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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 59. Go back in thread:
Posted by Christ_empowered on August 31, 2010, at 18:03:38
In reply to Scott - Re: Anti-psychotics not mood stabilizers?, posted by SheilaC on August 31, 2010, at 17:08:17
its the dissolving version of zyprexa. It is more expensive, but apparently doesn't have the weight gain associated with normal zyprexa--something about bypassing certain receptors in the digestive system nixes potential weight gain.
Just a thought.
Posted by Dinah on August 31, 2010, at 20:12:36
In reply to Anti-psychotics not mood stabilizers?, posted by SheilaC on August 31, 2010, at 16:24:01
Not for nothing are anti-psychotics called major tranquilizers. If your symptoms include anxiety and irritability, it makes sense that a medication with tranquilizing properties is helpful to you.
I am not sure that it's as simple as certain drugs fixing certain problems as an antibiotic works on a bacteria but not a virus. It is more that drugs have certain effects, and sometimes those effects are helpful for certain problems.
Or at least that's the theory I subscribe to. :)
Posted by obsidian on August 31, 2010, at 22:10:48
In reply to Re: Anti-psychotics not mood stabilizers? » SheilaC, posted by Dinah on August 31, 2010, at 20:12:36
interesting article Dinah...
my T has said, during times on less medication - effexor particularly, that my emotions were always present, but that the "volume" had just been turned up.
It does bother me sometimes that I can't react emotionally the way I might otherwise, as the emotions are often quite appropriate.
It's the intensity I suppose.
My last go at decreasing effexor was a failure, too overwhelmed to tolerate such a surge of hyperemotionality - I like to call it a backlash effect.There are many circumstances I wish were different in my life, things perhaps if I changed would allow me function well with my temperament off medication.
It bothers me also to think of myself so sensitive in my natural state... a state that without meds would require an avoidance of many things. Some things others might tolerate well. Let me call it a rock and a hard place.
It's a bit more complicated I suppose, as the effexor for instance doesn't give me a "whatever" attitude necessarily, and can make me quite irritable.
The seroquel...damn the seroquel, blunts me, just the little bit I take. It's the sleep perhaps that it induces.
anyway...I'm rambling
the article is food for thought, an interesting exploration of the grayer (as opposed to black and white) perspective of things.....Not that I question the absolute usefulness and necessity of medication in certain situations.
Posted by Dinah on September 1, 2010, at 7:19:35
In reply to Re: Anti-psychotics not mood stabilizers? » Dinah, posted by obsidian on August 31, 2010, at 22:10:48
Was the article anti-med?
I confess it was the part about how the medications worked that caught my attention. That they treated the symptoms rather than revealed the underlying cause. I think he was responding to the idea that if some people with a certain condition responded to an SSRI, it must mean that their condition resulted from low serotonin. He was saying it was more like treating pulmonary edema. It can be caused by many things, but the symptoms have to be addressed.
So that in this case, responding to antipsychotics isn't necessarily diagnostic of any particular condition. (Unlike response to an antibiotic which would indicate that the infection was bacterial rather than viral.) It just means that anxiety and agitation respond well in some people to the tranquilizing effects of antipsychotics. Not finding seroquel tranquilizng might be more diagnostic than finding it tranquilizing, from all I hear of it.
If I'm making sense.
I suppose he is also saying that addressing the symptoms isn't really sufficient, and it would be better to address the root cause as well. Just as with pulmonary edema you would both treat the symptoms and address the underlying condition? And perhaps that sometimes the effect of medications may make it difficult to address the root cause?
I suppose all that would be where clinical judgment comes in.
Or at least that was my reading of it. But since I latched on to the portion I liked, I might have missed the meaning of the article as a whole. :)
Posted by obsidian on September 2, 2010, at 22:13:15
In reply to Re: Anti-psychotics not mood stabilizers? » obsidian, posted by Dinah on September 1, 2010, at 7:19:35
> Was the article anti-med?
no, I don't think so, perhaps just a more well rounded perspective..
