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More lunacy at the APA meeting this week. Now there is discussion of whether Bipolar Disorder should be re-categorized as a Psychotic Disoder. Well, long term readers of the Drug Safety and Health News will remember my views on Bi-polar Disorder…
What are you so upset about? I told you I was Bi-Polar.
I’m not saying bipolar is a totally bs diagnosis. I am just saying it is way overdiagnosed.
Now it looks like I am going to have to become a candidate for Post-traumatic Embitterment Syndrome (Yes it too is being proposed as a new diagnosis at the APA, sigh) if the DSM Psychosis Work Group led by William Carpenter MD decides to move bipolar disorder into the psychotic disorders. I mean, there already is enough stigma associated with psychotic disorders. What are you going to do about the “bipolar II” people? Tell them they are psychotic too? And what about those four year olds with the bipolar diagnosis?”
Carpenter did say the shift would happen “over a few dead bodies” but that they “did want to get rid of schizoaffective disorder.”
Maybe the fact that Dr. Carpenter’s list of disclosures leads like a phone directory of the world’s drug companies might have something to do with this odd behavior. I mean, if it is a psychotic disorder, then people won’t quibble about giving antipsychotic drugs for it, right? Even if they do cause a 25% rate of akathisia.
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Didn’t I say, they’d better burst into tears and so on?
BUT: Somehow, as I’ve said before in a comment at Furious Season’s, the outcry from the folks in the bipolar-camp has something disturbing about it, imho. “I’ve never been psychotic!” Oh, really?? Us and them-thinking par excellence: “The schizophrenics”, “the psychotics” are the real nutcases, the real bad boys. BD on the contrary is just sooo chic! Don’t you dare to ruin that for us!…
BTW: Yup, they should add themselves as a cause of Post Traumatic Embitterment Syndrome.
this is what I wrote at Furious Seasons:
frankly this looked like BS immediately exactly because it would decimate all those people’s diagnosis with mood swings…what would we label all those poor lost souls. What would happen to their identity and their doctors credibility…???
I do believe it would take dead bodies to let go of psychiatry’s love affair with diagnosing anyone with affect with bipolar disorder.
I just don’t think it would fly…too much attachment to the mildest of mood swings being called bipolar…
Our current, and limited, system of diagnostic classification in psychiatry is based on clinical phenomenology and epidemiology-not biology of disease or biology of treatment response-though that is a long-term goal. It is of necessity a psychological and epidemiological taxonomy because we do not have a scientific understanding of how the brain constructs the mind/conciousness/sentience and very limited understanding (relative to the complexity of the problem) of causality in relation to the biology and genetics of psychiatric illness and treatment response.
Psychiatric illness, like most forms of general medical illness, is “complex” in the sense that disease is often a syndromal endpoint that may be reached through multiple physiological pathways, supported by multiple sets of genes that may be each influenced in variable ways by the environment (in contrast to single-gene disorders like Huntington’s Disease or different metabolic diseases like Phenylketonuria or Alkaptonuria). Given the complexity, i think we have substantial distance to go before we have a biologically-grounded system of diagnosis in psychiatry but i very much think it is an important journey to make.
The prominent disturbance in any of the “types” of bipolar disorder is functionally-significant alteration of mood, hence it’s present inclusion in the Mood Disorders category, and NOT disturbance in the form or content of thought (as in Psychotic Disorders) although this may be present as well, up to and including psychosis. For what it’s worth, patients with psychotic disorders may also have significant mood disturbance as well which was what gave Jacob Kasinin the impetus to coin the term “schizoaffective” for this group of patients.
I have no idea what the scientific rationale of moving bipolar disorders i.e. (I, II, Cyclothymia, & NOS) into the psychotic disorders category could possibly be. Diagnosis is important because it allows prognosis and informs treatment. Although there is linkage and association data connecting alcoholism, depression, bipolar disorder, and schizophrenia, the nature and strength of these relationships isn’t clear. Only a modest fraction of patients with Bipolar I experience psychosis during some phase of their illness. While antipsychotic medications have anti-manic properties so do anticonvulsants and lithium. Response to treatment may suggest hypotheses about pathophysiology to test experimentally but it is absurd and unsupported by current data to classify bipolar disorders on these grounds. If this is about hierarchy of symptom severity, with psychotic symptoms being the most severe, then wouldn’t all psychiatric disorders be subsumed under psychotic disorders category? After all, since psychosis isn’t inherently required for any bipolar diagnosis, why should it be different for cat phobia, ADD, or dysthymia. Maybe we need a subcategory of Potentially-psychotic Disorders…
Mania is a psychotic phase. Full stop. It simply is wise to move Bipolar Disorders under the category of psychosis. I totally agree with APA. Besides there is no Schizoaffective Disorder, the category should be moved out.
Mania can be expressed in a psychotic phase,which is acute manic psychosis. Yet this is infrequent, and symptoms expressed as such resemble a distant relative of schitzophrenia. If one is in an acute manic psychosis, it is brought on often with the sufferer experiencing interpersonal tensions, or if they are treated unfairly in some way. This is only a possible, and infrequent aspect of bipolar disorder, rather than a psychotic disease state, which bipolar disorder is not.
[...] Bipolar Disorder as Psychotic Disorder Before You Take That Pill Posted by root 13 minutes ago (http://www.beforeyoutakethatpill.com) Jun 2 2009 but somehow as i 39 ve said before in a comment at furious i just don 39 t think it would fly too much attachment to the mildest of mood swings being called bipolar before you take that pill is powered by wordpress Discuss | Bury | News | Bipolar Disorder as Psychotic Disorder Before You Take That Pill [...]
Bi-polar disorder was very recently known as “Manic Depressive Psychosis” it has always been a psychotic disorder. I wonder what will happen to all the folks who are DX with schizoaffective disorder if they decide to eliminate that DX. They are fragile folks to begin with. Maybe some of them will learn that the labels really mean nothing as far as who they are as human beings.