![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 25 to 49 of 49. Go back in thread:
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
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 MMVIInteresting -- maybe we should go back to
the different flavours of dementias;Squiggles
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
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
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
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
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
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? LOLWe'll see.
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
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).
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
Posted by Squiggles on October 13, 2006, at 6:42:56
In reply to Re: OCD as an example, posted by alexandra_k on October 13, 2006, at 1:17:54
Yes, i am generalizing from my own case.
But I think that most medical guidelines
recommend medication for bipolar disorder
maybe with therapy if available. I have
not seen many articles that prove the
roller-coaster can be stopped through
therapy in any book.
Squiggles
Posted by Squiggles on October 13, 2006, at 6:52:17
In reply to Re: Public Citizen, posted by cecilia on October 13, 2006, at 4:53:09
Yes, i came to that realization after
flying off the handle. Public Citizen
has many areas of concern, besides
drugs. If they are watchdogs for pharmaceuticals as well, then the FDA is not doing its job.
The FDA should be able to catch things like
Serzone liver failure, etc. Why do we need
a consumer group to do this? Does it mean
that the FDA is corrupt?Squiggles
Posted by cecilia on October 14, 2006, at 5:14:27
In reply to Re: Public Citizen » cecilia, posted by Squiggles on October 13, 2006, at 6:52:17
In my opinion, the FDA is totally corrupt. Cecilia
Posted by Squiggles on October 14, 2006, at 7:02:40
In reply to Re: Public Citizen, posted by cecilia on October 14, 2006, at 5:14:27
> In my opinion, the FDA is totally corrupt. Cecilia
In Canada, we have a pretty good Health Canada
warning system on adverse effects and a
record keeping system the public can log
into; i get e-mail alerts every day on
harmful drugs;Does the FDA have a similar system?
And, your words "totally corrupt" *are* alarming -- can you elucidate a bit?
Squiggles
Posted by alexandra_k on October 14, 2006, at 7:32:53
In reply to Re: OCD as an example » alexandra_k, posted by Squiggles on October 13, 2006, at 6:42:56
> I think that most medical guidelines
> recommend medication for bipolar disorder
> maybe with therapy if available.As I said, I'm not advocating that anybody stop taking their meds.
> Abstract This paper asserts that, contrary to the beliefs of many clinicians, patients with bipolar affective disorder often experience a deteriorating course characterized by pervasive social dysfunction. It reviews the literature, identifying a rationale for group psychotherapy as an adjunct to medication in the management of these chronic patients. It outlines a theoretical approach to bipolar group therapy, and presents a retrospective study comparing the course of 43 lithium-treated bipolar patients before and after entering bipolar groups. During the year in group therapy, bipolar patients displayed significant improvements in symptom relief as well as social functioning. It is proposed that group process enhances treatment with medication, providing benefits not evident with medication alone.
Sh*t... Now I've lost the damned reference. There is stuff on psychotherapy as adjunct for bi-polar.
> I have
> not seen many articles that prove the
> roller-coaster can be stopped through
> therapy in any book.Sure. But then I haven't seen any articles saying that cellphones cause cancer either. Just because there is a lack of articles doesn't mean that cellphones don't cause cancer... The studies haven't been done. Maybe they will be one day but the trouble is not making people take drugs by law to see whether therapy can help them...
