tag:blogger.com,1999:blog-26666124.post2264842027970649086..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: Taxing TaxonomyUnknownnoreply@blogger.comBlogger8125tag:blogger.com,1999:blog-26666124.post-35081354562114040212007-04-06T22:35:00.000-04:002007-04-06T22:35:00.000-04:00Clink: I found four, each of which (I'm still impr...Clink: I found four, each of which (I'm still impressed by this!) aligned very closely with exactly one of the four proposed self-injury disorders in the literature.<BR/><BR/>I didn't ask about about ingestion of cell phones or other non-food objects, though. IMHO it's tough to separate that from factitious disorder...<BR/><BR/>And yes, I have a lot of brains in my fuzzy little head. But, you know, size doesn't matter ;)Gerbilhttps://www.blogger.com/profile/05908487212760713496noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-78896159117014998842007-04-06T15:23:00.000-04:002007-04-06T15:23:00.000-04:00I talked to that guy on the phone recently (Dr. Re...I talked to that guy on the phone recently (Dr. Regier)...does that make me famous??? (please, please)<BR/><BR/>MWWAK, I know you asked Clink, I'm just chiming in here. <BR/>Time limit? The world starts expecting you to move on after 6 months. Seems to me that people start to feel better around 18 months, maybe. Often, if you ask, people are still grieving for years and years. That's not normal, but it is. What's normal? Oh, never mind. Usually the sleep and appetite issues resolve in a year, how's that. It's not unusual for people in non-patient populations to drop a fair amount of weight after a major loss. The short answer: No Time Absolute Time Limit. How do you tell the difference: I'm still working on it. In Grief, people don't have lowered self-esteem, don't think they're a bad person, and any guilt is focused (...I should have brought him to the hospital sooner, should have done such and such, but not I'm the cause of world war II), and resolves with time. <BR/><BR/>Suicidality is never normal.<BR/><BR/>You're better off over-referring then under-referring. It's not the end of the world to talk to a shrink for a few sessions even if one doesn't have a mental illness but is merely grieving. Clink can disagree if she wants.<BR/><BR/>I used to think people got offended when their docs told them to see a shrink-- lately I'm struck by how many referred patients express gratitude that their primary care doc got them hooked in with some help.<BR/><BR/>Roy: why does increasing endothelium on vascular walls increase neuronal growth? Someone please send me back to med school...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-17173535069939604482007-04-06T11:14:00.000-04:002007-04-06T11:14:00.000-04:00clink: Yeah, the NYT article seemed to imply that...clink: Yeah, the NYT article seemed to imply that people who aren't depressed are being labled with and treated for depression (although I agree with Dinah, these people aren't being bludgeoned on the street and pulled into shrinks' offices and then treated for depression against their wills; but sometimes they're being referred by their obstetrician a few months into the aftermath of a perinatal loss or after their gynecologist (who they saw for poor sleep or lack of libido) becomes suspicious that they're actually depressed 6 months after a divorce). <BR/><BR/>The psychiatrist on talk of the nation(Regier, maybe, was his name), made the point about treating depression on the basis of severity not on the basis of whether or not someone's also grieving. Link: <A> http://www.npr.org/blogs/<BR/>talk/index.html </A> (Blog of the Nation, the blog of NPR's Talk of the Nation; the piece is about halfway down the page). It also seems to me that part of the problem that the study probably correctly points out is the use of screening checklists. Even in gynecology, actually taking a sexual history is much better than just using those forms that patients fill out. <BR/><BR/>Just out of curiousity, is there a time limit at which grieiving should be done and depression begins? And can't loss/stress precipitate the first episode of a major depression? And how do you tell the difference? (I'm really just curious, I'm going to continue to try to send these women to my shrinky colleagues.)Midwife with a Knifehttps://www.blogger.com/profile/04309579302399381913noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-8503267081692506142007-04-06T08:34:00.000-04:002007-04-06T08:34:00.000-04:00There is a difference between sadness and depressi...There is a difference between sadness and depression. One can still do daily chores, even if crying while driving to the grocery store. Depression keeps that same person from making a grocery list. Do meds help the person going through grief? I am sure of it. Bereavement is not handled the same as it was in our parent's generation. We live in a World where many people now believe that there is no time for grief. "Get on with your life". Our World is fast paced and it is hard enough for anyone to have a relaxing and rejuvenating vacation, much less take time to work through grief or loss. <BR/>And of course, where past generation's have worked through their loss emotionally, our generation and the younger ones grieve through lawsuits and the pursuit of a monetary amount that will replace the pain.