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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by Ame Sans Vie on August 26, 2003, at 9:51:45
I'm just curious to know what all of your opinions are about one particular thing. Which do you believe is more important in treating psychiatric patients -- accurate diagnoses (labels) or individual symptoms? I'll post my opinions concerning this after I absorb some of y'all's (oh boy... 8 years and TX and now the dialect is creeping up on me, lol) wisdom and insight. Oh, and of course "both" is an acceptable answer. :-)
Posted by galkeepinon on August 26, 2003, at 14:47:36
In reply to A poll for everyone... out of curiosity., posted by Ame Sans Vie on August 26, 2003, at 9:51:45
individual symptoms by far! (for many reasons) IMHO, labels are highly overrated, more so when it comes to depression and bipolar (which is what I have) and often inaccurate. For schizophrenia, schizo-affective, DID, MPD, SAD, etc. I can't comment.
> I'm just curious to know what all of your opinions are about one particular thing. Which do you believe is more important in treating psychiatric patients -- accurate diagnoses (labels) or individual symptoms? I'll post my opinions concerning this after I absorb some of y'all's (oh boy... 8 years and TX and now the dialect is creeping up on me, lol) wisdom and insight. Oh, and of course "both" is an acceptable answer. :-)
>
>
Posted by Eddie Sylvano on August 26, 2003, at 15:15:44
In reply to Re: A poll for everyone... out of curiosity. » Ame Sans Vie, posted by galkeepinon on August 26, 2003, at 14:47:36
Gotta be symtpoms. It's a bit of hubris on the part of the psychiatric community to think that the diverse range of states evinced by a faulty brain can be neatly categorized into domains and subtypes. To their credit, I see psychiatrists using the labels more as a means of communication about areas of concern than as an origin for prescription. It's probably the public that gets more hung up on being labeled.
Labeling in general is something that we as people do to give ourselves a sense of control and understanding. This mentality can be useful (electricity/reptiles/syphilis) or merely hopeful (Irritable Bowel syndrome/God/gravity). Still, it's in this spirit that we as a whole have been able to advance knowledge by simplfying communication.
Posted by JonW on August 26, 2003, at 15:35:44
In reply to A poll for everyone... out of curiosity., posted by Ame Sans Vie on August 26, 2003, at 9:51:45
> I'm just curious to know what all of your opinions are about one particular thing. Which do you believe is more important in treating psychiatric patients -- accurate diagnoses (labels) or individual symptoms? I'll post my opinions concerning this after I absorb some of y'all's (oh boy... 8 years and TX and now the dialect is creeping up on me, lol) wisdom and insight. Oh, and of course "both" is an acceptable answer. :-)
That's a tough one...
I would say, so long as the cause can in fact be identified, then it's important to seek the root of the problem. However, there is a lot to be said for reducing symptoms. People in pain should never be deprived of the ability to ease their pain. I think the best answer to this question would vary depending on the situation. In general, I think if it's possible to make the distinction between cause and symptom, then the cause should be treated first. Do we really know enough, though, to be saying what causes what? I don't know, and that will be my final point -- I don't know enough to have an opinion on this issue. Apparently, that didn't stop me from posting :)
On a side note, I do think it's dangerous to define any set of symptoms that a drug reduces as a bona fide disorder. This is good for the drug companies, but it may be at the expense of treatment-resistant outpatients.
Jon
Posted by Sabina on August 26, 2003, at 18:37:05
In reply to A poll for everyone... out of curiosity., posted by Ame Sans Vie on August 26, 2003, at 9:51:45
my answer today would have to be a proper, yet comprehensive, diagnosis. i guess that kinda counts as "both", though. i spent years with GP's streaking through visits with me like this:
here's a refill for your asthma med. anxiety? well, then here's some free samples and a scrip for the newest ssri. see you in six months!
i finally saw the importance of seeing a specialist, threw my self imposed stigma and fears out the window, and was referred to a pdoc by my trusted therapist.
it made a world of difference. now i am properly diagnosed bipolar II, not just high strung or moody. thankfully, my pdoc is very much taking a conservative approach to my individual needs and particular symptoms.
final vote: diagnosis with consideration of individual symptoms.
Posted by stjames on August 26, 2003, at 19:59:19
In reply to A poll for everyone... out of curiosity., posted by Ame Sans Vie on August 26, 2003, at 9:51:45
> I'm just curious to know what all of your opinions are about one particular thing. Which do you believe is more important in treating psychiatric patients -- accurate diagnoses (labels) or individual symptoms?
It doesn't bother me that I am a depressive
but being depressed causes me pain. Nor does
a specific Dx yield a better treatment as the meds
tend to treat many symptoms. Symptoms, for me, is where it is at.
