View Full Version : Rethinking diagnosis of psychosis (mentions ADHD)


TygerSan
12-20-15, 10:10 AM
I used to read a lot of primary literature on ADHD research (former researcher). Over the years I developed a hunch that the DSM-IV diagnostic categories for psychiatric disorders including ADHD, autism, bipolar, and schizophrenia would eventually blur and then fall as our understanding of root causes of particular symptoms increased.

I am pretty sure that there are as many flavors of autism, for example, as there are people with autism, and that the reasons for the overt symptoms of social difficulty and rigid routines may come down to very different physiological and genetic causes. The National Institutes of Mental Health (NIMH) has recently taken a perspective on mental health research that aligns with that notion, focusing research on genetic and biological markers of symptoms rather than the disorders themselves.

This (http://blogs.scientificamerican.com/mind-guest-blog/rethinking-how-we-diagnose-psychosis/?hootPostID=e019c06de320117be25e17778c51034c&) is a blog post from Dr. Thomas Insel, former director of NIMH, which articulates the alternative approach for diagnosis of psychosis, specifically, and outlines how diagnosing this way may produce very different categories of folks than classifying on overt behavioral symptoms as we have been.

Fortune
12-20-15, 09:17 PM
The article got a bit weird when it said that some people have features relevant to both schizophrenia and bipolar disorder and how hard that is to fit them into a diagnosis - but there is a diagnosis for people who have features of both. It's schizoaffective disorder (bipolar type).

Not that the point is that there could be biological or genetic markers that might represent a more accurate diagnostic picture than "diagnosis by symptom" we do now, just seems weird to make it seem like there's so much ambiguity between those two diagnoses without mentioning the diagnosis that combines the two in that context.

TygerSan
12-20-15, 09:48 PM
I think the point is that the boundaries surrounding the conditions are fuzzy, and the distinction between the 3 may have less to do with the symptom checklists we currently have and more to do with clusters formed by presence of different biomarkers and behavioral outcomes.

So, yes, schizoaffective disorder is a diagnosis that encompasses aspects of bipolar disorder and schizophrenia, but the 3 groups of folks they identified did not align with the DSM diagnoses.

But the three biotypes have very little relationship to the three diagnostic categories. In fact, people with schizophrenia and bipolar and schizo-affective disorders were distributed across the three biotypes.

So, if you use different criteria to make the diagnosis, you end up with different categories for diagnosis. (which I guess is a bit circular).

dvdnvwls
12-20-15, 10:04 PM
The article got a bit weird when it said that some people have features relevant to both schizophrenia and bipolar disorder and how hard that is to fit them into a diagnosis - but there is a diagnosis for people who have features of both. It's schizoaffective disorder (bipolar type).
It's possible that their point includes the idea that they view schizoaffective disorder (bipolar type) as a stopgap diagnosis whose ultimate validity is in question.

Fortune
12-20-15, 10:06 PM
It's possible that their point includes the idea that they view schizoaffective disorder (bipolar type) as a stopgap diagnosis whose ultimate validity is in question.

Then they should say so.

But it seems like they're saying all psychiatric diagnoses are effectively stopgaps.

BellaVita
12-20-15, 11:26 PM
Interesting read.

We have so much to learn about all of this stuff, we have barely scratched the surface.

Really though, what got my attention the most was when it said Google is now called Alphabet.

dvdnvwls
12-21-15, 03:06 AM
I just read the article: Fortune, are you and I even reading the same page? Schizoaffective disorder was mentioned pretty prominently and was referred to at least once more.

Fortune
12-21-15, 04:39 AM
It's more like you didn't read my post correctly. The part I am talking about is at the beginning, but schizoaffective isn't mentioned until further down. They made it sound like there's a dichotomy present wherein you have to be ONE or the OTHER and failed to mention the diagnosis that would encompass both until the article had moved past that point.

They also dropped the ball on describing schizoaffective as they made it sound like it is strictly a hybrid of bipolar disorder and schizophrenia, but there are actually two types of schizoaffective disorder - the other being a combination of psychotic features and depression.

TygerSan
01-04-16, 01:00 PM
But it seems like they're saying all psychiatric diagnoses are effectively stopgaps.

Yes. This exactly. NIMH is changing the way they study disorders by focusing less on established diagnoses, and more on biological and genetic markers that correlate with/ correspond to expression of psychological symptoms.

The point of the matter is that one may, for example, seem to lack the wherewithal for social interaction for a vast variety of reasons, from sensory sensitivities, to sensory processing disorders, to executive functioning problems, etc; all of which may result in similar phenotypes but with vastly different underlying causes.

I think the hope with looking at the biology underlying some of these symptoms is that we may be able to look, from the bottom up, in a way that we haven't been able to before. Of course, there are pitfalls with both approaches, and we may very much end up with a biological rather than behavioral DSM, which, IMO would not be much better than where we are now.