Into the Void

PSYweb DSM-IV Diagnoses and Codes.

PSYweb has a list of the DSM-IV Diagnosis Codes. Notice that there are a lot of psychiatric diagnoses caused by psych meds. This makes it totally clear that your meds can make you sicker, a good argument for doing the minimum meds to make you functional vs. medicating yourself into oblivion.

The following are a few examples of iatrogenic (physician-caused) psychiatric disorders:

292.84

Opioid-Induced Mood Disorder
Yes, pain meds can make you look like a bipolar.

333.99

Neuroleptic-Induced Acute Akathisia
He’s agitated, let’s give him more neuroleptic. Neuroleptics are old-fashioned antipsychotics such as Haldol.

292.12

Amphetamine-Induced Psychotic Disorder, With Hallucinations
Some of the ADHD meds they give to kids, including Ritalin and Adderall, are amphetamines. Can you imagine turning your kid into a Speed Freak?

292.89

Sedative-, Hypnotic-, or Anxiolytic-Induced Anxiety Disorder
Anxiety from anti-anxiety pills? Some of the benzodiazepines can even induce hypomania, however there doesn’t seem to be a diagnosis code for it. Maybe in the DSM-V. Or maybe not. I hear it’s being written by Big Pharma.

Another cool thing on psyweb is a Mood Disorder Flow Chart that is able to distinguish bipolar disorder from the other mood disorders. A real kick in the head is the question “Symptoms Psychotic in nature, occur at times other then during Manic or Mixed Episodes?”

This seems to imply that bipolars don’t have psychotic depressions, but other mood disorders do. Note that the only the 296 numbers are mood disorders, and only a few of those are called bipolar disorder. Been there, done that, bought the t-shirt.

A couple of years ago I did a decision tree for the bipolar disorders based on the DSM-III. It’s a little different from the DSM-IV-based version.

Psyweb also has a decision tree for differential diagnosis, and that’s a better choice than the mood disorders tree, even for diagnosed bipolars. This tree helps you figure out whether you have another psych diagnosis masquerading as bipolar, something that a 15-minute psych eval will definately miss. That would be truly disastrous, being treated for life for bipolar instead of dealing with something less severe. Have fun!

I think I’m going to invent Seroquel jimmies for ice cream.

Well, we are losing ground. There are a number of groups that are fighting for more humane treatment of mental patients, except that by “humane” they mean “treating the poor benighted bastards whether they want it or not.”

Although there are are indeed patients who are unaware of their illnesses, it is unacceptable to treat all of the mentally ill that way. It opens the door to unimaginable abuses. By the way, anognosia is also found in stroke victims with damage to the frontal lobes. And on a more chilling note, some psychiatric treatments induce anosognosia.

NAMI is once again at the forefront in this growing threat.

Anosognosia Keeps Patients From Realizing They’re Ill
A growing body of evidence points to the fact that for many people with serious mental illness, lack of insight is a medically based condition.
About half of the people with schizophrenia and bipolar disorder may not be getting the treatment they need because of a brain deficit that renders them unable to perceive that they are ill, according to one expert.
Xavier Amador, Ph.D.: “People will come up with illogical and even bizarre explanations for symptoms and life circumstances stemming from their illness.”
Anosognosia, meaning “unawareness of illness,” is a syndrome commonly seen in people with serious mental illness and some neurological disorders, according to Xavier Amador, Ph.D., who spoke at the 2001 convention of the National Alliance for the Mentally Ill in Washington, D.C., in July.
People with this syndrome do not believe they are ill despite evidence to the contrary, said Amador, who is director of psychology at the New York State Psychiatric Institute and professor of psychology in the department of psychiatry at Columbia University College of Physicians and Surgeons.

Treatment Advocacy Center
“The Treatment Advocacy Center has been the catalyst for many positive changes in our laws and a shift in our perception of the importance of intervention. Their unique advocacy is restoring the important balance between individual freedom and caring coercion.”

Legislation
These issues of “involuntary commitment” and “assisted outpatient treatment,” are labeled in academia as “controversial”, a concept interpreted by many as too difficult for the average person to understand. Without the support of scientific research, we all felt until now, intimidated and afraid to be rendered guilty of tampering with everyone’s civil rights. To continue protecting their civil rights only allows our loved ones to remain psychotic, addicted to substances, wandering the streets of the USA, wasting their lives in jails and using, over and over again, most of the economic resources available to treat ALL mentally ill persons. We cannot forget that, not too long ago, freeing the slaves and fighting for an end to discrimination were also considered “controversial” subjects.