>
> I confess it was the part about how the medications worked that caught my attention. That they treated the symptoms rather than revealed the underlying cause. I think he was responding to the idea that if some people with a certain condition responded to an SSRI, it must mean that their condition resulted from low serotonin. He was saying it was more like treating pulmonary edema. It can be caused by many things, but the symptoms have to be addressed.made sense to me....
>
> So that in this case, responding to antipsychotics isn't necessarily diagnostic of any particular condition. (Unlike response to an antibiotic which would indicate that the infection was bacterial rather than viral.) It just means that anxiety and agitation respond well in some people to the tranquilizing effects of antipsychotics. Not finding seroquel tranquilizng might be more diagnostic than finding it tranquilizing, from all I hear of it.
>
> If I'm making sense.of course! :-)
>
> I suppose he is also saying that addressing the symptoms isn't really sufficient, and it would be better to address the root cause as well. Just as with pulmonary edema you would both treat the symptoms and address the underlying condition? And perhaps that sometimes the effect of medications may make it difficult to address the root cause?yeah, I suppose as it is with a lot of questions, "it depends" ;-)
>
> I suppose all that would be where clinical judgment comes in.guess that's why therapy + meds is better than either alone
>
> Or at least that was my reading of it. But since I latched on to the portion I liked, I might have missed the meaning of the article as a whole. :)I don't think so, it had a lot of different points.
Posted by hrguru on September 5, 2010, at 5:15:43
In reply to Re: Anti-psychotics not mood stabilizers? » SheilaC, posted by SLS on August 31, 2010, at 16:56:40
I don't know hardly anything about anti-psychotic meds. I do take 2 different kinds of anti-convulsants, though. I had a few problems getting adjusted to the first (Topamax), and the second one made me very depressed for the first few days (Trileptal). In fact, I ended up having a mixed episode with suicidal thoughts. Apparently, having suicidal thoughts is a rare side effect (and my doctor could not definitively say that this was due to the medication), but it does happen for some. So it's recommended that if you have depression and/or bipolar, when starting a new anti-convulsant, you should monitor symptoms very carefully. I'm dx'd Bipolar type 1- and I'm very, very sensitive to most medications (especially anti-convulsants). A new med or change in dosage can make all the difference (positive or negative). My advice is to ask your pdoc before jumping to any conclusions :)
Posted by hrguru on September 5, 2010, at 5:30:32
In reply to Anti-psychotics not mood stabilizers?, posted by SheilaC on August 31, 2010, at 16:24:01
Oh, I forgot one more thing. You mentioned: "anti-psychotics work for me, but I am not schizophrenic." One time my doctor asked me if I'd like to try an anti-psychotic med, because we could not find a mood stabilizer that would work well for my depression. This is what I think doctors are sometimes looking to target with anti-psychotics (depression) in BP patients, as we don't do well on traditional AD's. I asked him why I would need to take an anti-psychotic if I am not experiencing psychosis?
He said, "Think of it this way. You take an anti-convulsant, but you don't have epilepsy, do you? In the same way, it's very common for patients with bipolar disorder to take an anti-psychotic medication to help with their symptoms. However, it does not necessarily mean that they are psychotic, or experiencing psychosis." It made sense to me.
Which mood stabilizers have you tried? And did you give them each a good chance to work? Sometimes they can take up to a month to get a person stabilized. It took about 3 weeks for me before I really started to notice a difference.
I also come from the school of thought that every person's bipolar is completely different. Just as our DNA and chemistry is different. What works for you, may not work for me. I'm glad you've found something that works! :)
Posted by hrguru on September 5, 2010, at 5:45:31
In reply to Re: Anti-psychotics not mood stabilizers? » SheilaC, posted by SLS on August 31, 2010, at 16:56:40
Hi SLS,
>You may have guessed right. You may very well have borderline personality disorder. Trileptal and Zyprexa can be helpful for this condition. I think it is more appropriate that you allow your doctor to offer a diagnosis and his rationale for choosing the drugs you are taking. Do you trust your doctor?
