#nosology

[alienated-alienist]

According to the DSM-5, "A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above."

Many MUDs fit this description. This is not because MUDs are accurate, valid, reliable, or even safe. This is because the definition is bullshit.

[eligalilei]

Diagnosis vs Symptomatology as Guide to Treatment

OP:

It's a view within psychiatry that diagnoses are not that helpful and we should look at symptoms or symptom clusters and treat those. I don't share that view, but it is a view.

If you don't want medication then you likely don't want a long term therapeutic relationship with a prescriber.

You may need to see someone different to get the clear diagnosis that you want. Me:

In what way is this an insufficient perspective? There are for sure some clear clinical entities, but regardless of whether you call them 'symptom clusters' or 'diseases,' the world contains plenty of limit cases and statistical 'long tails.' This seems to be a way to deal with feeling like you're locked in to a particular set of solutions based on a term that might or might not fit the totality of the clinical presentation.

Regardless, someone is going to have to put something down for insurance at some point, so at the end of the day this all may be moot. OP: I feel that the major issue is that medications are tested against diagnoses. So eg throwing antidepressants against all low mood when they have only been tested against (episodic mood associated with fatiguability and anhedonia) mdd is not ideal. For instance for the chronic low mood associated with borderline, they either haven't been tested or possibly worse, they've been small scale tested and failed. Me:

As I said, there are relatively concrete disease entities; they can be seen to consist of possible sets of transformations of states which are defined in contrast. You're right, you can't just treat symptoms, but you can recognize continua and patterns from one state set in other presentations, and thus, even, treat aspects of a patient that don't fit with the clinical picture as a whole, but don't neatly fit into another diagnosis either.

Borderline is a particularly good example, since one can have borderline features in many senses, especially in crisis, and even view yourself through the lense of these criteria while in a crisis state, without necessarily meeting the five requisites. This could reason to give us pause in using, hypothetically, more activating meds in people who present with affective switching, or use an antimanic in someone who tends toward activation and psychotic intrusions, but doesn't meet duration criteria for BP. Possible cyclothymia with some borderline features would present as another point of connection between BP and BPD, for instance, and might merit consideration of a stabilizer on either side. Is this tested? No. But it's no more an unreasonable of a leap as that of assuming that another clinician took a good patient history that wasn't biased by the confounds of the particular moment and context of presentation. Btw, is the suggestion that BPD's instability is aggrivable by ADs? I could buy that. And, like, while we might be able to conceive of BPD as a distinct category... we have at least some biomarkers for TRD that suggest there's utilable subtypes in depression, some of which interlap with BPD (inflammatory cytokines, cortisol abnormalities) so even if BPD is distinct as a system of behaviours and states, options within the MDD formulary with antiinflammatory properties might be worth keeping on the table due to lack of options .

There's also, then, the issue of the repeatability of diagnosis, which, while not null, is sometimes questionable. By using the data from studies, you implicitly trust that some random guy (never the people doing the studies, not uncommonly a rushed ward doc with hundreds of patients) was able to render a sufficient picture of the patient so as to be actually rule out all other possible codings. Patholognomes don't always perform on command, some are probably even shy characteristically; yet others may prefer the stage of the ward, and be otherwise reclusive.

I doubt the brain has some quantitative gauge such that a system of affects becomes some totally new thing after a requisite time has passed symptomatic. And who is to say that one couldn't have MDD and BPD, if they are indeed semi-discrete entities. Or does the BPD eat the MDD?

Basically, I'm just saying you should look at the clinical picture as focused on relations between states and their possible factors, since that's more logical than a list of symptoms. The numbers on AD efficacy are already not so great. If you'll take a chance on giving someone a drug at all, you might as well take a chance on getting a treatment for them specifically, the nature of which is literally nothing you'll be able to discern from a study, though occasionally a case. I kind of think both sides of the aisle strawman each other, but at least the symptoms side has the advantage of appearing to acknowledge complexity and individuality, though it refuses the patient the sacrament of symbolic suture which is specification.

