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OfflineLiquidSmoke
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Approaches to Psychiatric Diagnosis
    #7563975 - 10/26/07 05:04 PM (16 years, 6 months ago)

Since it's been an ongoing issue of debate, i'll post basically, the highlights of the lecture given to medical schools on the process and challenges of psychiatric diagnosis.

I know there's alot to read here, but it will help shed new light on how alot of issues in psychiatry are approached.

People on these boards have accused Medical Institutes of simply supporting the advents of psychiatric diagnosis, when many fail to realize that THE MOST CRITICAL perspectives on this issue is directly FROM the psychiatrists.

Quote:



Introduction to Psychiatric Diagnosis

Necessity of Diagnosis
-Simplify our thinking and reduce the complexity of the field
-Facilitate communcation between clinicians and the insurance and legal systems
-Assess need for services
-Predict Outcome
-Plan Treatment
-Promote research into pathophysiology and etiology of illnesses

Challenges of Diagnosis
-Although we have learnt a great deal about the neural mechanisms underlying normal and abnormal psychological function in the last 50 years, we do not understand specific etiologies and do not have specific laboratory diagnostic tests
-Our ability to elicit and measure the many nuanced symptoms and signs of psychiatric disorder is limited by the complexity of psychological experience.
-An interview approach is the primary means to making a diagnosis, rather than using objective tests.

Compensation of Challenges with Psych. Diagnosis
-We must take detailed histories and pay special attention to developing rapport and empathy with the patient. We have developed many symptom checklists and rating scales to supplement the detailed history taking.
-We observe the patients' symptoms over time and more frequently than required by other physicians who do not deal with these difficulties
-We must pay special attention to the personal history of the patient and developmental norms in a population in an attempt to distinguish the normal from the abnormal
-We must use detailed diagnostic criteria in order to improve reliability and validity of our diagnostic constructs - (Leading to the advent of the DSM)


Hierarchical approach to differential diagnosis

-Disorders that are due to a known cause preempt those whose cause is not well known. More pervasive disorders preempt less pervasice ones. Although recent tests have downplayed the importance of this principle, it is a usefull principle to follow in attempting to master the skill of psychiatric diagnosis


(here's where it starts getting interesting)

Advantages and Disadvantages of current Diagnostic system

Advantages
-Facilitation of differential diagnosis
-Improved reliability - capacity of two observers to agree on what they see

Disadvantages
-Questions of validity - capacity to make useful predictions i.e. ability to predict prognosis, outcome, response to treatment and ultimately etiology
-Validity may have been sacrificed by the DSM calissification in the search to improve reliability - "We may be precisely measuring something that is not worth measuring at all"
-False sense of certainty to inexperienced clinician because everything seems so definitive. May encourage clinicians to treat diagnosis as a mere checklist and not recognize the patient as a person


Caveat to take with you
-DSM criteria are provisional agreements arrived at by a group of experts, selection of signs & symptoms are relatively arbitrary and based upon clinical experience and field trials - they are useful tools and one should have a healthy sense of skepticism in applying the diagnostic criteria







Hope this helps


--------------------
"Shmokin' weed, Shmokin' wizz, doin' coke, drinkin' beers.  Drinkin' beers beers beers, rollin' fatties, smokin' blunts.  Who smokes tha blunts?  We smoke the blunts" - Jay and Silent Bob strike Back

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InvisibleMushmanTheManic
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Re: Approaches to Psychiatric Diagnosis [Re: LiquidSmoke]
    #7564525 - 10/26/07 07:54 PM (16 years, 6 months ago)

They forgot to mention that a large amount of psychiatrists are not trained to make diagnoses. Kind of hard to make an accurate diagnosis based purely off the DSM and some tests, especially when it comes to the mood disorders.

I have know a lot of people that have been diagnosed with a psychiatric disorder, only to learn years later that they have a general medical condition that is the real cause of their symptoms. (Hypothyroidism, metabolic disorders, etc.)