Posted by Squiggles on October 14, 2006, at 7:51:12
In reply to Re: OCD as an example, posted by alexandra_k on October 14, 2006, at 7:32:53
Well in my case, the depressive side of
manic-depression was so bad, so alien,
as if someone had given me a poison, that
i would have killed myself. And i would
have killed myself, not in the comfort of
my living room, deciding how many pills to
take or how to do it, but in an impulsive
desperate race to get out of my skin. That's
how bad it feels.Are you bipolar? Have you been in any
of the psychotic states of manic-depression?As for literature, there is plenty on the
suicide rates of untreated manic depression,
and major depression.This therapy you recommend is a nice thing
to have if you are in a more or less stable
state of mind; in a psychotic state, you'd
probably wish they would shut up and take
you to the hospital.Squiggles
Posted by Squiggles on October 14, 2006, at 8:38:00
In reply to Re: OCD as an example » alexandra_k, posted by Squiggles on October 14, 2006, at 7:51:12
p.s. the social dysfunction you speak of
is the price that a lot of mental patients
have to pay-- the drugs are hard to live with and you are not normal. A friend and a sympathetic ear is consoling; group therapy is not necessarily everyone's cup of tea.I would also like to tell you something from my own experience, something anecdotal, outside the medical journals and statistics.
I have witnessed with my own eyes a desperate attempt at a hanging. (i stopped it and
took my friend to the hospital). This action,
which should not surprise you if you read
the news about people who do crazy things in
the grips of depression, was in response to
a mounting major depressive state.Now, i ask you - should i have taken this person
to group therapy or to a dr. who gave meds?Hmmm?
It's a rhetorical question, you don't have to
answer, but if you have been to group therapy
i hope you picked up some compassion and understood that mental illness is an illness and not a coffee table game. Once again, most meds
suck, and they ruin your life and your dreams in many cases, and there is stigma. But it's all we've got right now. Group therapy sounds nice, but it cannot reverse mental illness - it is possibly an adjunct as you mentioned. Personally, i find reading a good book or speaking to a friend preferable.Squiggles
Posted by alexandra_k on October 14, 2006, at 22:03:42
In reply to Re: OCD as an example » alexandra_k, posted by Squiggles on October 14, 2006, at 7:51:12
i really don't know how many times i have to say this:
I'M NOT ADVOCATING THAT PEOPLE STOP TAKING THEIR MEDICATION.
another thing:
I'M NOT ADVOCATING THAT ONE MUST CHOOSE ONE AND ONLY ONE VARIETY OF TREATMENT.
i've just been saying that for the majority of disorders they have found that a combination of BOTH medication and psychotherapy is most effective
and that while there is a lot more research to do (on the effectiveness of psychotherapy for schizophrenia and bi-polar in particular)
it looks like a combination of both medication AND therapy is most effective
and hence the argument from 'biomedical condition hence therapy doesn't help' is wrong as a matter of empirical fact. for the reason that... therapy targets biology too...
Posted by alexandra_k on October 14, 2006, at 22:08:05
In reply to Re: OCD as an example » Squiggles, posted by Squiggles on October 14, 2006, at 8:38:00
> p.s. the social dysfunction you speak of
> is the price that a lot of mental patients
> have to payso there is nothing we can do we may as well stop researching it and just accept this as an inevitable consequence of mental disorder?
> A friend and a sympathetic ear is consoling; group therapy is not necessarily everyone's cup of tea.
sure. medication is not necessarily everyone's cup of tea either. there is stuff in individual therapy too, i picked this one because it seemed to be a SOCIAL intervention more than a PSCYHOLOGICAL intervention even.
> Now, i ask you - should i have taken this person
> to group therapy or to a dr. who gave meds?and i have to choose one and only one option?
> i hope you picked up some compassion and understood that mental illness is an illness and not a coffee table game.i never said or meant to imply it was a 'coffee table game'. do you think therapy is a 'coffee table game'?
>Once again, most meds
> suck, and they ruin your life and your dreams in many cases, and there is stigma. But it's all we've got right now.there are other interventions too...
> Group therapy sounds nice, but it cannot reverse mental illness
that is an empirical matter. the data will decide. the studies haven't been done...
Posted by Squiggles on October 14, 2006, at 22:30:55
In reply to Re: OCD as an example, posted by alexandra_k on October 14, 2006, at 22:03:42
> it looks like a combination of both medication AND therapy is most effective
>
> and hence the argument from 'biomedical condition hence therapy doesn't help' is wrong as a matter of empirical fact. for the reason that... therapy targets biology too...