[faitsansorganes]

I like how when I first submitted my essay proposal my teacher was like "I wonder how much you're going to polemicize with modern psychiatry, it's a bold move so use literature if you do" and I thought mmmmm polemicizing with modern psychiatry, that sounds interesting and now it's a significant section of the essay (with literature ofc)

[counterintelligent]

I agree with your point(s), degenerative neurological conditions are often overlooked in research and deserve much more attention by the public and by research! Though, I would personally argue that Robin Williams was not necessarily misdiagnosed, as we are now learning that Lewy body diseases (PD, PDD, DLB) exists on a spectrum; these diseases are not clearly pathologically distinct and have significant variance in presentation that makes choosing one disease over another difficult if not a matter of nosology. It's my hope that further research and public awareness of Lewy body diseases continues to expand our understanding of the pathology and treatment of these diseases, as well as increase our empathy and understanding for those who deal with these difficult diseases. I hope that we come to a point where no one considers a Lewy body disease (or any neurodegenerative disease, really) a "death sentence".

This is an odd post but as someone who has been depressed and suicidal off and on since the age of 13, I don’t love the way people talk about Robin Williams’s suicide without acknowledging the fact he had an extremely aggressive form of dementia at the time he ended his life.

He fought depression and addiction for much of his adult life.

His suicide wasn’t because of the baseline depression he had battled, his brain was quite literally being destroyed at the time of his death. He was helplessly losing bits of himself, his memory, his physical abilities, he was aware, he could feel it and it frightened him. His death should make you angry, not because ‘suicide bad’ but because we are not doing enough to support people with degenerative neurological conditions, it should make you angry that he was misdiagnosed with Parkinson’s and therefore never knew what was happening to his mind.

Instead people make corny asinine posts on the anniversary of his death that say things like “The people that smile the most are often the saddest, check on your funny friends. 🥺” and go back to ignoring mental health for the rest of the year. Completely failing to acknowledge that his suicide wasn’t because he was ‘sad’ it was because he was experiencing one of the worst things a human can experience.

[transmutationisms]

i think when people talk about dsm diagnoses being 'destigmatised' it's usually the case that what they mean is the public perception of the diagnosis name (depression, anxiety, etc) has become associated with minor, temporary, or resolvable forms of distress. the experience of being so depressed you cannot get out of bed, or brush your teeth, or work -- that experience and those behaviours have never been 'destigmatised,' only associated with other diagnostic labels in certain discourses seeking to present 'depression' as treatable or minor. it's basically a semantic nosological shift, rather than any actual 'destigmatisation' of the behaviours psychiatry exists to pathologise -- widening (minimising) the diagnosis, then just moving any leftover 'scary' symptoms to a different diagnostic bucket. it's a rhetorical shell game that does not challenge, but exists symbiotically with, the ableism that causes behaviours like "not being able to get out of bed" to be stigmatised in the first place.

[sysmedsaresexist]

(A Shitty But Important) News Flash ⚡️

📣🚨📣🚨📣🚨

Record scratch

Stop now

Please read

Before we forge on, this is unfinished. I just couldn't get through it. This article upset me. Posting just for the link and my unfinished thoughts.

Put down your pitchforks and pick up your reading glasses, we've got a mutual enemy.

Explanatory hypotheses of the ecology of new clinical presentations of Dissociative Identity Disorders in youth

This was published in 2022 and... please tell me no one else knew this paper existed? How have I never seen it before? I feel cheated. I feel like I just found out there's mean girls talking about our communities behind our backs.

I'm kind of speechless. I've highlighted the important bits, read those.