Bill mandates treatment for mentally ill (phillyBurbs.com)
Others, though, contend there is little evidence the court orders are effective, and the laws deflect attention from deeper problems plaguing the mental health system, such as a lack of funding for expanded treatment and support services.
Patient advocates fear that law could be abused by applying it whenever a patient disagrees with a doctor’s recommendations. A 2005 state law allows for psychiatric advanced directives specifying treatment preferences when a person’s decision-making is impaired, patient advocates added.
“I believe that the bill has grown out of a sincere desire to help people with mental illness,” said Joseph Rogers, president of the Mental Health Association of Southeastern Pennsylvania. Unfortunately, if it became law, it would have the exact opposite effect.”

Be afraid. Be VERY Afraid. If you disagree with your caregivers, they can pull out the anosognosia label to get you out of the way.

Get out one of the books you are reading - the first one that comes to hand is ok. Find chapter 8, the 8th paragraph or section and the 8th sentence or first sentence in the 8th paragraph. If you can’t figure out what I mean, do something that has a bunch of 8s in it.

Mine:

“They observed a significant peak in depression for women in November, with a secondary peak in April, and a peak for men in admissions for both depression and mania in April.”
– Manic-Depressive Illness Second Edition, Goodwin & Jamison.
Chapter 8
Section 8
first sentence in Paragraph 8

Boring, huh? I’ll try another book later. Or another combination of 8’s from this one.

What’s yours?

I found this in my drafts folder. I have no idea where I was going with it or who I was answering.

I hear that they are studying drug-induced coma as a treatment for mania. Granted, sleep is a good prophylactic for bipolar. It’s just too, too creepy. The end game will be to stack comatose mentally ill off in a warehouse somewhere. Didn’t Robin Cook write a chilling medical fiction about something like this?

How much sleep does it take? Are they researching conversion tables to translate hours of coma to days of sleep?

There’s a good section on sleep and bipolar in Dr. Fieve’s latest book, Bipolar II: Enhance Your Highs, Boost Your Creativity, and Escape the Cycles of Recurrent Depression.

There was also a chapter in the first edition of Goodwin and Jamison. Incidentally, Manic-Depressive Illness Second Edition is out.

It’s rather disheartening to hear that the researchers are repeating the same old studies over and over instead of exploring new treatment options that would enable us to go back to work instead of turning us into mental cripples by reducing our IQs and impairing our short-term memory. And then stigmatizing us for having cognitive deficits.

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Genius May Be an Abnormality: Educating Students with Asperger’s Syndrome, or High Functioning Autism

Center for the Study of Autism - Temple Grandin

neurodiversity.com - Temple Grandin’s Hug Machine

THINKING IN PICTURES

Geek Syndrome

“…Look, without humor we would all have committed suicide. We made fun of everything. What I’m actually saying is that that helped us remain human, even under hard conditions.”
– Holocaust survivor, quoted by Dr. Chaya Ostrower, PhD of Beit Berl College, Israel
in Humor as a defense mechanism in the Holocaust

I came across the above quote this morning while checking the Pendulum listing on dmoz.org. Holocaust humor? WHAT????

The article above is about the victims of the death camps using humor to stay sane in an inhuman, insane situation. Humor is a great coping mechanism. If it worked for people who lived in the shadow of a crematorium, it can certainly work for us.

No, there was nothing funny about the Holocaust. There is nothing funny about genocide. There is nothing funny about a thing that goes beyond hate, that stigmatizes, dehumanizes, and then brings formerly rational human beings to methodically exterminate their next-door neighbors.

“Holocaust” means “complete burning.” The word Holocaust is technically used to refer to the six million Jewish victims. The goal was to exterminate an entire race just because they weren’t Christian. Ok, well, there were other factors, but nobody had to wear an “successful” badge. They had to wear a Judenfleck.

I am misusing the word to include the three million non-Jewish victims. Feel free to comment.

My personal interest in the Holocaust focuses on the “Aktion T 4,” the Nazi euthanasia program to eliminate “life unworthy of life”. The Nazis tuned up the Death Machine on mental patients before grinding through the other 9,000,000 victims.