----Hey now ;) I just have to know where you heard that Trileptal is helpful for Borderline Personality Disorder, because I have not heard this. I have Bipolar 1, and my doctor prescribed this for me. It works very well. I don't have BPD, though it is sometimes diagnosed as co-morbid with Bipolar Disorder.
When there is no Bipolar present, doctors don't usually prescribe a mood stabilizer. At least, that's what my doctor told me. They usually go with an SSRI and a benzo for anxiety, or something similar.
I do agree that if there is any question as to the official diagnosis, just ask the doctor. That's what I did. I wasn't too happy with the answer of BP 1 :) but having asked the question, I figured I should be prepared for the answer.
Posted by SLS on September 5, 2010, at 5:58:09
In reply to Re: Anti-psychotics not mood stabilizers? » SLS, posted by hrguru on September 5, 2010, at 5:45:31
> ----Hey now ;) I just have to know where you heard that Trileptal is helpful for Borderline Personality Disorder,
http://www.ncbi.nlm.nih.gov/pubmed/16187767
J Clin Psychiatry. 2005 Sep;66(9):1111-5.
Oxcarbazepine in the treatment of borderline personality disorder: a pilot study.Bellino S, Paradiso E, Bogetto F.
Unit of Psychiatry, Department of Neuroscience, University of Turin, Turin, Italy. silvio.bellino@unito.it
AbstractBACKGROUND: According to available studies concerning treatment of patients with borderline personality disorder, mood stabilizers have been found effective in controlling core symptoms of borderline pathology, in particular impulsive behavior and mood instability. Oxcarbazepine, an anticonvulsant structurally related to carbamazepine, has been tested in psychiatric settings for treating patients with bipolar disorders, substance abuse, resistant psychosis, and schizoaffective disorder. The present article is a pilot study on the efficacy and tolerability of oxcarbazepine in the treatment of borderline personality disorder.
METHOD: Seventeen outpatients diagnosed with DSM-IV-TR borderline personality disorder were included. Patients were administered oxcarbazepine, 1200 to 1500 mg/day supplied twice daily, and tested at baseline, week 4, and week 12 using the Clinical Global Impressions scale-Severity of Illness item (CGI-S), the Brief Psychiatric Rating Scale (BPRS), the Hamilton Rating Scales for Depression and Anxiety (HAM-D, HAM-A), the Social Occupational Functioning Assessment Scale, and the Borderline Personality Disorder Severity Index (BPDSI). Adverse effects were collected and serum sodium level was measured. Statistics were performed by using the analysis of variance for repeated measures.
RESULTS: Four patients discontinued treatment in the first 4 weeks due to noncompliance. A statistically significant response to oxcarbazepine was observed according to CGI-S and BPRS mean score (p = .001), HAM-A mean score (p = .002), BPDSI total score (p = .0005), and 4 BPDSI items, including interpersonal relationships (p = .0005), impulsivity (p = .0005), affective instability (p = .0005), and outbursts of anger (p = .045). No cases of significant hyponatremia or severe adverse effects were reported. Mild to moderate adverse effects included sedation, dizziness, nausea, and headache. Seven patients reported no adverse effects.
CONCLUSION: Oxcarbazepine was found an effective and well-tolerated treatment in the management of borderline personality disorder patients.
PMID: 16187767 [PubMed - indexed for MEDLINE]
Posted by hrguru on September 5, 2010, at 21:36:40
In reply to Re: Anti-psychotics not mood stabilizers?, posted by SLS on September 5, 2010, at 5:58:09
SLS,
Thanks for the info :) The article also says that it has been tested for treating patients with bipolar disorders as well. Have you seen anything regarding Trileptal being more effective for BPD than for bipolar? Just out of curiosity. Because I was screened for BPD (more than once), and was not diagnosed as having it. I don't have severe issues with impulse control, so I don't know how Trileptal helps with that- but I do get very manic (and depressed). This med really helps to even things out. It also helps to reduce anxiety (I've found). I could see how these benefits could easily cross over, so that Trileptal could be used to treat other disorders.