Abstract

Dissociative Identity Disorders (DIDs) are controversial psychiatric conditions encountered in clinical practice and nosology. DID, as described in the international classifications, has little similarity with the clinical picture of “DID” met in current youth psychiatry. From this perspective, we hypothesize that this current clinical presentation does not satisfy the categorical criteria of the international classifications. Based on the two terminological challenges related to the definition of DID (i.e., the notion of dissociative disorders and the different meanings of the term identity), we propose to differentiate two distinct entities from each other. The first is medical and listed in diagnostic criteria of international classifications; the second comes from popular culture and refers to the vast majority of clinical presentations received in daily clinical practice—presented under the term Dissociative Identity Conditions (DIC).

Pause, because I need that to sink in.

We've been downgraded.

I say "we," as if I'm including myself in this "youth" group. This article will tell you that it cannot be applied to adults.

But despite the fact that I'm (very) old, and despite that it explicity says it can't be applied to me, it does.

I feel personally attacked, despite my journey ending long before this applied to me. This tells me there's a flaw somewhere.

Since the status of DIC is a hot topic in current clinical psychiatry, we aim to identify eight possible explanations that can be provided to support its occurrence: (1) impact of iatrogenicity;

I need to stop right there and just... bask for a moment.

This article is about to tell you that your knowledge of DID is so good that you EDUCATED yourself into having a fake form of it.

There's no going back. We forge on.

(2) factors of suggestibility and desire for social acceptability; (3) psychoanalytic explanations; (4) neuropsychological explanations; (5) socio-cognitive explanations; (6) emotional labeling; (7) narrative explanations; (8) and transient illnesses explanations.

Let's pause again.

Let's think very hard for a second.

In conclusion, we sustain that DIC results from a narrative interpretation of medical discourse by popular culture, developing in patients presenting undeniable distress. Such a transient disease fits in an ecological niche, which echoes the values of society, persisting under the action of a need for narrative continuity of the self.

[ghelgheli]

something that reading histories of the transgender child really solidified for me is how deep the pathological narrative of transness as an acute condition runs. doctrines of the body as developmentally plastic, with this plasticity fading over time, with puberty as the main punctuation of this decrease—and nosology of transness as something that demands treatment and correction, normalization, modification up to an end goal—these work together to 1) render the "late" (post-pubescent) transitioner a primitive relic of times we did not know or could not do better, something to be dreaded and avoided through the "right" "treatments" we have now, and 2) the trans child as a site of repair-through-plasticity, so that they grow up into an unmarked form that the ideologies of binary gendersex can be at ease with, so that their transness is transient as far as the public is concerned and, adding 1 to 2, so that adult transness disappears outside the clinic

[dansnotavampire]

reblog for sample size and also a cookie

[eligalilei]

ex tempore remarks on (self-)diagnosis and its critics

I wrote most of this up as a comment, but thought it might be worth reposting, since it seemed like a pertinent thing to add to the discussion. I imagine this will get hate, if the enthusiasm of the opposing 'argument' is any indication, but I felt it bore repeating.

Before you jump down my throat about using the word 'enjoyment’ (sive/cum *jouissance*, plastic, &c. + their concepts) in certain contexts… I'll say that all things that serve a psychological function are accompanied by some manner of satisfaction. No, no one has a diagnosis purely recreationally, but they serve a certain role in the constitution of identity psychologically: the constitution of both 'reasons' and ‘causes’ for experiences:, they 'explain' why one is different, and are the foci of communities which offer various sorts of support and camaraderie (nothing said of their more or less positively certain antinomes). So, in that(,) they take on a(/,) not unmelancholic,(/) set of positive emotional valences. Even anger serves to give a kind of enjoyment, if not in the same way as more positive emotions.

I think that these attacks on people who are independently exploring, or merely at the beginning of an undertaking of exploration of, diagnosis are an indicator of some things that are deeply problematic about the psychology and 'politics' of identity in communities built around mental health diagnoses.

What I think is interesting, is that,: while the presence, or perhaps even the mere existence, of 'fakers' and the 'self-diagnosed' (or even just the not-yet-diagnosed) is often decried, few provide any kind of actual reasoning for their being troubled by it, much less one that seems to justify the vitriol, and the need for it to be restated every few days.

