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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6 to 30 of 30. Go back in thread:
Posted by Lamdage22 on September 28, 2021, at 3:17:12
In reply to Re: DSM-5: Download the entire book - PDF, Epub, Mobi, posted by Lamdage22 on September 28, 2021, at 3:16:08
Two people with similar diagnoses may need very different treatments.
Posted by Lamdage22 on September 28, 2021, at 9:08:31
In reply to Re: DSM-5: Download the entire book - PDF, Epub, Mobi, posted by Lamdage22 on September 28, 2021, at 3:17:12
Its not like "ah he is bipolar 1 we are gonna do this and that". At least I think it shouldn't be. Every story is unique and may fall somewhere in between two or more diagnoses
Posted by SLS on September 30, 2021, at 7:48:46
In reply to Re: DSM-5: Download the entire book - PDF, Epub, Mobi, posted by Lamdage22 on September 28, 2021, at 3:16:08
> Well it gets complicated when you are schizo-affective and the schizo part is in remission but the affective part is not. They havent thought of every possibility in my opinion. Every person is an individual anyway.
Now that you have access to the complete DSM-5, how you tried it to see it successfully leads to your correct diagnoses?
- Scott
Posted by Lamdage22 on October 2, 2021, at 8:59:46
In reply to Re: DSM-5: Download the entire book - PDF, Epub, Mobi » Lamdage22, posted by SLS on September 30, 2021, at 7:48:46
I am prejudiced against it. I don't deem it that valuable for my particular problem. It is probably made by the same people by the same voting process.
Posted by undopaminergic on October 2, 2021, at 12:46:48
In reply to DSM-5: Download the entire book - PDF, Epub, Mobi, posted by SLS on September 25, 2021, at 9:23:19
> Hi, all.
>
> If you don't already have a copy of the DSM-5, this is the URL link to download the entire book. You can download PDF, Epub, and Mobi.
>Thank you! I already had several copies in PDF format, but yours seems to be of the highest quality.
I read the whole chapter on psychotic disorders. I'm beginning to think I have the DSM-5 version of schizophrenia, which is not necessarily Bleuler's classic schizophrenia. Needless to say, other diagnoses are also required to account for the smorgasbord of psychopathology that I am.
Why schizophrenia? The key is the role assigned to negative symptoms by the DSM-5. Another key is the delineation of delusions; I'm willing to concede that I have (had) more of them than I've traditionally maintained.
I have had episodes that met the criteria A for longer than a month (even less is required if treated). More specifically, I have had some delusions (typically taking their beginnings during a manic episode) that lasted for longer than a month, *and* I have had negative symptoms (largely the same as in depression) for even longer, especially apathy.
According to criterion C, the complete duration of an episode needs to be at least 6 months, and needs include only 1 month of active symptoms (see above), and a prodromal and/or residual phase that needs include nothing more than negative symptoms. I easily qualify for that.
It appears I do not qualify for schizoaffective disorder, because the depressive episode has to feature a (significantly) depressed mood, not just anhedonia or concentration difficulties.
*But* I have been manic, which is enough to qualify me for bipolar I disorder. Moreover, the loss of critical thinking in mania has been the major factor in the development of delusions.
Posted by Jay2112 on October 4, 2021, at 19:09:51
In reply to DSM-5: Download the entire book - PDF, Epub, Mobi, posted by SLS on September 25, 2021, at 9:23:19
I use the DSM-5 in my job in addictions and mental health. One BIG change, for me, was the change in criteria for treatment of bereavement. The one month rule is now gone, and patients/clients can/are now (be) treated immediately after the death of someone close..or anyone, really, that causes distressing symptoms. I don't remember the actual wording or such, but you get the point.
After becoming suicidal after losing my beautiful pet dog, I *begged* my pdoc for extra meds..as my insurance only covers a small amount of psych meds. I have been on almost every psych med in Canada, and was almost ready to turn to heroin..SERIOUSLY!! And...the only thing that saved me at the last moment was an almost 1 month hospitalization for pneumonia and a collapsed lung. (Which would have killed me, anyway.)
