Monday, April 6, 2009

Depression, Diagnosis, Addiction, Recovery part 2

I am doing a series on depression and discussed how psychiatric diagnoses are phenomenological ( based upon clinical signs and symptoms) and how this is similar to other conditions such a migraine and Parkinson's. But phenomenological diagnoses are simply approximations and may include different "entities" within the same diagnosis. These approximations are useful though as they give us a common language, help make predictions regarding prognosis and types of treatment and provide diagnostic criteria for research purposes so that groups of people and treatment responses can be studied. In psychiatry these diagnoses are listed in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision, or DSM-IV-TR. One of the limitations of DSM-IV-TR is that diagnoses are categorical, that is listed as discrete and separate problems while in reality there are many overlaps. What is missing is the dimensional character of many problems, that is symptom problems that may be associated with many categorical diagnoses that are measured on a spectrum from mild to severe. Despite these limitations DSM-IV-TR is quite helpful.

One of the main things to understand about categorical diagnoses is that all of the diagnoses do not carry the same "weight". That is some diagnoses are much more reliable than others and probably do represent discrete "entities" and some do not. A characteristic of this type of diagnosis is that the greater the severity of the problem the more stereotyped it is in presentation and more likely does represent a certain entity. For example binge drinking in college may turn out to be a number of things from a transient problem to the beginnings of a more severe problem. There is no way to predict who may go on to develop alcoholism. So binge drinking is not a reliable diagnosis or a single entity. End stage alcoholism is different. It looks the same in most people. The same signs and symptoms are present, the same health problems are experienced and it is very predictable that death will ensue if the person does not stop drinking. The same goes for eating disorders Many people with a variety of problems may engage in the purging behavior of bulimia but severe malnourished life threatening anorexia nervosa is different. It does appear to be an entity all of it's own whose signs and symptoms are the same from person to person.

Depression is also one of those diagnoses that occur on a spectrum. I will talk more about that tomorrow.

Thought for the day

Happy Monday!

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