which your not quite sure about either. Unfortunately we dont yet have suitable logic probes nor a manual! I certainly can conceive a day when we will have exact hypotheses about the way the brain works which fit actual results, but until that day I think its quite acceptable to experiment.
>
> Bunny
>

Opiates were used before the Thorazine and chlorpromazine, with some success. Doctors always wanted something better. But i think you are right about their use for psychosis -- perhaps not; but definitely effective for depression and anxiety, right?

As for the new drugs-- i don't know. All i can say is i am hopeful, but they certainly produce an artificial, flat, mental environment. I guess that's better than jumping in front of a train. It did used to be much worse with the neuroleptics.

Squiggles

 

Public Citizen Squiggles

Posted by Squiggles on October 11, 2006, at 15:37:48

In reply to Re: experts say...ditch schizophrenia label xbunny, posted by Squiggles on October 11, 2006, at 10:19:13

I just noticed that the antibiotic i am
taking is on the list for a BLACK BOX by
Public Citizen. So, is the drug that
my ****** is taking. That scares me. What
scares me even more is that Public Citizen
is supposed to be the good guys-- you know
anti-Bush, pro-Carter, socialist, huminitarian,
started by Ralph Nader, out to preserve the safety
and rights of consumers and patients who are being taken for a ride by the big corporations (see movie by Moore) and the evil drug companies. At least that's what my ******* think. And I believe them, being a sensitive person and wanting to side with the good guys.

If I break a leg (that's the black box warning)
or get any psychotic reactions from this drug,
i'll let you know. There was a time in my life,
when I did not fear the medical man -- now,
i'm too scared to take an aspirin. Do I need
cult deprogramming? LOL

We'll see.

Squiggles

 

Re: Public Citizen Squiggles

Posted by Squiggles on October 12, 2006, at 18:51:07

In reply to Public Citizen Squiggles, posted by Squiggles on October 11, 2006, at 15:37:48

Please accept my apologies for that
outburst. I really do think that
groups like Public Citizen make a
contribution to the public good.
If I offended anyone there, i am sorry.
These medical matters are not all
black and white.

Squiggles

 

Re: OCD as an example

Posted by alexandra_k on October 13, 2006, at 1:17:54

In reply to Re: OCD as an example alexandra_k, posted by Squiggles on October 11, 2006, at 8:14:44

> I think this article is an exception to the rule.

Anxiety and depression (the two most prevalent disorders) seem to be similarly exceptions:

fMRI predictors of treatment outcome in pediatric anxiety disorders.

McClure EB, Adler A, Monk CS, Cameron J, Smith S, Nelson EE, Leibenluft E, Ernst M, Pine DS.

Department of Psychology, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302-5010, USA, emcclure@gsu.edu.

INTRODUCTION: A growing number of studies have found evidence that anxiety and depressive disorders are associated with atypical amygdala hyperactivation, which decreases with effective treatment. Interest has emerged in this phenomenon as a possible biological marker for individuals who are likely to benefit from tailored treatment approaches.

OBJECTIVE: The present study was designed to examine relationships between pretreatment amygdala activity and treatment response in a sample of anxious children and adolescents.

MATERIALS AND METHODS: Participants, who were diagnosed predominantly with generalized anxiety disorder (GAD), underwent functional magnetic resonance imaging (fMRI) scanning before treatment with fluoxetine or cognitive behavioral therapy (CBT).

RESULTS: Results indicated significant negative associations between degree of left amygdala activation and measures of posttreatment symptom improvement in the group, as a whole.

DISCUSSION: Taken together with research on associations between adult amygdala activation and treatment response, these findings suggest that patients whose pretreatment amygdala activity is the strongest may be particularly likely to respond well to such widely used treatments as selective serotonin reuptake inhibitor (SSRI) medications and CBT.

PMID: 16972100 [PubMed - as supplied by publisher]

So that is three disorders. The three that are... Most prevalent. I'm fairly sure that depression, anxiety, and OCD are the most prevalent disorders...

> It takes some pretty strong brain-washing methods to change brain states through therapy.

That is an empirical matter. Precisely what works in therapy is still open just like precisely what works in medication is still open...

> try therapy on a
> manic in the middle of extreme anxiety and agitation and i'll bet you that a benzo is worth one thousand kind words.

So you derive your rule from your disorder. I thought we were talking about mental illness more generally...

There isn't much on CBT with bi-polar and symptoms of schizophrenia. Though researchers have been turning to symptoms of schizophrenia i imagine bi-polar research won't be too far away. i'm not saying that medication is hopeless, remember. Just saying that therapy tends to be undervalued (that is to say undervalued considering the findings of its effectiveness).

 

Re: Public Citizen

Posted by cecilia on October 13, 2006, at 4:53:09

In reply to Public Citizen Squiggles, posted by Squiggles on October 11, 2006, at 15:37:48

Public Citizen and the drug companies are on opposite extremes. The drug companies say every new drug is wonderful, the more expensive the better. Public Citizen is always trying to remove things from the market because of rare side effects. (For example Serzone, which can cause liver damage in some people but is also the only AD that works for some people, who are more than willing to risk the liver damage.) Like all extremes, there needs to be somewhere in the middle to meet, more research, better informing people of possible side effects, but not snatching things from the market because some people have problems with them. Cecilia


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