>
>I hear you. And one more time -- therapy is to manic-depression, what cleaning with water is to puerperal infection-- you need an antibiotic to fight it.
In other words, therapy alone will not stabilize
a manic-depressive; drugs first, therapy later if desired.Squiggles
Posted by Squiggles on October 14, 2006, at 22:37:41
In reply to Re: OCD as an example » Squiggles, posted by alexandra_k on October 14, 2006, at 22:08:05
> > p.s. the social dysfunction you speak of
> > is the price that a lot of mental patients
> > have to pay
>
> so there is nothing we can do we may as well stop researching it and just accept this as an inevitable consequence of mental disorder?It varies from person to person, according to
what kind of drugs they take, what their social
position is, what demands are made of them, and whether they are poor. But in general, there is not much you can do about the side effects of drugs except change the side effects.
>
> > A friend and a sympathetic ear is consoling; group therapy is not necessarily everyone's cup of tea.
>
> sure. medication is not necessarily everyone's cup of tea either. there is stuff in individual therapy too, i picked this one because it seemed to be a SOCIAL intervention more than a PSCYHOLOGICAL intervention even.If it works for you, good.
>
> > Now, i ask you - should i have taken this person
> > to group therapy or to a dr. who gave meds?
>
> and i have to choose one and only one option?I can't think of a third, except hit her with a hypodermic full of sedatives-- not the kind of thing that is immediately available to the man-on-the-street.
>
> > i hope you picked up some compassion and understood that mental illness is an illness and not a coffee table game.
>
> i never said or meant to imply it was a 'coffee table game'. do you think therapy is a 'coffee table game'?I can't say -- as i have never been to one; but i think i would feel as if i were at a social gathering-- nice for a normal state to share your problems. Actually, i think i do that on the net.
For me that is good, because i am a shy person with crowds. Maybe a one-to-one i could handle, but the only things i would ask about would be drugs anyway.
>
> >Once again, most meds
> > suck, and they ruin your life and your dreams in many cases, and there is stigma. But it's all we've got right now.
>
> there are other interventions too...
>
> > Group therapy sounds nice, but it cannot reverse mental illness
>
> that is an empirical matter. the data will decide. the studies haven't been done...
>If it works for you, then that's good, because
the drugs are very challenging and unpleasant.Squiggles
Posted by alexandra_k on October 15, 2006, at 1:22:14
In reply to Re: OCD as an example » alexandra_k, posted by Squiggles on October 14, 2006, at 22:30:55
> therapy is to manic-depression, what cleaning with water is to puerperal infection-- you need an antibiotic to fight it.
but that is an empirical matter.
it is like... if you go back in time 100 years then what is the treatment for bipolar? there isn't really one... then you get medications developed... and the medications work more or less well and they do studies on which are most effective and clinicians do a little bit of experimentation 'will this work for you... no... how about this?' and they do more studies and over time the treatment gets better. psychological and social treatments are still in their infancy *especially* with symptoms of bi-polar and schizophrenia. they really are in their infancy. not many studies have been done and not many psychological and social interventions have been developed yet for those disorders even less gone on to be studied empirically to see how well they work.just as medications are advancing...
therapy is advancing...
and social treatments too...> In other words, therapy alone will not stabilize
> a manic-depressive; drugs first, therapy later if desired.with the current psychotherapies and social interventions that are available for bi-polar you might well be right.
but then... you might be wrong because the studies haven't been done and thus we don't know.
with future psychotherapies and social interventions that are yet to be developed... who knows.
personally... i think it would be a great thing if those kinds of interventions helped (either by better prognosis COMBINING those with medication) or even alone so people don't have to suffer the negatives of drug treatment. but the best treatment or treatment combination is an empirical matter and the studies need to be done...