Who cares if someone says something on the internet? Who cares if someone 'diagnoses themself? They aren't writing themselves scripts for antipsychotics, ffs (and, let’s all be frank: before c. aripiprazole… who the hell would?) And while there probably have been literal 'fakers' at times, the people doing that clearly have some kind of psychological or social issue (which may, in isolated instances, even be theirs!) and thus deserve our pity, care, and carefully differentiated compassion, not hate. How crazy do you have to be to want to be crazy, exactly? Is such a desire plausible,.. even and especially if its subject(ivities) are capable of bringing them voice?

…

If you can't explain why something bothers you, or the depth of your botherment, I think there's a good chance that the reasoned or plummable cause is might be something with which your conscious mind might not be comfortable, and thus might not be entirely reasonable. Ok, sure, you don't get behind the idea of self-diagnosis, or just the idea of internet diagnosis, but why treat it as something that's a threat to the community? And to treat it as that to the patient themselves, or, much less, that as pathology or nome itself… how hard is it just not to click on a post? (Or, hell… just not to freaking post… lookin’ at you, Jorpers..) … Problem easily avoided.

I feel like the issue has something to do with the way we see psychiatry as being a tiny bit like a church .. (to what extent? And, thatmentioned, some not at all, with their bloody inheritances… ) with True Knowledge being only available through the priest-doctor, as well as maybe envy of those who are able to question diagnosis, which is a kind of substitute satisfaction, or supplement to identity that allows one to excuse one's failings (which we must see as being 'truly real' and 'scientific' in order to be valid, science being the arbiter of truth in this day and age).

On some level, people might feel that if anyone can receive such an identity from oneself, that it undermines the feeling of Truth it gives them. One needs to be seen by one with Knowledge to Actually Have the identity; it's an excuse for failings that must be doled out by one with authority... (which is never yet still quite theirs). if anyone can get it, then it no longer feels as good or 'real' of an excuse, and it fails to be as good of a suture for the severance from the social order which is the illness itself.

Also, all in(/-)groups come with a kind of unconscious enjoyment one can derive from inscribing its borders, and their inscription: only done by exclusion and inclusion. The gaze of the doctor is the means by which this is accomplished, which gives it scienceyness, allows it not be our own acts of inclusion or disclusion, and therefore we're not mean, just being 'Scientific'.

I think that sometimes, the very fact that an explanation is bothersome, might even be a clue that it's in fact true, since the uncomfortable is what is disavowed/repressed into the unconscious, or, rather, never fully constructed in the conscious mind to begin with, and perhaps even learned by imitation.

Honestly, I think the very fact that there are all these weird gatekeeping posts could be an indication that something like what I'm saying is the case; people enjoy communally making borders, and kicking people out, and by placing the onus on psychiatry, this enjoyment can be disavowed. Furthermore, there is else sadly deserving of comment: the idea of allowing people to consider (cf.: etym., *’desire*, ‘divine’ [perhaps astrally…], or even scry,] their own diagnosis as undermining or deprivileging the role of the psychiatrist, thus undermining the psychological 'satisfaction' (or, perhaps more easily understood, the 'role') of diagnosis and/of identity… for themelves, others, or, most comically… médicos themselves.