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OfflineSneezingPenis
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Re: Approaches to Psychiatric Diagnosis [Re: LiquidSmoke]
    #7565089 - 10/26/07 10:49 PM (16 years, 6 months ago)

thanks for posting that paper. It is refreshing to see that the psychiatric community admits some of its faults...

but.... here are some problems that I would like to see the psychiatric community address.
1) They are for giving children mind altering drugs. Which I see absolutely no justification for, especially at ages like 5 years old, when minds and brains are still developing.
2) in giving drugs to children, they take the theory that some mental problem is biological, and create a true physiological problem by precribing these drugs to a developing human being.
What would the real medical field say about giving a 5 year old cocaine every day until they were 16?
and I know ritalin and the ilk arent cocaine, but it is an amphetamine salt that works in almost the exact same way.... also, since you are a pharmacology student, Im sure you know that methamphetamines are only a methyl group away from amphetamines, and the methyl group is merely a structure which allows the drug to be absorbed much quicker.
3) if the psychiatric community realizes that kids are overprescribed, realize that many of their methods and studies are inherently flawed, realize that misdiagnosis is rampant... what have they done to ensure that this doesnt happen beyond talking about it?
I think the entire field needs to take a step back, and restructure itself and rethink its role in our society, because IMO, and many other peoples opinions, psychiatry does far more harm than it does help.
4) I will try to find it again, but there was a paper that I quoted in a thread somewhere about how it is a disincentive for psychiatrists to give psychotherapy over prescribing drugs.... so basically, psychiatrists have become nothing more than faulty diagnosis machines with Rx pads.... imagine if the entire field of medicine became condensed to going to see a person to tell you which drug you can/should buy.
5) mental abberation, and mental abnormality.... where do I begin... the APA needs to decide whether or not it is trying to define sanity within the context of our society, or whether it is actually trying to define it for all humans. I believe the latter to be impossible, and the former to be "designing society".
1 in 4 people.... that is what most websites as well as the APA will tell you.... that 1 in 4 people have some psychological disorder.
How is that possible? that isnt an abberation, that isnt an abnormality.... that is pandemic. 25% of the worlds population is mentally ill?
I think they need to rethink that one.... it isnt possible.
6) the false data that psychiatrists tell people, as well as the advertisments telling people if they "feel this way" then they have "this disease" is basically fear mongering. Basically, the entire field of psychiatry is to blame for people having mania, anxiety... their methods and "labelling" of everything has created not only personal justifications for poor behaviour and personal flaws, but given people an avenue to take drugs and slip into being "comfortably numb" or just plain drug induced apathy.
Psychiatry begats psychiatry.... has psychiatry ever done a study on the psychoogical impact that psychatry has had on society? that would be interesting.

and I could go on and on with line items , but those are the ones relevant to this discussion.

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OfflineSneezingPenis
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Re: Approaches to Psychiatric Diagnosis [Re: SneezingPenis]
    #7565112 - 10/26/07 10:58 PM (16 years, 6 months ago)

also....

how do you treat someone with psychotherapy that doesnt believe in psychotherapy?
seems like you have to believe in it, for it to work.
"you are smothering your inner child"
"doc, I got no inner child"
"yes you do, and stop smothering it"
psychiatry leads people to believe that they are in fact complex individuals for just having some "complex" (see how that works? it is effortless on my part). It satiates the ego to believe that you are somehow more complex than everyone else, like you are such a genius that all your thoughts are too much for anyone to handle, let alone yourself.
granted, there is some merit in just letting people talk it out... but that is hardly scientific.

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OfflineSneezingPenis
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Re: Approaches to Psychiatric Diagnosis [Re: SneezingPenis]
    #7565132 - 10/26/07 11:06 PM (16 years, 6 months ago)

7)
Quote:

In 1800 the number of individuals in asylums in all of England and France was only in the low hundreds.[34] By the late 1890s and early 1900s this number skyrocketed to the hundreds of thousands.[34] The United States housed 150,000 patients in mental hospitals by 1904.[34] German speaking countries housed more than 400 public and private sector asylums.[34] These asylums were critical to the evolution of psychiatry as they provided a universal platform of practice throughout the world.[




all psychiatry has to do is raise the bar of sanity. if they say that by waking up every morning is insane, then they have just taken everyone in as a psychiatric patient.
I dont see how in anyway that sanity can be objectively defined. granted, they have now reached the point that probably 1 in 2 people will have some interaction with a psychiatrist (or their drugs) on a professional level. see, they realized as a whole, that they couldnt make any money or gain any influence/power if they treated the "really bat shit crazy people".... the ones who are truly abnormal by anyones definition... so they had to make names for personality traits or actions or thoughts that people have, which sounded scientific, and say, if you exhibit any of these things, you are insane and need to come in and see us.