<BR/>This is not meant to be negative--just more reality based of now. so, yes, I think meds along with therapy help.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-31219736356540308922007-04-06T06:15:00.000-04:002007-04-06T06:15:00.000-04:00MWAK: I'm with you. Just getting through the six c...MWAK: I'm with you. Just getting through the six continuum section was a labor (pardon the pun) much less the section where they interpret each medical modical using them. It's no wonder it took two years for this article to get published. The NYT article implied that people were being misdiagnosed and/or improperly treated but that wasn't the point of the Arch Gen Psych article really.<BR/><BR/>Gerbil: So many brains in such a little furry rodent! How many classifications are there? I bet I've seen them all. Especially the category where they swallow their cell piece by piece.<BR/><BR/>Dinah: Thanks that's sweet. One of the factors they compared was 'service use' which I take to mean intensity of treatment or type of treatment, something like that. So yeah, it's a self-defining group that probably does select out for more severe reactions/symptoms.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-13603746010745075292007-04-05T23:21:00.000-04:002007-04-05T23:21:00.000-04:00What a great synthesis, you are one amazing ClinkS...What a great synthesis, you are one amazing ClinkShink!<BR/><BR/>With regard to MWWAK's question: my read on the article was that Major Depression is overdiagnosed and overtreated in people who are "merely" having normal reactions (e.g. Sadness) to tough circumstances.<BR/><BR/>It's often a touch question and for myself, I've come to this conclusion-- Sadness and assorted symptoms are a normal response to loss. The normal response to loss, however, is to grieve, to lean on friends, to know that such suffering is a normal response. the normal response to loss is not to go to a psychiatrist. By the time someone wanders in to see me, it's because everyone else is saying their grief has gone on too long, the suffering is not letting up, they should be doing better. Psychotherapy can be very comforting and very powerful (and diagnostically, we can call this Adjustment Disorder, with depressed mood, if you'd like). But if someone comes in after a loss, meeting criteria for depression, and asking for medication (and yes, they ask, and no, I don't knock on their doors), that too can be very helpful. Though admittedly, I've had people get a lot better with very very low doses of meds, a handful of sessions, and that all powerful healer: Time.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-71494186873336247662007-04-05T22:46:00.000-04:002007-04-05T22:46:00.000-04:00Oh my god, you have unleashed SUPER DORK GERBIL. T...Oh my god, you have unleashed SUPER DORK GERBIL. The question of diagnostic category vs. continuum has almost aphrodisiac qualities for me.<BR/><BR/>Soooo... who wants to read my dissertation on mathematically-derived classifications of deliberate self-harm? ;)Gerbilhttps://www.blogger.com/profile/05908487212760713496noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-17600052626670792132007-04-05T22:30:00.000-04:002007-04-05T22:30:00.000-04:00Six dimensions seems like a lot. Yet another reas...Six dimensions seems like a lot. Yet another reason why I'm an obstetrician. All of our decisions (and most of our diagnoses) are dichotomous: deliver now, deliver later. Pregnant or not pregnant. Baby good or baby bad. Sick or not sick. Deliver vaginally or deliver by c-section. I'm not really smart enough for a decision tree with more than two branches! ;) What if they invented a whole new diagnostic paradigm, would everybody go along with it?<BR/><BR/>Then I was wondering about the nyt article; and I listened to a little piece on npr about it. I'm trying to figure out if they're saying that fewer people should be treated because people who are bereaved are being incorrectly diagnosed and/or not distinguished from the "real" depressed; or are they saying that rather than base treatment decisions on whether or not someone's had a recent loss, treatment decisions should be based on the severity of symptoms (i.e. someone with moderate to severe symptoms) should be treated whether or not they are recently bereaved, because bereavement behaves like depression.<BR/><BR/>I suppose I should go onto Pubmed and try to read the paper.<BR/><BR/>(and, by the way, you are a good one!)Midwife with a Knifehttps://www.blogger.com/profile/04309579302399381913noreply@blogger.com