[librarycards]

i keep seeing that bpd is a response to complex trauma, but i developed bpd symptoms before experiencing any trauma at all. i would say it was probably "diagnosable" in high school, even tho nothing traumatic had ever happened to me. isn't it possible that there are mental illnesses that just exist? just an unhappy mix of genetics and brain chemistry? bc antipsychiatry seems founded on the predicate that mental illness is a response to life lived, but that hasn't been my experience

this is a good question! i think there are a couple of things to note here.

i should have been more clear about what i meant by trauma, and probably not used the clinicizing add-on. i disagree with the psychiatric monopoly on what does and does not constitute trauma, especially 'capital T'.

given the above, i think that it is more reasonable to say that personality traits - both those that are understood as normative and those seen as pathological - develop as a result of our lived experiences, traumas (quotidian and significant), relationships, and - i mean, maybe genetics, but i'm agnostic on the role of 'biology'.

i think that there is also space for the ineffable here. things that develop out of nowhere, for no discernable reason. part of the project of medicine/psychiatry is to name and "confirm" not only what it defines as problems but also their respective etiologies, hence the fixation with biology, life experiences, etc. as "creating" certain diagnoses.

so...

with all of this in mind, i think you have a few options. you don't have to identify with the diagnosis of bpd at all. you can use it as a way to contextualize the way you experience the world, with or without recourse to particular life experiences or perceived genetic antecedents. you can use it strategically to find support and abandon it otherwise. you can mix these up or imagine something else entirely.

i think what's important to remember here is that bpd, like any dx (especially PD dx's) are shorthands used to describe a collection of traits that a group of people seem to share. you are you before you are someone who has been marked as having bpd, and your personality is your personality regardless of what it's called, or if it's identified as somehow deviant. antipsychiatry doesn't mean that you need to find "organic" experiences that correlate 1:1 with pathologized traits, but instead to free yourself from the nosological impulse to find a concrete reason, definition, and reaction to everything you do/are.

tl;dr: you're you. you have traits associated with the contemporary diagnosis of bpd. what matters isn't so much "why," but what you do next.

[whencyclopedia]

Germ Theory

The Germ Theory, which emerged in the late 19th century, demonstrated that microscopic germs caused most human infectious diseases. The germs involved included bacteria, viruses, fungi, protozoa, and prions. Louis Pasteur (1822-1895), a French chemist and microbiologist, and Robert Koch (1843-1910), a German physician and microbiologist, are credited with the discovery of the germ theory in the 1860s-1880s.

Regarded as the most important discovery in the history of medicine, the germ theory challenged the medical profession to reevaluate how disease was thought about, offered possibilities for both the prevention and treatment of disease, as well as the discovery and implementation of new technologies to combat disease.

Previously, doctors assumed that disease was an internal process of the human body especially Hippocrates' long-standing four humors theory notion that excesses or deficiencies of four bodily fluids (blood, phlegm, yellow and black biles) led to illness and disease. The germ theory contradicted that idea by separating the disease from the afflicted persons. Furthermore, the new theory ushered in a regimented way of classifying diseases (nosology) according to the type of microorganisms causing the disease.

Historical Theories of Disease

Prior to the discovery of the germ theory, various theories were advanced as possible explanations for illness and disease in humans. The earliest theory was the miasma theory attributed to Hippocrates (460-370 BCE), a Greek physician. Derived from the Greek word meaning pollution or "bad air", the miasma theory suggested that decomposing particles from organic materials, plants or animals, poisoned the air. Although easily detected by smell, people who inhaled the "bad air" would become ill. Additionally, planetary movements, disturbances to the Earth, poor hygiene, and polluted water often contributed to miasma. Attempts to remove waste along with cleanliness were thought necessary to improve the atmosphere to avoid infection and disease.

Aristotle (384-322 BCE), a Greek philosopher, offered the spontaneous generation of disease. It was possible, Aristotle thought, for living organisms to spring from non-living matter. Furthermore, this process, like maggots appearing from dead flesh, was a regular and natural phenomenon.

Galen (129-216 CE), a Roman physician, extended Hippocrates' earlier speculation about the imbalance of bodily fluids as the cause of disease. Galen attached each of the four humors to a particular season characterized by hot, cold, dry, and wet. For example, colds and flues occurred most often during cold and wet weather. Any change in the weather or season could upset the balance of the four humors so treatments were devised to restore said balance e.g., purges, bloodletting, enemas, and vomits. These ancient theories dominated Western medical thinking about illness until the 19th century.