Nine Million. Can you even get your brain around such a number? That is like murdering the inhabitants of SIX Philadelphia, PAs. (Philadelphia population is from the Census Bureau’s State & County QuickFacts.)

“The murder of the lunatics contains the key to the Pogrom of the Jews…”
– Max Horkheimer (1895-1973)
quoted in The Cynical Republic, “Haus des Eigensinns – House of maddening beauty”

I’ll be talking about this some more.

Technorati: suicide Nazi holocaust T+4+Aktion mental+illness Judenfleck

How to identify mania:

One way is to make a rough calculation of the percentage of support list email that is yours. Is half the email yours? That’s the support list equivalent of being at a party and running around in a frenzy trying to keep tabs on every conversation.

My personal favorite way to tell is to read my own posts and count how many times I begin a paragraph with the word “I”. If I write a post and every goddam sentence is about me, me, me, then I know that I should be talking to a therapist instead of taking energy from people whose boundaries are too soft for them to say or even think “no” or “you are a boring, self-involved twit.” When folks talk talk talk, it’s because there’s something that they want to say. Not the mush that comes tumbling out in idle chit-chat, but something important and maybe life-changing. OMFG, no, keep talking loud and fast so that you can’t hear it.

In case you aren’t aware of yourself enough to gauge when your thoughts are racing, you are emotionally labile, or you are feeling overly optimistic, grandiose, charitable, attractive, psychotic or whatever else might be part of your mania, then you have to focus on your behavior. Or more specifically to others’ reactions to your behavior.

I realize that gaining some awareness is the first step in being able to reduce your meds, get out and make new friends, do volunteer work or maybe even get job training, and eventually even stop hating yourself and your bipolar disorder. In a way, allowing yourself to be competent and independent is like sawing off the branch you’re sitting on if your continued access to medical care requires that you be sick enough to qualify for it.

Can you imagine being paid to stay sick?

Pretty much any psych med by itself will affect sex drive. I see folks taking a half a dozen of them, and then another med or two to counteract the side effects. The pdocs tell us that they DON’T because they don’t want us to quit taking them.

Perhaps we should refer to our meds as a “pharmaceutical chastity belt.”

Anything that tweaks your dopamine down is going to get rid of the emotional spark required to have something resembling a sex life. And anything that tweaks UP serotonin receptors does so at the expense of dopamine receptors. See this article, Notes on Anhedonia and SAD.

For men, there’s also the problem of peripheral blood flow - a strictly mechanical problem. Can’t get the old hydraulics to run, eh? Viagra and Cialis work by improving blood flow. Heck, coffee dilates the blood vessels too, and if you brew it at home it’s way cheaper than an ED pill. Diabetes is common cause of ED, so antipsychotics that affect blood sugar (most of the atypicals) might contribute to it.

Maybe the whole idea is to give us drugs that prevent us from breeding lots of little bipolars.

Today I learned that the Arabic word for mental illness has the same etymology as the Arabic word for evil spirits. This has an unfortunate effect on how the mentally ill are perceived in the Middle East.

Language is an odd thing. It enables you to express your innermost thoughts and feelings. BUT it almost guarantees that the thoughts and feelings you express have been totally shaped by the language itself. In the words of comedian Lenny Bruce,

“Believe me, I’m not profound, this is something that I assume someone must have laid on me, because I do not have an original thought. I am screwed. I speak English. That’s it. I was not born in a vacuum. Every thought I have belongs to somebody else.”
– Lenny Bruce, quoted on Rakes Progress: Lenny Bruce is not afraid

So what’s happening is that as long as the doctors use that old-fashioned word to describe mental illness, demon-possessed the mentally ill will remain.

Arabs don’t have a monopoly on superstition though. The following TinyUrl will take you to a google search for “mental illness exorcism.”
http://tinyurl.com/5gwe4p

A reminder: I’m an engineer. This is all my opinion based on readings in a field that is not my own. I request that as you read my posts, you also check my references.

Cigarettes are powerful anti-anxiety drugs. It’s my opinion that may smokers are self-medicating an anxiety disorder.

Nicotine has calming effects on stress-induced mood changes in females, but enhances aggressive mood in males

“Exposure to moderate stress significantly increased ratings of anxiety, discontent and aggression and nicotine blocked these mood changes in females, but enhanced them in males. This suggests that young women may start regular smoking as a form of stress self-medication, which implies that preventative and smoking cessation programmes would be more successful in women if they addressed issues of stress and anxiety, which may be core factors underlying initiation and maintenance of regular smoking.”

