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smithy

biopolar and schizophrenia

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The more I read about the above conditions it seems that a neokraepelin classification suggesting that they are separate conditions (further suggesting a separate aetiology) is doubtful.

Instead it seems that they reprsent different ends of the same spectrum.

Any views on this.

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The more I read about the above conditions it seems that a neokraepelin classification suggesting that they are separate conditions (further suggesting a separate aetiology) is doubtful.

Instead it seems that they reprsent different ends of the same spectrum.

Any views on this.

I think this a resonable argument considering that the treatment for both conditions (ie :BPAD :manic/depressive phase with psychosis and Schizophrenia )are more or less the same.

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Smithy,

One of my gripes against the way we look at diagnosis is the way we try to fit all the symptoms into 1 diagnosis. For example is it PD or Mental Illness etc…Some one who has Diabetes also can have Hypertension or Rheumatic Arthritis etc… Why cant some with Schizophrenia not have Bipolar Disorder or Anxiety Disorder as well?Infact May be they might have only one episode of Psychosis & then may suffer anxiety. We then don’t know if this separate diagnosis of anxiety or if his anxiety is related to any stressors or if anxiety is a part of Schizophrenia. Because of this problem of trying to explain all problems in one diagnosis, we then use every medication for every ailment in our realms, which further makes our speciality look like quackery.

Secondly, the arbitrariness of the duration of illness.For example if some one has First Rank Symptoms for 29 days, then is it not schizophrenia? How did we fix the duration for depression,mania or schizophrenia? Was there any evidence or is it arbitrary?

Third, There are some diagnosis in ICD-10 like Mixed anxiety & Depressive Disorder. Is there any epidemiological basis for this?

Fourth, ICD-10 &amp:lol:SM-4 differ for axample DSM has Narcisstic PD & ICD does not have & so on and so forth.

Around 2001 July, An editorial appeared in Acta Psychiatrica Scandinavia(if my memory serves me correctly) about how a meeting of Epidemiologists & Phenemenologists of both the ICD &amp:lol:SM-4 happened in London & they realised how there was paucity of e vidence in this area of Psychiatry & so any attempt to classify further was postponed by another decade or so.

Furthering my interest I read a book titled “Psychiatric Diagnosis & Classification” by Mario Maj,Wolfgang Gaebel,Juan Jose Lopez-Iber & Normal Sartorius Under the Auspices of the World Psychiatric Association & published by Wiley Publications (ISBN:-0471496812) Which is one of the best books on Psychiatric classification I have read.

Norman Sartorius is a big name in classification of mental illness.

Incidentally Indian doctors were the first in the world to classify mental disorders in Ayurveda(accepted by most mental health historians), may be 1500-2000 years ago.

We needed Psychiatric Classification urgently in 1973 after Rosenhaun’s Seminal Publication in of “Being Sane in Insane Places” when some doctors tricked Psychiatrists initially by saying they were hearing voices , but they denied this later and did not show any other signs of mental illness.But they were diagnosed with a variety of disorders, which shook Psychiatry from its foundations.

Later the Anti-Psychiatry Movement by RD Laing & Thomas Szaz & various abuses of Psychiatry like justifying Nazi,Soviet &Apartheid policies(Yes! Psychiatrists provided the reasons!).This led to the moral outrage & so the US-UK study & IPSS(International Pilot Study of Schizophrenia) & Classification evolved.

Psychiatric classification in short was needed for reliability(patients with same complaints were diagnosed as bipolar in US & Schizophrenia in UK) & so when Classification first came into existence Validity was not an issue,Reliability was.

We have a substantial reliability in our diagnosis now, compared to the past.

Our challenge is to make our Classification more valid & Evidence based.

When they started classifying there were Biological,Psychological & Social proponents & in some ways Classification till today was a compromise between these 3 threads.But we need to revisit these again armed with Radiological, Hamatological &Epidemilogical evidence & emerging Psychosocial under pinnings.

This is a very huge topic & I am afraid I am trying to woffle here, So I will start Winding down. But Various sub types of Schizophrenia,Affective Psychosis,Boundaries between Mental Illness & Personality Disorder are very contentious & opinionated & very Controversial for now.

The continuum as a spectrum you are suggesting is the Greisenger’s Unitary concept of Illness I guess. When I was taught in India, I was told a Neurotic fear without reality testing is delusion, when treated becomes Obsession(beliefs held with less certainity & amenable to change(in some cases!) ). I know its simplistic, but certainly worth a thought.

Just my thoughts.......

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Incidentally Indian doctors were the first in the world to classify mental disorders in Ayurveda(accepted by most mental health historians), may be 1500-2000 years ago.

We needed Psychiatric Classification urgently in 1973 after Rosenhaun’s Seminal Publication in  of “Being Sane in Insane Places” when some doctors tricked Psychiatrists initially by saying they were hearing voices , but they denied this later and did not show any other signs of mental illness.But they were diagnosed with a variety of disorders, which shook Psychiatry from its foundations.