Another theory of the origin of diseases referred to supernatural causes. A person's sins resulted in contracting a disease or illness as a punishment from the gods or God. Ghosts, demons, and evil spirits also possessed the ability to afflict a person with illness. Magic, divination, spells, exorcism, and various drugs were used to diagnose and treat illness. It fell to a variety of healers – shamans, priests, diviners, medicine men – to drive away the evil spirits. Illness as a punishment for sins, as well as a test of faith, was later offered by Christian theologians as an explanation for disease.

Additional theories on the origin of diseases continued to emerge. Girolamo Fracastoro (1476-1553), an Italian physician, is credited with first using the word "contagion" when describing the transmission of illness. His "seeds of disease" theory argued that disease could be spread by direct or indirect contact or over long distances through no contact at all. A German chemist, Justus von Liebig (1803-1873), one of the early founders of organic chemistry, suggested that as a result of a chemical process from decaying organic matter, disease simply emerged in the blood (the body's "chemical factory").

Continue reading...

[brazenautomaton]

>what is the master list of things that mark your argument as being wrong 100% of the time - David Stove's "What's Wrong with Our Thoughts?" is relevant here. It's hard to build a nosology of thought - there's one correct way to reason, many wrong ones, one good move in chess, many bad ones, etc. you can't simply say "this chess move has X feature, therefore it's bad" unless X is very specific and context-dependent, and even then there will be edge cases where it's the best move. Stick to 90%.

no.

there are many more potential arguments than chess moves, and therefore, many more situations where X is always bad furthermore arguments have semantic content and not just board position. a chess move is only a chess move and thus analyzed strictly in terms of winning a chess game. it is possible for a chess move to be disadvantageous but not possible for it to have invalid reasoning.

I am very confident in saying that anyone who is cornered on their use of a word who then starts to talk about linguistic prescriptivism is wrong, because what is happening there is that they used a word in a way nobody else understood it, proceeded to say "no my definition is correct you can't be a prescriptivist," and are ignoring the idea that words exist to communicate meaning and are no longer concerned with communicating meaning. if you are making a valid argument elsewhere, it has nothing to do with this argument you're making because this one is wrong and can't support anything else.

"bread and circuses" is an incoherent concept. it refers to something that doesn't exist and makes no sense. if you cite a thing that doesn't exist and makes no sense as support for your argument, your argument is wrong. if you're making a valid argument elsewhere, it has nothing to do with this one, because this one is wrong.

[transmutationisms]

& more broadly it just comes down to like. why is it apparently soooo tempting to decribe any like, pleasurable or compulsive or unwanted habit as an addiction, and what do we mean by that. often there's an assumption that invoking a word used in clinical context means having recourse to a specific, defined, observed biological disease state but ofc this is often not true and is never true where psychiatric nosology is concerned. so when you say that [eating disorders / BFRBs / whatever] are addictive or are addictions, really you're just defining compulsion and addiction in reference to one another and trying simultaneously to use each to legitimate the other. it's silly at best and more likely to resurface in clinical efforts to limit patient autonomy than anything else

[obfuscated-abstract]

Title: Diagnosis and management of functional neurological disorder

Date: January 2022 Published in: The BMJ Publicly available? It is now.

Citation: Aybek, S., & Perez, D. L. (2022). Diagnosis and management of functional neurological disorder. BMJ, 376. https://doi.org/10.1136/bmj.o64

Full text (including figures and tables)

Abbreviations:

CBT: cognitive behavioural therapy

DMS-5: Diagnostic and Statistical Manual of Mental Disorders 5th Edition

FND: functional neurological disorder

ICD: International Classification of Diseases

Article Summary

Abstract

Introduction

Historical background:

Describes historical context and explains the current state of research around FND

Nosological classification:

FND is classified as 'conversion disorder/functional neurological symptom disorder' in the DMS-5 and as 'dissociative neurological symptom disorder' in the ICD. The variability in classification causes problems.