Posted by SLS on September 6, 2010, at 7:28:40
In reply to Re: Anti-psychotics not mood stabilizers?, posted by hrguru on September 5, 2010, at 21:36:40
> Thanks for the info :) The article also says that it has been tested for treating patients with bipolar disorders as well.
I guess that should be expected since the cousin drug to Trilepal, Tegretol, has been used in bipolar disorder for so long.
> Have you seen anything regarding Trileptal being more effective for BPD than for bipolar?
I think I see where you are coming from. I don't think one can use their responsivity to Trileptal as an indicator of one illness over the other.
> I don't know how Trileptal helps with that- but I do get very manic (and depressed). This med really helps to even things out. It also helps to reduce anxiety (I've found). I could see how these benefits could easily cross over, so that Trileptal could be used to treat other disorders.
I hope that you continue to find Trileptal to be so effective. Mental illness sucks.
- Scott
Posted by SheilaC on September 7, 2010, at 14:37:23
In reply to Re: Anti-psychotics not mood stabilizers?, posted by hrguru on September 5, 2010, at 5:30:32
> Oh, I forgot one more thing. You mentioned: "anti-psychotics work for me, but I am not schizophrenic." One time my doctor asked me if I'd like to try an anti-psychotic med, because we could not find a mood stabilizer that would work well for my depression. This is what I think doctors are sometimes looking to target with anti-psychotics (depression) in BP patients, as we don't do well on traditional AD's. I asked him why I would need to take an anti-psychotic if I am not experiencing psychosis?
>
> He said, "Think of it this way. You take an anti-convulsant, but you don't have epilepsy, do you? In the same way, it's very common for patients with bipolar disorder to take an anti-psychotic medication to help with their symptoms. However, it does not necessarily mean that they are psychotic, or experiencing psychosis." It made sense to me.
>
> Which mood stabilizers have you tried? And did you give them each a good chance to work? Sometimes they can take up to a month to get a person stabilized. It took about 3 weeks for me before I really started to notice a difference.
>
> I also come from the school of thought that every person's bipolar is completely different. Just as our DNA and chemistry is different. What works for you, may not work for me. I'm glad you've found something that works! :)
Actually, I have tried Depakote, Tegretol, Trileptal and Lithium. Both Depakote and Lithium caused depression within about 4 days. Maybe they are making me too low. So, I seem to do better with Geodon and Klonopin added for anxiety. Lithium also causes terrible stomach issues with me.I just don't respond well to the mood stabilizers. I don't need a drug to make me feel depressed. Ugh.
But at least the Geodon and Klonopin work.
Posted by Simon Sobo M.D. on September 14, 2010, at 6:15:33
In reply to hrguru - Re: Anti-psychotics not mood stabilizers?, posted by SheilaC on September 7, 2010, at 14:37:23
Reading over your posts it occurred to me that you probably would find these articles helpful. http://www.simonsobo.com/pursuing-treatments-that-are-not-evidence-based. and http://www.psychiatrictimes.com/display/article/10168/54226 They follow through on the ideas you found clarifying in the first article. Basically it questions the validity of a great many illnesses defined by DSM IV. Bipolar disorder is being wildly overdiagnosed, but also the kind of reasoning used for "evidence based" treatment has many shortcomings.
Posted by SLS on September 14, 2010, at 7:13:22
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers?, posted by Simon Sobo M.D. on September 14, 2010, at 6:15:33
> Bipolar disorder is being wildly overdiagnosed,
We hear this quite often delivered as an opinion. What evidence can you cite that this is indeed true?