A bipolar most certainly will get a high score on an ADD screening test like the Copeland symptom checklist. The symptoms of ADD overlap with the symptoms of bipolar. A bipolar child scores higher on the ADD screening test that a child with ADD. Your GP isn’t qualified to make a differential diagnosis, and in fact is likely to misdiagnose you and make your illness worse.

I’m going to quote from articles about children because misdiagnosis kills so many of them. It applies to adults too, but we don’t have parents to FORCE us to continue taking ritalin when it is obviously tearing us to pieces.

Diagnosing Bipolar VS. ADHD: Similarities

“There is concern that ADHD is being overdiagnosed and bipolar disorder underdiagnosed in the population of children.”

That being said, yes, I have ADHD combined type. My psychiatrist diagnosed it after I’d been seeing him for 10 years and after an evaluation that DIDN’T included taking an ADD screening test. Screening tests are useless for bipolars. You have to be cautious.

I have been through the entire pharmacopia, or it seems that way. Every ADD med I’ve taken makes me hypomanic within a week. So how I work it is that on days I really REALLY need to focus I take it. I have tried:
Ritalin (methyphenidate) - this is the one they give our children. Somebody please explain to me why 40% of American children need psych meds?
Strattera - this was the absolute worst for me. It interferes with metabolism in the liver of SSRIs, resulting in a huge buildup of both drugs. I was up there in 3 days and in a nasty mixed state in a week.
Provigil - similar to Strattera, but takes longer to build up. YMMV!
Adderall - amphetamine. SPEED FREAK! Three days in a row and I’m have “racoon eyes” and am well on my way to psychosis.

Strattera Risks May Widen
FDA,s warning about Eli Lilly’s drug Strattera causing suicidal thinking in children used for ADHD caught many parents and doctors by surprise.

“Dr. Laughren says the agency also plans to ask Lilly to include a stronger caution on Strattera’s label about its risk of inducing mania and similar mood destabilization, along with the new “black box” warning out this week. The new warning will focus on the drug’s risks for kids with undiagnosed bipolar illness, according to Dr. Laughren. In fact, “very often bipolar illness is not recognized until you [give] patients a drug like Strattera,” he says.”

Bipolar Disorder, Co-occurring Conditions, and the Need for Extreme Caution Before Initiating Drug Treatment

“Now understanding that early-onset bipolar disorder is frequently co-morbid with other childhood psychiatric conditions, doctors and parents should be concerned that a medication used to treat these other conditions may “flush out” a previously quiescent bipolar gene that can significantly worsen the course of illness and potentially wreak havoc with that child’s life. It is therefore vitally important that parents learn everything they can about their family histories, and if mood disorders (depression or manic-depression), suicide, or alcoholism come to light, treatment should proceed very cautiously. Mood stabilizers should perhaps be the first line of treatment (and it may take two such medications to stabilize the child), and attentional, obsessional, or depressive symptoms be treated only after a therapeutic dose of the mood stabilizer is achieved.”

The Overlap With ADHD

Perhaps the greatest source of diagnostic confusion in childhood bipolar disorder is that its symptoms overlap with many of the symptoms of attention-deficit disorder with hyperactivity. At first glance, any child who can’t sit still, who is fidgety, impulsive, easily distracted or emotionally labile is more likely to receive a diagnosis of ADHD than bipolar disorder. However, since over 80 percent of children with a bipolar disorder will meet full criteria for attention-deficit disorder with hyperactivity, ADHD should be diagnosed only after bipolar disorder is ruled out. While these two conditions seem highly co-morbid, stimulants unopposed by a mood stabilizer can have an adverse effect on the bipolar condition. 65 percent of the children in our study had hypomanic, manic and aggressive reactions to stimulant medications. Parents wrote to us and described some of their children’s reactions to stimulants. They said things like: “He got sky-high on Ritalin and then violent”; “Ritalin caused physical aggression”; “She got psychotic on stimulants”; “He got suicidal and tried to get run over by a car”; “He went bonkers…”

Don’t let a GP play with screening tests. See a psychiatrist.

Technorati: bipolar bipolar+disorder ADD ADHD Nicotine Copeland+symptom+checklist