Aims of this review:

To highlight relevant literature that express the importance of multi- and interdisciplinary approaches to the care of FND patients

To present evidence to healthcare professionals that will allow them to better diagnose and treat FND patients

Incidence and prevalence of FND

FND is a frequent and disabling condition affecting young people and it often has a poor prognosis. This section also presents specific numbers for the prevalence of different subtypes of FND.

Sources and selection criteria:

Details how the studies were found and selected for the review.

Diagnosis of FND

Criterion A from the DSM-5 requires 'one or more symptoms of altered voluntary motor or sensory function'. Patients can be divided into two broad categories: negative symptoms (lack of movement, weakness) or positive symptoms (abnormal movement such as tremor, jerks, dystonia, etc). Symptoms can also resemble epileptic seizures.

Criterion B from the DSM-5 requires that 'clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions'. A rule-in diagnosis can be made by evaluating postive signs that distinguish FND from other medical conditions.

Highlights the importance of explaining how the diagnosis was reached.

Highlights the signs of motor FND, and seizure type FND that a healthcare professional should look for to make a diagnosis

Criterion C from the DSM-5 requires that 'the symptom or deficit is not better explained by another medical or mental (health) disorder.' Highlights that a patient can have FND and a comorbid neurological condition. Suggests further testing that can be done to clarify a diagnosis.

Criterion D from the DSM-5 requires that 'the symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.' States that the fact that a patient is seeking medical attention shows that the symptoms have a significant impact on daily activities.

Explains the impact symptoms tend to have on quality of life.

Provides recommendations for what language to use and not to use to avoid stigmatising the condition and making a patient feel invalidated.

Treatments

Treatment is extremely variable and should be individualised.

Research is limited but communicating the diagnosis appears to show some reduction in emergency room visits and inpatient hospitalisations for seizure type FND

Psychoeducation can have a positive effect but does not positively affect recovery without other treatment options

Physiotherapy is a first line treatment but more research is needed to optimise and personalise its use. Recent advancements are detailed.

Psychotherapy: The use of CBT (on its own and in combination with other treatments) continues to be examined and shows mixed results.

Psychopharmacology: SSRI and SNRI medications can be used to treat concurrent mental health symptoms but not directly to treat FND.

Emerging treatments

Psychotherapy treatments being evaluated include mindfulness based therapy, prolonged exposure, psychodynamic psychotherapy, group psychotherapy (including dialectical behavioural therapy), and hypnosis.

Other treatments being explored are the use of botulinum neurotoxin to manage motor symptoms, transcranial megnetic stimulation, therapeutic sedation, placebo, and other management strategies.

Mental health concerns (depression, anxiety, post-traumatic stress disorder, etc.) and non-motor phsyical symptoms (pain, fatigue, dizziness, cognitive symptoms, etc.) often co-occur with FND and can increase the severity of FND symptoms

Guidelines

Conclusion

[oleandersbertamendez]

The Moon' paragraphy nosology deflects counsciouness, and advert the rest of its mind to a sense of passangers of aisles; in which its intended the solar system to manner a replica, just by moving ecuations and making present he breaktrought of time.

What is the purpose of light in ilumination?

[mailorderfictionalcharacter]

Anxious, Agitated, & Mixed Depressions; Dysphoric/Mixed Hypo/manias

Things I’ve been reading recently. Standard does not equal endorsement not a professional not uncritical of what diagnostic labels are doing disclaimers.

Anxious Depression &/vs Agitated Depression

Anxiety vs Mania - How To Tell the Difference (video, Tracey Marks)

Activated Depression: Mixed Bipolar Disorder or Agitated Unipolar Depression? (Available on Sci Hub)

MDD with Mixed Features vs Mixed Hypo/mania

How to Diagnose Mixed Features Without Overdiagnosing Bipolar (Psychiatric Times) 

Mixed features are common in practice but poorly described in DSM. They are caused by the overlap of depressive and manic symptoms, but it’s hard to understand them by reading separate descriptions of these two states. It would be like trying to imagine green by studying yellow and blue.