- Scott
Posted by Conundrum on September 14, 2010, at 7:24:48
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers? » Simon Sobo M.D., posted by SLS on September 14, 2010, at 7:13:22
> > Bipolar disorder is being wildly overdiagnosed,
>
> We hear this quite often delivered as an opinion. What evidence can you cite that this is indeed true?
>
>
> - ScottMy pdoc has recently suspected I have issues with mood stability. I'm not sure it fits. I haven't responded well to lamictal or abilify, except that abilify seems to work like a cup of coffee for a few days and then stops. I'm not sure the lamictal has done anything at all and I am on 400mgs now.
I'm guessing my suspected diagnosis will change since those meds didn't work and higher doses of abilify made me feel worse.
Posted by SLS on September 14, 2010, at 8:15:16
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers?, posted by Conundrum on September 14, 2010, at 7:24:48
> My pdoc has recently suspected I have issues with mood stability. I'm not sure it fits. I haven't responded well to lamictal or abilify, except that abilify seems to work like a cup of coffee for a few days and then stops. I'm not sure the lamictal has done anything at all and I am on 400mgs now.
I was on Lamictal 300mg for quite awhile. It produced unacceptable cognitive impairments. When I first reduced the dosage to 200mg, I experienced an increase in the severity of depression for two days, and then stabilized. Similarly, I have recently reduced to 100mg with the same outcome. I feel no better at 100mg than I did at 300mg. I think people are fooled into raising the dosage when they experience transient improvements upon each dosage increase.
> I'm guessing my suspected diagnosis will change since those meds didn't work and higher doses of abilify made me feel worse.
That's disheartening. In what ways did Abilify make you feel worse?
- Scott
Posted by Conundrum on September 14, 2010, at 9:04:25
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers? » Conundrum, posted by SLS on September 14, 2010, at 8:15:16
I think there might be some cognitive impairment with lamictal too, or at least in combination with abilify. It seemed like I had trouble recalling words and I would just say something else a couple times until I got the right word. Obviously this wasn't all the time, but enough that I took notice.
Also at 5mg abilify made my head feel like it had a lot of pressure in it and got worse at night. I seemed to feel less motivated at that dose. Its ok though since I can't afford it anyway.
Posted by violette on September 14, 2010, at 21:43:28
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers?, posted by Simon Sobo M.D. on September 14, 2010, at 6:15:33
Thanks for sharing your blog...it really touches on alot of important areas of improvement needed in the mental health system. I could not access the other article.
I was on the medication merry-go-round for ten years before I was able to determine the best course of treatment through personal resarch. This was because psychiatrists used psychology less than car salesmen!! Unfortunately, the biological reductionism trend seems to be growing, and I don't see things getting better until they get worse...I consider myself fortunate to now have a psychodynamic psychiatrist-therapist....as a result, i have a much brighter prognosis.
Psychodynamic psychiatrists are the best!
Posted by Simon Sobo, M.D. on September 15, 2010, at 5:52:23
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers? » Simon Sobo M.D., posted by SLS on September 14, 2010, at 7:13:22
> > Bipolar disorder is being wildly overdiagnosed,
>
> We hear this quite often delivered as an opinion. What evidence can you cite that this is indeed true?
>
>
> - ScottAllen Frances http://www.psychiatrictimes.com/dsm-5/content/article/10168/1425378?verify=0 in this link, head of the DSM IV taskforce, described a pseudoepidemic! of bipolar, autism, and ADHD as a result of DSM IV. In my article, also in the Psychiatric Times, I describe the issue, confusion about what is meant by "mood swings". In order to access these articles you have to register with Psychiatric Times. Annoying but it is free. If you continue to have difficulties. you can take a look at my blog which summarizes my conclusions. http://simonsobo.blogspot.com/2005/03/summary-of-bipolar-disorder-article.html I might also add that there was a 40 fold increase in the diagnosis of bipolar disorder in children over 10 years, an example of the wild diagnosing going on as psychiatrist pursue a name as the answer to clinical issues rather than understanding. http://www.psycheducation.org/depression/SoboOnKids.htm But then how much understanding can you expect from 15 minute once a month visits.
