Thursday, April 2, 2009

Depression, Diagnosis, Addiction, Recovery

I thought I would take some time over the next days to review depression, a common problem we see here at Cottonwood as we are a dual diagnosis treatment facility specializing in the treatment of addictions complicated by other psychiatric disorders. I will talk a bit about diagnosis in general, then about depression itself, what it is etc., and then how we appraoch the treatment of depresion here at Cottonwood. This will be a somewhat lengthy series which I will break up from time to time as other thoughts and other subjects come to me. I hope that it will be useful and not too boring as it will be a bit didactic and I welcome comments and questions as we go along.

Before we talk about depression itself though I want to talk a bit about psychiatric diagnosis in general, particularly the concern that some have that our diagnoses are too subjective since we don't have objective signs such as lab tests etc. There are four types of diagnoses made in medicine and the diagnosis by signs and symptoms is a legitimate diagnostic strategy that also has it's place in other branches of medicine. The first kind of disgnosis is that based upon tissue pathology. This is what we do in cancer. A biopsy of certain tissue is made and then there is a determination of whether or not there are cancer cells. The second kind of diagnosis is made by defining a deviation from the standard norm. This is how we define such conditions as hypertension, diabetes, and obesity. The third type of diagnosis is based upon the identification of the etiologic or causative agent. This is common in infectious diseases such as streptococcal pharyngitis,urinary infections, HIV, and hepatitis.

The fourth kind of diagnosis is phenomenological or based upon a common set of signs and symptoms This type of diagnosis is used in psychiatry but also includes such conditions such as migraine, Parkinson's disease, Alzheimer's disease, and suspicion of an acute abdominal condition such as appendicitis. So phenomenologic diagnoses can be quite specific and objective as well. I will speak further on this on Monday, how psychiatric diagnoses are made.

Thought for the day

"Let justice roll down like waters and righteousness like an ever flowing stream".

The Hebrew prophet Amos

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