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OfflineLiquidSmoke
My title's cooler than yours DBK


Registered: 09/04/01
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Re: Approaches to Psychiatric Diagnosis [Re: SneezingPenis]
    #7565201 - 10/26/07 11:34 PM (16 years, 6 months ago)

So is there anything in the notes you found interesting?


--------------------
"Shmokin' weed, Shmokin' wizz, doin' coke, drinkin' beers.  Drinkin' beers beers beers, rollin' fatties, smokin' blunts.  Who smokes tha blunts?  We smoke the blunts" - Jay and Silent Bob strike Back

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InvisibleLand_Crab
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Re: Approaches to Psychiatric Diagnosis [Re: SneezingPenis]
    #7565866 - 10/27/07 05:44 AM (16 years, 6 months ago)

YawningAnus, it's too late for me to address your comments properly and completely, but to ferret out the point of contention I agree with the most:
(In America) we have come to rely *almost* exclusively on the "medical" or "disease" model of mental disorders. OK, now this is way fucking better than previous models, such as the supernatural model (demonic possession) and the moral model (you're depressed because you're weak) -- and the medical model is accurate, to a point. But to rely on it to the exclusion of the cognitive, behavioral, psychodynamic, sociocultural (and other major) fields of psychology is irresponsible to say the least...

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Offlinekriminalelement
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Re: Approaches to Psychiatric Diagnosis [Re: Land_Crab]
    #7567789 - 10/27/07 07:48 PM (16 years, 6 months ago)

Some children are even being given drugs at the age of 18 months for attention disorders, which I read about in the Dallas Morning News a few months ago and couldn't find a link to.

The effects psychiatry has on society:

This is anecdotal but very telling. I was sent to a psychiatrist at the age of 8. My father was insane. He screamed ALL THE TIME. About everything. He threw things around the house. He actually tried to choke me. And he only targeted me, not my mother or my sister. He had severe Obsessive compulsive disorder and could not control himself in any way. This started when I was around seven, and I became very withdrawn, nervous, and constantly afraid. Things got so bad that my FIVE YEAR OLD sister actually managed to call social services. I started to develop OCD as well. At one point I thought death was living in my pool drain, and I had to do rituals to keep him away. I was always, always terrified, and I thought that I was at fault for my father's violence and emotional instability.

My father also refused to believe his actions were that of a man who was not well in the head. He didn't want to take psychiatric drugs or see a therapist. So I went to the therapist, and the psychiatrist told my mother that I didn't have a disorder, I was just anxious because I had an abusive father. Desperate to alleviate my obvious suffering and not willing to get a divorce, my mother thought it was best to try prozac. On an 8 year old.

Needless to say, I went nuts. I became manic and frantic and never slept. I wouldn't stop talking. I became very irritable. Drugs are NOT meant for 8 year olds. I am convinced if I had simply been removed from my father I would have gotten better. Instead, I spent the rest of my adolescence in therapy.

My time in psychiatry made me feel that I was the person at fault in my family for everything that had gone wrong. Because I was at a doctor's, I felt that I was ill and that my illness was ripping apart my family. I also learned that taking a pill will end all of your internal mental issues. This is not a good lesson to learn.

Now I am twenty one and I am addicted to xanax. I went through a serious personal crisis a year ago and was panicking constantly. I went to a very reputable and expensive doctor. After speaking with me for FIVE MINUTES he prescribed me 4 mg of xanax every day, 150 mg of wellbutrin, 90 mg of buspar, and a sleeping pill called rozeram. Now I am trying to get off the xanax.

Psychiatrists are the scum of the earth. Especially those that deal with pediatric cases. Children don't have an option when it comes to taking drugs that they are force fed.

FORCING PEOPLE TO TAKE DRUGS has caused a sort of mental fascism in our society. People are forced from a young age to feel a certain way. They are drugged and conditioned to behave "correctly" under the influence of mind altering substances. After I successfully clean up from xanax I will never speak to a psychiatrist again.


--------------------
While there is a lower class, I am in it
While there is a criminal element, I am of it
While there is a soul in prison, I am not free.

Eugene V Debs

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InvisibleLand_Crab
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Re: Approaches to Psychiatric Diagnosis [Re: kriminalelement]
    #7568792 - 10/28/07 04:51 AM (16 years, 6 months ago)

Quote:

kriminalelement said: After I successfully clean up from xanax I will never speak to a psychiatrist again.



How about a psychologist or a therapist? (No drugs -- just talking)

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