Posted by SLS on September 15, 2010, at 7:10:41
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers?, posted by Simon Sobo, M.D. on September 15, 2010, at 5:52:23
> > > Bipolar disorder is being wildly overdiagnosed,
> >
> > We hear this quite often delivered as an opinion. What evidence can you cite that this is indeed true?
> >
> >
> > - Scott
> Allen Frances http://www.psychiatrictimes.com/dsm-5/content/article/10168/1425378?verify=0 in this link, head of the DSM IV taskforce, described a pseudoepidemic! of bipolar, autism, and ADHD as a result of DSM IV."For instance, a seemingly small change can sometimes result in a different definition of caseness that may have a dramatic and totally unexpected impact on the reported rates of a disorder.20 Thus are false epidemics created. For example, although many other factors were certainly involved, the sudden increase in the diagnosis of autistic, attention-deficit/hyperactivity, and bipolar disorders may in part reflect changes made in the DSM-IV definitions. Note this."
This is still opinion, and not the results of empirical study. Where is the evidence that there is indeed a "false epidemic" occurring? A sudden increase in the diagnosis of various disorders could be the result of greater accuracy in nosological categorization and diagnostics. Where are the numbers? You place so much importance on empirical evidence to substantiate your claims, but still produce no citations demonstrating such evidence.
> In my article, also in the Psychiatric Times, I describe the issue, confusion about what is meant by "mood swings".
Who or what is confused? Psychiatrists? DSM?
Mood dysregulation and mood lability are features of various mental disorders as is detailed in the DSM. Where is the confusion? Any misconception of the phenomenon of "mood swing" might be a part of pop-culture language rather than the result of scientific inquiry.
> I might also add that there was a 40 fold increase in the diagnosis of bipolar disorder in children over 10 years,
Where can I find out more about this number?
What would you say is the true rate of occurrence of pediatric bipolar disorder?
How does this number compare with the true rate of occurrence of adult bipolar disorder?
With the information you have provided, I don't think you have proven that bipolar disorder is overdiagnosed in any population.
From what I have read recently, there are some researchers who feel that bipolar disorder in pediatric populations is still underdiagnosed. This is an unpopular opinion of the lay public at this point in time.
Some interesting perspectives:
http://www.medscape.com/viewarticle/727955?src=mp&spon=12&uac=41170BN
I am ambivalent regarding whose opinions to place trust in with these issues. I don't have sufficient education to effectively debate them. I am just trying to exercise some cautious skepticism.
- Scott
Posted by violette on September 15, 2010, at 8:52:13
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers? » SLS, posted by Conundrum on September 14, 2010, at 9:04:25
My psychiatrist said there's a consensus in the the field regarding the overdiagnosis of bipolar. There is research, not sure what the best sources are, never did research on the issue, but here's just one study:
METHOD: Seven hundred psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV (SCID) and completed a self-administered questionnaire, which asked the patients whether they had been previously diagnosed with bipolar or manic-depressive disorder by a health care professional. Family history information was obtained from the patient regarding first-degree relatives. Diagnoses were blind to the results of the self-administered scale. The study was conducted from May 2001 to March 2005.
RESULTS: Fewer than half the patients who reported that they had been previously diagnosed with bipolar disorder received a diagnosis of bipolar disorder based on the SCID.
Posted by SLS on September 15, 2010, at 10:15:52
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers?, posted by violette on September 15, 2010, at 8:52:13
> My psychiatrist said there's a consensus in the the field regarding the overdiagnosis of bipolar. There is research, not sure what the best sources are, never did research on the issue, but here's just one study:
That one study was written by the same author (Zimmerman) who predominates the only 12 Medline citations that appear when using the keywords "bipolar disorder overdiagnosed"
I applaud Zimmerman for approaching this issue using a scientific methodology. He might be right. However, there remains a paucity of data produced that corroborate his thesis. That being said, a paucity of data doesn't exclude the accuracy of the few studies that exist.