Posted by Janelle on August 26, 2003, at 20:27:17
In reply to Re: A poll for everyone... out of curiosity., posted by Sabina on August 26, 2003, at 18:37:05
I'm going to go out on a limb here and say DIAGNOSIS, but ... with careful consideration of ALL symptoms to arrive at the diagnosis or diagnoses (plural).
Posted by MelD on August 26, 2003, at 21:28:48
In reply to Re: A poll for everyone... out of curiosity., posted by Janelle on August 26, 2003, at 20:27:17
I believe symptoms are more important than labels. We are all different, and need to be accomodated according to our set of needs. To me, labeling someone with a DX is like asking them their sign and saying "Oh, you are a Libra - so you should have drug xyz.
Posted by MINNIEP on August 26, 2003, at 22:45:41
In reply to Re: A poll for everyone... out of curiosity., posted by Eddie Sylvano on August 26, 2003, at 15:15:44
Yes symptoms by far problem finding psychiatrist who will actually listen long enough to hear them befor running you out with your prescriptions is the problem.
Posted by kar on August 26, 2003, at 23:16:29
In reply to Re: A poll for everyone... out of curiosity., posted by MINNIEP on August 26, 2003, at 22:45:41
Initially, before i had a dx, I was searching for what could possibly be wrong. I had some wacky symptoms that were throwing everyone off. My mom (I was 16 at the time) had me from neurologist to endocrinologist to nutritionist to chiropractors...It was ceaselessly frustrated and scared to think that they'd never find out what what wrong. So in that sense, i feel that dx is very important. as a reassurance...as a justification. Wow! This crap I'm living with has a NAME??
After that it would have to be symptoms and dx. i'm w/ Sabina on that. There are certain things that my doc knows about treatment and research and typical behaviors of people who are bipolar. He can use that knowledge to treat me effectively. He's never seen me manicky. I havent' been manicky since I was 17. So he needs both bits of info about me and about the disease, to treat the "whole" me.
Posted by galkeepinon on August 26, 2003, at 23:55:24
In reply to Re: A poll for everyone... out of curiosity., posted by MelD on August 26, 2003, at 21:28:48
Hey MelD, kinda like saying 'oh~I'm a Cancer and moody, but not Bipolar'? lol;)
I hear ya!
> I believe symptoms are more important than labels. We are all different, and need to be accomodated according to our set of needs. To me, labeling someone with a DX is like asking them their sign and saying "Oh, you are a Libra - so you should have drug xyz.
Posted by tealady on August 27, 2003, at 3:33:46
In reply to Re: A poll for everyone... out of curiosity., posted by MelD on August 26, 2003, at 21:28:48
> I believe symptoms are more important than labels. We are all different, and need to be accomodated according to our set of needs. To me, labeling someone with a DX is like asking them their sign and saying "Oh, you are a Libra - so you should have drug xyz.
Oh, what type of drugs are Libra folk supposed to have <g>
Posted by KimberlyDi on August 27, 2003, at 12:04:49
In reply to A poll for everyone... out of curiosity., posted by Ame Sans Vie on August 26, 2003, at 9:51:45
Would an accurate diagnosis even be possible without the patient's symptoms? I never liked the human need to label everything. It does help with suggesting treatment that has been successful before on other people with the same symptoms. Shouldn't it all come down to whatever medicine helps the patient to become a healthy functioning adult? (or child) I personally don't think I fall squarely into this or that disorder. I feel like I have a hodgepodge of many problems with none of them being dominant enough to require a label. So how would one prescribe me without resorting to labels?
KDi in Texas
> I'm just curious to know what all of your opinions are about one particular thing. Which do you believe is more important in treating psychiatric patients -- accurate diagnoses (labels) or individual symptoms? I'll post my opinions concerning this after I absorb some of y'all's (oh boy... 8 years and TX and now the dialect is creeping up on me, lol) wisdom and insight. Oh, and of course "both" is an acceptable answer. :-)
>
>
Posted by KimberlyDi on August 27, 2003, at 12:08:27
In reply to Re: A poll for everyone... out of curiosity. » MelD, posted by tealady on August 27, 2003, at 3:33:46
Posted by Larry Hoover on August 27, 2003, at 14:06:00
In reply to A poll for everyone... out of curiosity., posted by Ame Sans Vie on August 26, 2003, at 9:51:45
> I'm just curious to know what all of your opinions are about one particular thing. Which do you believe is more important in treating psychiatric patients -- accurate diagnoses (labels) or individual symptoms? I'll post my opinions concerning this after I absorb some of y'all's (oh boy... 8 years and TX and now the dialect is creeping up on me, lol) wisdom and insight. Oh, and of course "both" is an acceptable answer. :-)
Well if diagnosis could ever be accurate, it would save a lot of problems. When I go to a doctor, I go because of symptoms, not because I'm looking for a diagnosis. A diagnosis is a tool for doctors, and may not even be in the patient's best interests. The standard paradigm is:
SX --> DX --> TX --> PX?