I got looked after like a *prince*! I had morphine in my i.v. whenever I requested, 24/7. I had my Vyvanse (amphetamine redux) increased, with large amounts of the strongest pro-GABA med out there, Lyrica. I had a small amount of carbamazepine to take the edge off the Vyvanse. I had 1mg of clonazepam 4x a day. I had 2mg of nabilone (synthetic cannabis..sorta) 4x a day.
Nurses, basically obeying my orders...because I was VERY assertive (in a nice way), and they knew that I KNEW what I was talking about when it came to meds. Plus, healthy meals, 24/7 antibiotics (which was good because it made me 'go' when the morphine constipated me).
One thing I learnt while living in poverty, is how to manipulate doctors, and anyone in the healthcare profession. So...I got home...started feeling really bad again, and am now experimenting with cannabis + nabilone, and some amino acids to really perk me up.
Ok..Ok..I am way off track...but you get the picture.
Jay
Posted by SLS on October 6, 2021, at 22:06:47
In reply to Beginning to think I have schizophrenia » SLS, posted by undopaminergic on October 2, 2021, at 12:46:48
Hi, UD.
I'm glad the manual offered you meaningful information that might enhance your ability to differentiate between symptom clusters and better identify treatments with better chances of success.
Yours is not an easy case to characterize. Have you already discounted schizoaffective disorder, particularly the bipolar subtype?
- Scott
Posted by SLS on October 6, 2021, at 22:09:28
In reply to Beginning to think I have schizophrenia » SLS, posted by undopaminergic on October 2, 2021, at 12:46:48
By the way, UD, your open mind regarding your illness serves you well.
- Scott
Posted by undopaminergic on October 7, 2021, at 12:12:18
In reply to Re: Beginning to think I have schizophrenia » undopaminergic, posted by SLS on October 6, 2021, at 22:06:47
> Hi, UD.
Hi SLS.
> I'm glad the manual offered you meaningful information that might enhance your ability to differentiate between symptom clusters and better identify treatments with better chances of success.
>From the point of view of treatment, (unipolar) depression would seem to be the most useful diagnosis. With schizophrenia, there's a risk the clinician will overemphasise antipsychotics, and likewise with bipolar and mood stabilisers.
> Yours is not an easy case to characterize. Have you already discounted schizoaffective disorder, particularly the bipolar subtype?
>Not entirely. But the schizoaffective criteria require that a mood disorder be present for most of the time of the illnesss. A major depressive episode has to include depressed mood, not just anhedonia. I don't suffer much from a depressed mood, and haven't for some years. Moreover, my delusions are not associated in any apparent way with depression, only with mania. And delusions have far outlasted my manias. Taken literally, I might qualify, because I have had (mild) mood symptoms before, and the criteria don't state explicitly that the depression has to be the *cause* of the delusions. I don't think I qualify if we consider the "spirit" of the criteria. What do you think?
-undopaminergic
Posted by SLS on October 7, 2021, at 15:47:05
In reply to Re: Beginning to think I have schizophrenia » SLS, posted by undopaminergic on October 7, 2021, at 12:12:18
Hi, UD.
I think you may be getting somewhere.
>
> Hi SLS.
>
> > I'm glad the manual offered you meaningful information that might enhance your ability to differentiate between symptom clusters and better identify treatments with better chances of success.
> >
>
> From the point of view of treatment, (unipolar) depression would seem to be the most useful diagnosis. With schizophrenia, there's a risk the clinician will overemphasise antipsychotics, and likewise with bipolar and mood stabilisers.
>
> > Yours is not an easy case to characterize. Have you already discounted schizoaffective disorder, particularly the bipolar subtype?
> >
>
> Not entirely. But the schizoaffective criteria require that a mood disorder be present for most of the time of the illnesss. A major depressive episode has to include depressed mood, not just anhedonia. I don't suffer much from a depressed mood, and haven't for some years. Moreover, my delusions are not associated in any apparent way with depression, only with mania. And delusions have far outlasted my manias. Taken literally, I might qualify, because I have had (mild) mood symptoms before, and the criteria don't state explicitly that the depression has to be the *cause* of the delusions. I don't think I qualify if we consider the "spirit" of the criteria. What do you think?