Exploring Diagnostic Strategies in the Assessment of Mixed Affective States (Psychiatric Times)

Although there is room for improvement, at least the new DSM-5 classification system has helped to identify more patients suffering from mixed states compared with previous nosology because of broadening the DSM-IV-TR criteria.15 For example, in one study, patients previously diagnosed with bipolar disorder were examined when they were having a manic or hypomanic episode, and mixed features were detected in 20.4% during the episode using the DSM-5 criteria; however, using the DSM-IV-TR criteria, only 12.9% of the patients had a mixed episode, showing what appears to be a lower degree of sensitivity toward mixed affective states.

Wired and Tired: Untangling a Bipolar Mood Episode with “Mixed Features” (Brooke Baron, bphope, blog post)

Then there are times when I feel quite worthless and depressed. I have no energy; I feel sluggish and isolated. Simple tasks become mountainous—even basic hygiene and eating practices. I have no bandwidth for anything.But I can’t sleep, because inside my mind there’s a grand finale fireworks display of thoughts. Some of them are about the past, some are about the future, and some are vivid ruminations about horribly tragic accidents happening to my loved ones—complete with unspeakable graphic imagery and a racing heartbeat. Intrusive thoughts, much?

Activated Depression: Mixed Bipolar Disorder or Agitated Unipolar Depression? (Available on Sci Hub, linked above)

Mixed/Dysphoric Hypo/mania

Exploring Diagnostic Strategies in the Assessment of Mixed Affective States (Psychiatric Times, linked above)

What It's Like to Experience Mixed Episodes With Bipolar Disorder (Personal essay, The Mighty)

I blast music in my car, in my ears, in my room, just to try to drown out half of the thoughts and slow down the stream. It helps sometimes. I don’t sleep much because the mania part doesn’t let me and because the thoughts keep me up late. I dream more during this period than at any other time because my brain won’t rest, even if I am sleeping. I can start a sentence off crying and be laughing by the end, the early tears still streaming down my cheeks... I want people to know what these feel like. Over the years, I have found myself frantically searching the web for others’ descriptions of their mixed episodes, and found material sadly lacking. 

How My Experience With Dysphoric Mania Led to a Psychiatric Hospitalization (The Mighty, personal essay) Note: author did not find experience traumatizing, discussion of non-consensual institutionalization.

I was super depressed at moments — couldn’t get out of bed, didn’t want to go to work. And then wildly hyper at other moments — waking up at 2 a.m. and deciding to make macaroni and cheese, cleaning the house in the middle of the night. My mind was filled with intrusive thoughts of self-harm and suicidal ideation.

What is Mixed Mania and How Do We Treat It? (Tracey Marks, video)

Dysphoric Mania Is Not 'Fun' (Mel Herbert, The Mighty, personal essay, archive link)

Because all of that energy that comes with mania does not come out in the happy-go-lucky way of euphoric mania, but rather as rage. Pure, blinding rage. I often describe this anger as being so immense I want to slice myself open and crawl out of my own body. Not in a way of self-harm, but to escape the anger inside of me. The anger I experience in these times is physically painful, to the point where I lie in bed and writhe because I’m not an angry person, and I need some way to escape this all-consuming rage.

What is a Mixed Episode? (Julie A. Fast, bphope)

During a mixed episode, I am abnormally restless and can’t settle down. I will pace, drive for hours, sit down and stand up, pick at my fingernails, drive too fast, yell at people, wonder why the world is such an ugly place, hate my life and hate people as well.

Welcome to My Dysphoric Manic World (Julie A. Fast, bphope blog post)

Everything is wrong. People are stupid. The government is stupid. The world is stupid. There is a desire to get away in order to feel better.