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Simultaneous existance of mental disorders.

18 posts in this topic

Ok, I know mental illness can co-exist with mental impairment or personality disorder.That is not what I wanted to discuss.

Why can't a patient who has Schizophrenia not suffer from Bipolar Affective Disorder or OCD?

For example a person can have diabetes as well as hypertension,its not either or.

Why is it we try to find one disorder that fits all symptoms?

Affective Psychosis for example Schizoaffective disorder, is it a separate entity or just co-existence of schizophrenia & bipolar Affective disorder?

Any interesting papers/research in this area?

Looking forward to a thought provoking discussion.

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I think that the main reason is a pedantic one, in that the systems of classification that we use don't allow for this. The hierarchical nature of organic to schizophreniform to affective to anxiety to neurotic is fixed in the diagnostic criteria for each illness. Hence someone with bipolar and schizophrenia would likely meet the criteria for schizo-affective disorder, or affective psychosis and that is therefore their diagnosis.

Whether that distinction is a valid one is open to intepretation, given that our basis for the diagnostic categories is arbitrary and based on observations of patterns of behaviour which can vary considerably between patients.

I'd be for lumping major affective and psychotic illness into a single broad category of dopamine system disorder, and add minor depression, ED, OCD, anxiety to a seperate serotonin system disorder category. But we would need to understand more about the aetiology of these conditions before we would know if this was an any less arbitrary classification. Perhaps the classification should be broken up by areas of structural changes in the brain, or by response to particular types of medication. At the end of the day though, until a fuller understanding of the causes of these experiences is ascertained, any nosology is going to be arbitrary.

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well jim van os talks about dimension or symptoms. I understand that he doesnt diagnose as such but comments on the levels of psychotic symtoms or affective, etc. He has written an interesting article on this. ...er which icant be bothered to find!

;)

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Omer,

Its not urgent, but it would be great if you can post the reference.I know what you mean about can't be bothered !LOL!

Thanks.

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oh alright then! :D

but didnt u all do in ur first year journal club discussion thingys???

Here it is: actually more about dimensions for describing psychosis...which would make more sense as he did the work with prof murray. anyway a couple of articles, both in psychmed:

'A comparison of the utility of dimensional and categorical representations of psychosis' Van Os et al.

Psychological Medicine (1999), 29: 595-606

'Evidence that three dimensions of psychosis have a distribution in the general population' STEFANIS et al (including J. VAN OS last author) Psychological Medicine (2002), 32: 347-358

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the problem is our classification system is imperfect. and how we use it is even less perfect.

eg if someone met criteria for schizophrenia at one point in time, mania at another, depression at another.

so what's the diagnosis?

three separate episodes, schizoaffective disorder, bipolar?

some people would keep the diagnosis as schizophrenia throughout, but add a depressive episode as a diagnosis for the 3rd.

some would say it was schizoaffective (despite the fact the diagnostic criteria for that are not met)

some would say they had schizophrenia and bipolar disorder.

others would say three separate episodes of unrelated illnesses.

others would say they were never ill and society was at fault.

others would say that they were never ill, they experienced some symptoms as a result of stress and the subsequent episodes were due to medication that was wrongly prescribed.

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Although not directly related to the topic, some stuff on OCD & Schizophrenia :-

http://www.priory.com/psych/ocd.htm

http://www.schizophrenia.com/sznews/archives/002116.html

http://www.medscape.com/viewarticle/473557

http://ajp.psychiatryonline.org/cgi/content/full/160/5/1002

http://ajp.psychiatryonline.org/cgi/content/full/159/4/684

I am not able to get one more paper called &quot:lol:elusions revisited' by Issaec Marks from the Institute of Psychiatry,London. The theory is delusions are false beliefs held with:-

extraordinary conviction(with no reality testing)

Total preoccupation &

causes considerable distress to patients & carers & society

If after treatment his insight returns then it becomes an obsession.

There may be other theories too !

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We know there are patients who have (anxiety & depression) or (eating disorders & mood disorders) or (OCD & Mood disorders) & between (Schizophrenia & affective disorders)----------------------->(http://www.priory.com/psych/genetics.htm is the reference)(http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12942993&dopt=Abstract)

(http://www.genetics.med.ed.ac.uk/blog/?page_id=4)

My gut feeling is our patients suffer more than one mental illness at times but we are trying to pigeon hole them into 1 category only.

Sometimes we see mood stabilisers being useful in schizophrenia and antipsychotics in affective psychosis. one view is there is a biological basis for this.

Another view could be that the patient may be suffering from 2 mental illnesses at the same time.

we know there is good evidence that many patients with personality disorder suffer from more than 1 personality disorder at the same time. why is it then that when trying to explain symptoms of mental illness we always think of only 1 disorder to describe???

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i don't think we try to pigeon hole our patients into having a single diagnosis.

survey 100 psychiatrists, i'm pretty sure that the vast majority would say someone with Sz can also have depression, ocd, anxiety, personality disorder, etc. (the majority would probably not agree with both sz and bipolar though).

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why not Schizophrenia & Bipolar? is there any evidence to suggest that they cannot co-exist?

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i think they can. i don't think the majority would agree. i say that because of the response i get when i say that i think they can. i don't think there is any published evidence either way.

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J,

I know this thread needs to be active for long. For sure, we cant find anything straight away, but if you do find anything interesting,please post the reference anyway.

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

When I get it(I requested it from Library) I will post the names of authors,month of publication etc........(& Perhaps a few main points too)

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i knew a pt once who had a clear diagnosis of schizophrenia for many years, who then had a floridly manic episode requiring PICU which was nothing like previous episodes of psychosis. I'd say she had both. Sorry I know that's not evidence as such...

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Trouble is some clinicians try to call it the affective component of a Schizophrenic Patient. Who is to argue against that.

More recently, We have had 2 patients who have been on clozapine or above BNF limits of antipsychotics who have shown marked improvement on addition of Semisodium Valproate(moderate doses). 2 isnt a lot but I have had conversations with other clinicians who also told me that Mood stabiliser augmentation to antipsychotics in treatment resistant Schizophrenia seem to help a proportion of patients.

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i knew a pt once who had a clear diagnosis of schizophrenia for many years, who then had a floridly manic episode requiring PICU which was nothing like previous episodes of psychosis. I'd say she had both.  Sorry I know that's not evidence as such...

Perhaps her diagnosis is/always was Schizoaffective disorder ! :) (or even Bipolar Disorder-current episode manic with/without psychotic features )

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