>
> -undopaminergic
1. How do you differentiate between schizophrenia and schizoaffective disorder?2. How would you describe the difference between bipolar mania and the delusions that persist after the manic episode resolves?
3. What exactly is meant by saying "depressed mood"? I really don't know.
4. Does "depressed mood" differ from "melancholic depression"?
5. Psychotic depression is not often talked about. The TCA, amoxapine (Asendin), emerged in the early 1980s and was touted as being effective in the treatment of psychotic depression. This is not unexpected. Amoxapine (an antidepressant) is an active metabolite of loxapine (the parent molecule that acts as an antipsychotic). Once inside the body, loxapine is metaboized into amoxapine and several other compounds that are inert. Some research clinicians are advocating the use of loxapine rather than amoxapine to treat psychotic depression. Since the metabolism of loxapine yields large amounts of amoxapine, one can argue that using loxapine by itself would serve to introduce amounts of amoxapine sufficient to produce a TCA antidepressant effect.
1. Mixed-state bipolar with psychotic depression?
2. Schizoaffective disorder presenting with a bipolar mixed-state?
3. Schizoaffective disorder presenting as a bipolar mixed-state where the depressive component is that of psychotic depression.
Is there any history of seizures, traumatic brain injury, or multiple concussive injuries?Lyme Disease? I doubt it, but Lyme infection produces a plethora of strange combinations of psychiatric symptoms.
In treatment resistant psychiatric disorders, some very smart doctors often subscribe to the ancient adage that if you throw enough crap against the wall, some of it is bound to stick.
- Scottt
Posted by undopaminergic on October 8, 2021, at 8:49:08
In reply to Re: Beginning to think I have schizophrenia, posted by SLS on October 7, 2021, at 15:47:05
> Hi, UD.
Hi SLS.
>
> 1. How do you differentiate between schizophrenia and schizoaffective disorder?
>In schizoaffective disorder, a mood episode (depressive or manic) is ongoing for most of the whole duration of illness.
> 2. How would you describe the difference between bipolar mania and the delusions that persist after the manic episode resolves?
>Classic mania is an episode of elated mood or even euphoria, as well as associated symptoms such as impulsiveness and a lack of critical thinking. The impulsive thinking leads to (typically grandiose) delusions. The delusions remain although the mania subsides.
> 3. What exactly is meant by saying "depressed mood"? I really don't know.
I think in the DSM, it is meant to be self-explanatory.
> 4. Does "depressed mood" differ from "melancholic depression"?
Depressed mood is a feature of melancholia, but can occur in the absence of the latter. As I understand it, it is a condition of low mood that can include feelings of sadness, worthlessness, guilt, hopelessness, etc..
> 5. [psychotic depression and amoxapine and loxapine]
I'm not familiar first hand with psychotic depression. From what you say, I agree that it would make sense to treat it with loxapine. Another option would be trimipramine, which is a dopamine antagonist and has substantial antipsychotic properties. (I'm currently on trimipramine.)
> 1. Mixed-state bipolar with psychotic depression?
>
> 2. Schizoaffective disorder presenting with a bipolar mixed-state?
>
> 3. Schizoaffective disorder presenting as a bipolar mixed-state where the depressive component is that of psychotic depression.
>What about them?
> Is there any history of seizures, traumatic brain injury, or multiple concussive injuries?
>In my case? No. I even tried high doses (maybe 900 mg) of bupropion without even a hint of seizures.
> Lyme Disease? I doubt it, but Lyme infection produces a plethora of strange combinations of psychiatric symptoms.
>Yes, but I didn't have a tick bite until long after I fell prey to mental illness.
> In treatment resistant psychiatric disorders, some very smart doctors often subscribe to the ancient adage that if you throw enough crap against the wall, some of it is bound to stick.
>You mean throw more and more medications (in combination) at the problem to see if it begins to help a little?
I don't have access to any smart doctors.