What I was trying to represent is the following:
1. A patient presents with symptoms (SX).
2. A doctor selects the important ones (many may be irrelevant, at least to the doctor}, and comes to a diagnosis(DX).
3. The diagnosis (!) informs the treatment(TX). In other words, there's now a disconnect from the symptoms, but that wouldn't matter if the diagnosis is 100% accurate.
4. The prognosis (PX) is suggested by the TX, but we all know how much of a crapshoot that is.So, treating the symptoms is the only approach that is truly in the patient's best interests, IMHO.
Lar
Posted by galkeepinon on August 27, 2003, at 14:32:26
In reply to Re: A poll for everyone... out of curiosity. » Ame Sans Vie, posted by Larry Hoover on August 27, 2003, at 14:06:00
Posted by Ame Sans Vie on August 28, 2003, at 8:16:15
In reply to Re: A poll for everyone... out of curiosity. » MelD, posted by tealady on August 27, 2003, at 3:33:46
Thanks so much for all of your replies! :-)
I definitely have to agree with the majoriy of you that symptoms are most important... but you guys (<~~~~ consciously trying to avoid letting that "y'all" slip out again, lol) have already argued your points every bit as well as I could have, so I really feel there's no need to get any more into it, myself. Once again, thanks!
Posted by KimberlyDi on August 28, 2003, at 9:04:35
In reply to Re: A poll for everyone... out of curiosity., posted by Ame Sans Vie on August 28, 2003, at 8:16:15
Posted by Ame Sans Vie on August 28, 2003, at 9:08:14
In reply to What's wrong with y'all? KDi in Texas :) (nm) » Ame Sans Vie, posted by KimberlyDi on August 28, 2003, at 9:04:35
Posted by KimberlyDi on August 28, 2003, at 13:55:05
In reply to Nothing--I just don't like it when I say it, lol (nm) » KimberlyDi, posted by Ame Sans Vie on August 28, 2003, at 9:08:14
Posted by DSCH on August 30, 2003, at 9:52:27
In reply to Re: A poll for everyone... out of curiosity. » Ame Sans Vie, posted by Larry Hoover on August 27, 2003, at 14:06:00
> Well if diagnosis could ever be accurate, it would save a lot of problems. When I go to a doctor, I go because of symptoms, not because I'm looking for a diagnosis. A diagnosis is a tool for doctors, and may not even be in the patient's best interests. The standard paradigm is:
>
> SX --> DX --> TX --> PX?
>
> What I was trying to represent is the following:
> 1. A patient presents with symptoms (SX).
> 2. A doctor selects the important ones (many may be irrelevant, at least to the doctor}, and comes to a diagnosis(DX).
> 3. The diagnosis (!) informs the treatment(TX). In other words, there's now a disconnect from the symptoms, but that wouldn't matter if the diagnosis is 100% accurate.
> 4. The prognosis (PX) is suggested by the TX, but we all know how much of a crapshoot that is.
>
> So, treating the symptoms is the only approach that is truly in the patient's best interests, IMHO.
>
> LarAt this point, my intellectual vanity ;-) would like to offer up an earlier post of mine for comments.
http://www.dr-bob.org/babble/20030812/msgs/251620.html
Does anyone have data on what percentage of patients see substantial improvement in the double blind trials relative to placebo for some of the standard bearer medications for depression and ADD?
Posted by Larry Hoover on September 1, 2003, at 14:41:40
In reply to Re: A poll for everyone... out of curiosity. » Larry Hoover, posted by DSCH on August 30, 2003, at 9:52:27
> At this point, my intellectual vanity ;-) would like to offer up an earlier post of mine for comments.
Why does your inquiry invoke vanity? <Spock eyebrow>
> http://www.dr-bob.org/babble/20030812/msgs/251620.html
OK, from that post:
You said:
"The real answer is that we need greater discrimination in identifing the real problem(s) and then the ability to scientifically rather than "artistically" tailor treatment for that individual."That seems to be a description of the ideal towards which we are striving.....
" 'Ask not what disease the person has, rather ask what *person* the disease has.' "
Nice aphorism.
However, reality seems to be more aptly described in this quotation:
"B) Syndromes overlap. One could concievably have, for example, mild OCD along with ADD without hyperactivity and yet get lumped in with everyone under the umbrella of "ADHD"."