_____________
there are many medications. ranging from asprin to lithium...
there are many psychotherapies. ranging from a coffee table chat to intensive controntational varieties...not all of them are coffee table chats...
in fact... the coffee table chats seem to be fairly consistently outperformed by other varieties...
though the coffee table chats seem to outperform the absence of coffee table chats...
but babble and friendships are of CONSIDERABLE importance too, i hear you on that.
Posted by Squiggles on October 15, 2006, at 6:56:58
In reply to Re: OCD as an example » Squiggles, posted by alexandra_k on October 15, 2006, at 1:22:14
....
> but babble and friendships are of CONSIDERABLE importance too, i hear you on that.
>
>
I'm glad we agree on something. I'm sorry i'm
not dragging out the proof from studies on this--
i'm not up to it right now; but i have come to my conclusion on this both from personal experience, observation of others' and pretty intenstive reading on the subject. One more thing-- if psychotherapy *were* to work for major psychoses, it would be extremely time-consuming, expensive, and experimental-- may as well go back to Freud-- that's what he did-- psychotherapy. His wealthy patients were on the couch for decades.Squiggles
Posted by Squiggles on October 15, 2006, at 8:26:17
In reply to Re: OCD as an example » alexandra_k, posted by Squiggles on October 15, 2006, at 6:56:58
In support of your argument, here is one search
result-- take a look at related articles on the right hand side of the PubMed title:------------------------
1: Harv Rev Psychiatry. 2000 Sep;8(3):126-40. Links
Effectiveness of psychosocial treatments in bipolar disorder: state of the evidence.* Huxley NA,
* Parikh SV,
* Baldessarini RJ.International Consortium for Bipolar Disorder Research (Drs. Huxley, Parikh, and Baldessarini).
Cost-effective psychotherapeutic interventions can enhance pharmacotherapy and improve outcomes in major depression and schizophrenia, but they are rarely studied in bipolar disorder, despite its often unsatisfactory response to medication alone. Following a literature search, we compiled and evaluated research reports on psychotherapeutic interventions in bipolar disorder patients. We found 32 peer-reviewed reports involving 1052 patients-14 studies on group therapy, 13 on couples or family therapy, and five on individual psychotherapy-all supplementing standard pharmacotherapy. Methodological limitations were common in these investigations. Nevertheless, important gains were often seen, as determined by objective measures of increased clinical stability and reduced rehospitalization, as well as other functional and psychosocial benefits. The results should further encourage rising international interest in testing the clinical and cost-effectiveness of psychosocial interventions in these common, often severe and disabling disorders.
PMID: 10973937 [PubMed - indexed for MEDLINE]
Related Links* Psychosocial interventions for bipolar disorder. [Psychiatr Clin North Am. 1999] PMID: 10550862
* Psychological interventions in bipolar disorder: From wishful thinking to an evidence-based approach. [Acta Psychiatr Scand Suppl. 2004] PMID: 15330936
* Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modelling studies. [Health Technol Assess. 2005] PMID: 15774232
* The package of care for patients with bipolar depression. [J Clin Psychiatry. 2005] PMID: 16038600
* Psychotherapy for bipolar disorder. [Br J Psychiatry. 1995] PMID: 8564312
* See all Related Articles...
-----------------Notice these words in the abstract:
"despite its often unsatisfactory response to medication alone."
That is the foundation of this article. For those who have an unsatisfactory response to medication alone for bipolar, adjunct psychotherapy might help. Please feel free to avail yourself of this if it helps you. For me, my medication has worked for 25 years, with a lapse in a corrupted batch from a pharmacy, which sent me into mixed states, and a personal suspension, which started a depression. In both cases, resumption of the medication stabilized me from a dangerous situation.
If it were not for the level-headed, prompt response of my doctor, i may be dead now.
Still, the side effects leave a lot to be desired.Check out PubMed, Stanley Foundation, NAMI, American Psychiatric Association, Canadian Psychiatric Association and others on the net, under the key words for adjunct talk therapy with meds-- i doubt that any will say it is *not* helpful, but it is also not a substitute.
This is the end of the thread.
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