Posted by SLS on September 6, 2008, at 17:46:56
In reply to Re: Bipolar Spectrum: Very long but very accurate. » SLS, posted by Larry Hoover on September 6, 2008, at 12:08:50
Hi Larry.
> A very complex and challenging issue, no doubt.
>
> I remain concerned about the process, despite some progress, nonetheless. A patient presents at a doctor's office with symptoms, seeking treatment for those. The doctor makes a diagnosis, and treats accordingly. However, the treatment options all arise from the diagnosis, with all its defining characteristics, which match very few patients precisely.I was surprised at how accurate the descriptions of categories were as depicted in the summary article. They match very well what I have seen in myself and others with bipolar disorders. I disagree with the concept of treating symptoms without regard to defining the identity of the disorder being treated. Depression arising from hypothyroidism will not be well treated as a symptom by using antidepressants.
> We just don't fit cleanly into the theoretical cubbyholes.
This is just the point I was attempting to make. In my experience, the categorial schemas presented in the article described with unusual precision the various presentations of bipolar disorder that I have seen in myself and in others. It is unfortunate that so few clinicians even attempt to use such schemas more rigidly as they are defined in the article. I feel that great progress has been made in the diagnostics of mental illnesses compared to the state of the art as it existed in 1982.
I first presented with an ultra rapid cycling presentation of depression in the absence of hypomania or mania. I believe that my bipolarity would have been identified much earlier had my treatment team operated under the premise that any type of true ultra rapid cyclicity of mood state should indicate bipolarity. The absence of a bipolar diagnosis allowed the usage of antidepressants without the concomitant use of mood stabilizers; a treatment that eventually led me to a psychotic mania as the result of antidepressant treatment. The rest of the story is too long to describe here. However, let me say that I would never have appeared on Psycho-Babble had my doctor treated a disorder rather than a series of symptoms.
I believe my bipolar disorder would have been properly diagnosed were these diagnostic guidelines to be in existence at the time. As unusual as my case is, it can still be teased out using the diagnostic schemas described in the article.
The article does not propose a single diagnostic algorithm to be followed. Characterizing mental illnesses and applying it to diagnostics is a work in progress. Perhaps the key to choosing effective treatments is to be found in using microarrays to catalog gene activity. That is a hope of mine, anyway.
- Scott
poster:SLS
thread:850483
URL: http://www.dr-bob.org/babble/20080903/msgs/850680.html