-undopaminergic
Posted by Lamdage22 on October 16, 2021, at 14:03:41
In reply to Re: Beginning to think I have schizophrenia » SLS, posted by undopaminergic on October 8, 2021, at 8:49:08
Are you going to change your treatment based on this? You fought against that diagnosis if I recall correctly. I have moved on to more spiritual/psychosocial "diagnoses" because I feel that there no longer is a problem in need of additional psychopharmaceutical treatment. I take the meds and its fine, but I don't chase the super duper genius psychopharmaceutical combination anymore.
Posted by undopaminergic on October 17, 2021, at 8:38:10
In reply to Re: Beginning to think I have schizophrenia, posted by Lamdage22 on October 16, 2021, at 14:03:41
> Are you going to change your treatment based on this?
No. Whatever the diagnosis -- whatever you call it -- the underlying neurochemical problem (assuming it is *bio*logical) is going to be same, and will respond to the same treatment.
> You fought against that diagnosis if I recall correctly.
Yes. I'm still of the opinion that the diagnosis is inappropriate, if for no other reason than that (classic) schizophrenia is something worse than I have; it is the most severe and chronic psychotic illness; to call my minor psychoses schizophrenia is almost to make a mockery of that diagnosis.
What has changed, is that I've read DSM-5 more carefully, and I have come to the conclusion that a case can be made for my meeting the diagnostic criteria.
> I have moved on to more spiritual/psychosocial "diagnoses" because I feel that there no longer is a problem in need of additional psychopharmaceutical treatment. I take the meds and its fine, but I don't chase the super duper genius psychopharmaceutical combination anymore.
>I embrace both psycho- and pharmaco-dynamic approaches. Sometimes, a drug can compensate for faulty psychology, and a chemical imbalance can be compensated for by psychodynamic factors.
-undopaminergic
Posted by Lamdage22 on October 17, 2021, at 10:45:03
In reply to Re: Beginning to think I have schizophrenia, posted by undopaminergic on October 17, 2021, at 8:38:10
Does Schizophrenia have to be very severe to be Schizophrenia? Maybe that is a vernacular notion and not what psychiatry is saying?
> I embrace both psycho- and pharmaco-dynamic approaches. Sometimes, a drug can compensate for faulty psychology, and a chemical imbalance can be compensated for by psychodynamic factors.
To an extent probably, but I do believe it has limits.
Posted by undopaminergic on October 17, 2021, at 14:25:52
In reply to Re: Beginning to think I have schizophrenia, posted by Lamdage22 on October 17, 2021, at 10:45:03
> Does Schizophrenia have to be very severe to be Schizophrenia? Maybe that is a vernacular notion and not what psychiatry is saying?
>I confess that I haven't read Bleuler (who coined the term "schizophrenia"). According to DSM, it does not have to be very severe at all -- that's why I may qualify for a diagnosis.
But schizophrenia *is* considered the most severe and chronic psychotic disorder.
> > I embrace both psycho- and pharmaco-dynamic approaches. Sometimes, a drug can compensate for faulty psychology, and a chemical imbalance can be compensated for by psychodynamic factors.
>
> To an extent probably, but I do believe it has limits.Yes, drugs lack precision, at least unless they are injected right into the brain. Meanwhile, psychodynamics can't keep up the function of a brain that's dead and rotting -- unless you're God or something!
-undopaminergic
Posted by Lamdage22 on October 18, 2021, at 4:41:55
In reply to Re: Beginning to think I have schizophrenia, posted by undopaminergic on October 17, 2021, at 14:25:52
> But schizophrenia *is* considered the most severe and chronic psychotic disorder.
What are other psychotic disorders to be considered?
Posted by undopaminergic on October 18, 2021, at 5:00:08
In reply to Re: Beginning to think I have schizophrenia, posted by Lamdage22 on October 18, 2021, at 4:41:55
> > But schizophrenia *is* considered the most severe and chronic psychotic disorder.
>
> What are other psychotic disorders to be considered?