Later the Anti-Psychiatry Movement by RD Laing & Thomas Szaz & various abuses of Psychiatry like justifying Nazi,Soviet &Apartheid policies(Yes! Psychiatrists provided the reasons!).This led to the moral outrage & so the US-UK study & IPSS(International Pilot Study of Schizophrenia) & Classification evolved.

Most if not all ancient cultures had a concept and classification of mental illnesses. The Ebers Papyrus from Egypt also descibes depression, and early greek texts describe dementia, excitement, depression and confusion. And classification and the boundaries of psychiatric illnesses have been constantly evolving ever since. To a certain extent yes, they are determined by cultural and societal norms. Nobody today would (I hope) still consider homosexuality to be a mental illness. So I think to say that it was only after 'On being sane in insane places' was published that a need for classification arose is not quite correct. By this time a long line of nosologies had been established, from Linneus through Cullen, Pinel, Esquirol and Kraepelin to the ICD-6 in 1948 which included mental disorders, and DSM-1 in 1952.

Szasz published 'The Myth of Mental Illness' in 1960 as he felt that conceptually mental illness could not exist as it did not have a physical cause, and so diagnosis was a morally driven judgement which medicalized 'problems of living' and reduced the responsibility of the patient to change.

True we are using essentially Kraepelinian distinctions today over a century later and they are beginning to seem invalid. However it is only now that we have had the ability to understand mental illness in any detail (and we still have very little idea as to its causes and treatment), but it has the potential for future research to determine more accurate and distinct disease entities based on physical causes. Even Szasz said that if physical causes for mental illnesses were found he would agree that they were valid entities. Hopefully we are on the road to doing just that.

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The more I read about the above conditions it seems that a neokraepelin classification suggesting that they are separate conditions (further suggesting a separate aetiology) is doubtful.

Instead it seems that they reprsent different ends of the same spectrum.

Any views on this.

I think this a resonable argument considering that the treatment for both conditions (ie :BPAD :manic/depressive phase with psychosis and Schizophrenia )are more or less the same.

does lithium work for schizophrenia?

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Chris,

Thank you for the bit on Egyptian History & DSM-1 &ICD-6. I stand Corrected.

Re:- Homosexuality, I was not talking about today.Ofcourse, today, that is Prejudice of the worst kind. But apparently back in those days he was confined to an asylum.I gave it as a Historical example.

What I meant by following Rosenhaun article,Anti Psychiatry movement is that use of classifiction became wide spread (not discovered or devised then).

I agree with what you had to say after that.

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One of my gripes against the way we look at diagnosis is the way we try to fit all the symptoms into 1 diagnosis. For example is it PD or Mental Illness etc…Some one who has Diabetes also can have Hypertension or Rheumatic Arthritis etc… Why cant some with Schizophrenia not have Bipolar Disorder or Anxiety Disorder as well?Infact May be they might have only one episode of Psychosis & then may suffer anxiety. We then don’t know if this separate diagnosis of anxiety or if his anxiety is related to any stressors  or if anxiety is a part of Schizophrenia. Because of this problem of trying to explain all problems in one diagnosis, we then use every medication for every ailment in our realms, which further makes our speciality look like  quackery.

One of the problems with psychiatry is that we diagnose by putting together a number of symptoms and giving that condition a name. Many symptoms are common with different conditions/illnesses. Both ICD and DSM have exclusion criteria, which means that if one has one illness, cannot have another one (at least not a 'similar' one). That's why we just give one diagnosis.

We use medication mainly to treat symptoms, so we end up using the same medication to treat different 'illnesses' (just because they have the same/similar symptoms).

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The more I read about the above conditions it seems that a neokraepelin classification suggesting that they are separate conditions (further suggesting a separate aetiology) is doubtful.

Instead it seems that they reprsent different ends of the same spectrum.

Any views on this.

I think this a resonable argument considering that the treatment for both conditions (ie :BPAD :manic/depressive phase with psychosis and Schizophrenia )are more or less the same.

does lithium work for schizophrenia?

According to the Cochrane review (Leucht et al, 2006), there is no RCT evidence that Lithium on its own is effective in the treatment of schizophrenia (but there is no evidence of lack of effectiveness either). Anybody fancy a RCT?

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This is the book I was talking about.

http://human-nature.com/nibbs/02/perring.html

Another good book,Although a touch critical about psychiatry at times

http://human-nature.com/nibbs/03/dsm.html

(Current opinion in psychiatry) journal in 2006 has an article on overlap between Bipolar & Schizophrenia.

Unfortunately You have to pay for it or get it from your library.

Here is the Link :-

http://www.medscape.com/viewpublication/828_toc?vol=19&iss=2

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www.hsc.wvu.edu/.../powerpoint-slides/psychiatric-classification/psychiatric-

Interesting series of slides on ppsychiatric classification !

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I quite like the idea of a pyramidal model of psychiatric symptoms for affective and psychotic disorders as is hypothesised in this paper.

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