- Scott
Posted by Simon Sobo, M.D. on September 15, 2010, at 11:16:34
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers? » Simon Sobo, M.D., posted by SLS on September 15, 2010, at 7:10:41
Don't know if you read my article. I would appreciate your telling me whether you have. I did not do a scientific study but rather wrote it when all of a sudden half the patients being discharged from inpatient units were suddenly being discharged with a bipolar diagnosis. When I called the doctors about their diagnosis they cited "mood swings" as the reason. The patients did not have mood swings as is found in bipolar. I was also getting referrals from therapists asking me to give their patients "mood stabilizers" for their "mood swings." These patients were not bipolar. When I started checking around I found that this idea of mood swings had suddenly taken hold in all kinds of clinical situations. Alcohol programs were diagnosing half their patients with bipolar. Wild unruly teenagers, irritable patients, etc, etc. I wouold like you to read my article rather than go over the same thing here.
I don't get your reasoning regarding Dr. Frances' opinion that there is a pseudoepidemic "This is still opinion, and not the results of empirical study. Where is the evidence that there is indeed a "false epidemic" occurring? A sudden increase in the diagnosis of various disorders could be the result of greater accuracy in nosological categorization and diagnostics"
That quote regarding a false epidemic is from the head of the committee that put together DSM IV so referring to greater accuracy in nosological categorizaation is kind of meaningless since his committee created the new nosological categorization.
As to the 40 fold increase it is carefully documented in the link I included. Please look at it!!! But here it is Dr. Moreno from Columbia University (National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth). The article is in the Sept 07 issue of Archives of General Psychiatry, page 1032.
. By the way when I wrote to him congratulating him for his article, his comment was "Yeah, and wait til they make irritability a criteria in DSM V"
Posted by Simon Sobo, M.D. on September 15, 2010, at 11:23:15
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers? » violette, posted by SLS on September 15, 2010, at 10:15:52
Thinking it over, the simplest spelling out of my arguments is this one http://www.psycheducation.org/depression/SoboOnKids.htm
Posted by SLS on September 15, 2010, at 12:42:06
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers?, posted by Simon Sobo, M.D. on September 15, 2010, at 11:16:34
Thanks for attending to my comments and providing information.
> Don't know if you read my article. I would appreciate your telling me whether you have.
I did the best I could.
> I did not do a scientific study
That's all I'm saying.
> but rather wrote it when all of a sudden half the patients being discharged from inpatient units were suddenly being discharged with a bipolar diagnosis.
Perhaps a change in the rate of diagnosis of BP reflects greater accuracy in diagnostics. How would we go about testing this hypothesis?
> When I called the doctors about their diagnosis they cited "mood swings" as the reason.
All of them? I find the use of the term "mood swings" as a diagnostic descriptor offered by professionals in the mental health field to be quite disappointing. The only time I heard one of my doctors use the term "mood swing" was in describing the title of Ronald R. Fieve's book "Mood Swing - Fieve". Otherwise, I have never heard any professional use the term in front of me. I guess I have been lucky in this regard.
> I don't get your reasoning regarding Dr. Frances' opinion that there is a pseudoepidemic
Again, you are offering only the opinions of others. Where is the evidence you would present to validate these opinions? What evidence do these people use to substantiate their opinions? To me, it looks like Zimmerman's work offers the kind of methodology that would help resolve these questions. Perhaps you can comment on this.In my opinion, the fad of overdiagnosing bipolar disorder has been in decline over the last 10 years. I can't prove this, though. My opinion is the result of observing the prescribing habits of doctors in a partial hospitalization program. Of course, this is far from being scientific evidence.
- Scott
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