>According to the DSM-5 chapter on psychosis: (i) Delusional Disorder, (ii) Brief Psychotic Disorder, (iii) Schizophreniform Disorder, (iv) Schizoaffective Disorder, (v) Substance/Medication-Induced Psychotic Disorder, (vi) Psychotic Disorder Due to Another Medical Condition, (vii) Other Specified Schizophrenia Spectrum and Other Psychotic Disorder, and (viii) Unspecified Schizophrenia Spectrum and Other Psychotic Disorder.
In addition Schizotypal Personality Disorder is considered to be closely related to psychosis. Catatonia is also described in the psychosis chapter, but is diagnosed separately and noted as a specifier ("with catatonia") on other diagnoses.
-undopaminergic
Posted by undopaminergic on October 18, 2021, at 5:03:02
In reply to Re: Beginning to think I have schizophrenia, posted by undopaminergic on October 18, 2021, at 5:00:08
> > > But schizophrenia *is* considered the most severe and chronic psychotic disorder.
> >
> > What are other psychotic disorders to be considered?
> >
>
> According to the DSM-5 chapter on psychosis: (i) Delusional Disorder, (ii) Brief Psychotic Disorder, (iii) Schizophreniform Disorder, (iv) Schizoaffective Disorder, (v) Substance/Medication-Induced Psychotic Disorder, (vi) Psychotic Disorder Due to Another Medical Condition, (vii) Other Specified Schizophrenia Spectrum and Other Psychotic Disorder, and (viii) Unspecified Schizophrenia Spectrum and Other Psychotic Disorder.
>
> In addition Schizotypal Personality Disorder is considered to be closely related to psychosis. Catatonia is also described in the psychosis chapter, but is diagnosed separately and noted as a specifier ("with catatonia") on other diagnoses.
>
> -undopaminergic
>In addition, a mood disorder (mania or depression) with psychotic features has to be considered.
-undopaminergic
Posted by Lamdage22 on October 18, 2021, at 12:09:43
In reply to Re: Beginning to think I have schizophrenia, posted by undopaminergic on October 18, 2021, at 5:03:02
I see.
Posted by Lamdage22 on October 19, 2021, at 2:54:54
In reply to Re: Beginning to think I have schizophrenia, posted by Lamdage22 on October 18, 2021, at 12:09:43
My experience is that oftemtimes there isnt a diagnosis to accurately describe what is going on.
Posted by undopaminergic on October 19, 2021, at 8:41:41
In reply to Re: Beginning to think I have schizophrenia, posted by Lamdage22 on October 19, 2021, at 2:54:54
> My experience is that oftemtimes there isnt a diagnosis to accurately describe what is going on.
>Each case is unique. Diagnostic guidelines are not tailored to any specific person, but aim to identify common factors shared by a group of people.
I think that as an alternative to the DSM-5, you might wish to take a look at the Psychodynamic Diagnostic Manual (PDM-2). I'm just starting to look at it myself as of writing.
-undopaminergic
Posted by Lamdage22 on October 19, 2021, at 12:16:18
In reply to Re: Beginning to think I have schizophrenia, posted by undopaminergic on October 19, 2021, at 8:41:41
Thanks. Cool, from the sound of it I might like that one better.
Posted by undopaminergic on October 19, 2021, at 12:33:17
In reply to Re: Beginning to think I have schizophrenia, posted by Lamdage22 on October 19, 2021, at 12:16:18
> Thanks. Cool, from the sound of it I might like that one better.
My initial reactions are that it is somehow more considerate of the full spectrum of realities and perhaps therefore that it is more sober. At the same time, it feels more open-ended (and perhaps -minded). I've been (and still am) reading the chapter on adult personality.
-undopaminergic
Posted by Lamdage22 on October 19, 2021, at 12:36:40
In reply to Re: Beginning to think I have schizophrenia, posted by undopaminergic on October 19, 2021, at 12:33:17
Who uses it? Do you know?
Posted by undopaminergic on October 19, 2021, at 13:21:44
In reply to Re: Beginning to think I have schizophrenia, posted by Lamdage22 on October 19, 2021, at 12:36:40
> Who uses it? Do you know?
No, I don't know, but I would assume those inclined to more "dynamic" schools of psychology, as opposed to (in particular) psychopharmacologists or behaviourists.
-undopaminergic
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