The intellectual "pinch point" between the two is, obviously, obtaining the correct diagnosis. However, few disease states are so well-defined that we can unequivocally identify them. Arthritis is a symptom of over 100 diseases. Not all diseases that can cause arthritis do present with arthritis. When you get into mental illness, I would argue that the diagnostic categories themselves are flawed. If we can't even define the illnesses concisely in words, we certainly cannot diagnose them with 100% accuracy.
That is my opinion. I now offer my own words up for comment.
> Does anyone have data on what percentage of patients see substantial improvement in the double blind trials relative to placebo for some of the standard bearer medications for depression and ADD?
Well, I know of a few meta-analyses. Here's one:
http://www.psychiatrictimes.com/p000429.htmlLar
Posted by DSCH on September 1, 2003, at 20:56:18
In reply to Re: A poll for everyone... out of curiosity. » DSCH, posted by Larry Hoover on September 1, 2003, at 14:41:40
> > At this point, my intellectual vanity ;-) would like to offer up an earlier post of mine for comments.
>
> Why does your inquiry invoke vanity? <Spock eyebrow>Well, I feel like sometimes I can be an intellectual grandstander/poseur. That might be a lingering symptom of my depressed mode of thinking.
> > http://www.dr-bob.org/babble/20030812/msgs/251620.html
>
> OK, from that post:
>
> You said:
> "The real answer is that we need greater discrimination in identifing the real problem(s) and then the ability to scientifically rather than "artistically" tailor treatment for that individual."
>
> That seems to be a description of the ideal towards which we are striving.....Yes.
> " 'Ask not what disease the person has, rather ask what *person* the disease has.' "
>
> Nice aphorism.From the epigram page of Oliver Sacks' "An Anthropologist on Mars". It's attributed to William Osler.
> However, reality seems to be more aptly described in this quotation:
>
> "B) Syndromes overlap. One could concievably have, for example, mild OCD along with ADD without hyperactivity and yet get lumped in with everyone under the umbrella of "ADHD"."
>
> The intellectual "pinch point" between the two is, obviously, obtaining the correct diagnosis. However, few disease states are so well-defined that we can unequivocally identify them. Arthritis is a symptom of over 100 diseases. Not all diseases that can cause arthritis do present with arthritis. When you get into mental illness, I would argue that the diagnostic categories themselves are flawed. If we can't even define the illnesses concisely in words, we certainly cannot diagnose them with 100% accuracy.Some of that I was trying to express in point (C).
> That is my opinion. I now offer my own words up for comment.
>
> > Does anyone have data on what percentage of patients see substantial improvement in the double blind trials relative to placebo for some of the standard bearer medications for depression and ADD?
>
> Well, I know of a few meta-analyses. Here's one:
> http://www.psychiatrictimes.com/p000429.html
>
> LarThanks for that.
Posted by Larry Hoover on September 2, 2003, at 6:26:28
In reply to Re: A poll for everyone... out of curiosity. » Larry Hoover, posted by DSCH on September 1, 2003, at 20:56:18
> > > At this point, my intellectual vanity ;-) would like to offer up an earlier post of mine for comments.
> >
> > Why does your inquiry invoke vanity? <Spock eyebrow>
>
> Well, I feel like sometimes I can be an intellectual grandstander/poseur.I don't see that. (Just for feedback.)
> That might be a lingering symptom of my depressed mode of thinking.
It certainly arises from a schema, the pattern of thinking you use to describe yourself to yourself (self-image). How you think about yourself creates how you feel about yourself.
Lar
Posted by DSCH on September 2, 2003, at 13:50:29
In reply to Re: A poll for everyone... out of curiosity. » DSCH, posted by Larry Hoover on September 2, 2003, at 6:26:28
> > > > At this point, my intellectual vanity ;-) would like to offer up an earlier post of mine for comments.
> > >
> > > Why does your inquiry invoke vanity? <Spock eyebrow>
> >
> > Well, I feel like sometimes I can be an intellectual grandstander/poseur.
>
> I don't see that. (Just for feedback.)
>
> > That might be a lingering symptom of my depressed mode of thinking.
>
> It certainly arises from a schema, the pattern of thinking you use to describe yourself to yourself (self-image). How you think about yourself creates how you feel about yourself.
>
> LarQuite. The past few weeks have sparked much self-analysis in this regard. For instance, I now wonder if I am closer to the Myers-Briggs/Keirsey archtype of INTJ rather than INTP and indeed if have always been so but with ADD/depression/low self-esteem/schizodial or schizotypical tendancies always getting in the way (but for a brief window of clarity in my late teens).
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