Posted by SLS on December 2, 2000, at 7:59:42
In reply to Re: negative symptoms, posted by JohnL on December 1, 2000, at 5:25:22
> I think though that there is considerable overlap between this form of schizophrenia, depression, dysthymia, bipolar, social anxiety, etc. Though doctors attempt to draw clear boundaries between these different diagnosis, I don't see that that can realistically be done.It can be done, and it is done - every single day - successfully.
It might be hard for you to distinguish between schizophrenia and mania, but this is not to your discredit. I doubt you went to medical school and attended those classes devoted to one of the kingpins of medical practice: differential diagnosis. It can be done and it is done - even with two presentations located within the same spectrum of illnesses.
Differential diagnosis of many illnesses is very often more difficult than the treatments of that illness. Another one - childhood AD/HD and bipolar disorder. Not only do they have some similar symptoms (overlap?), but both can occur comorbidly. If you were to treat one without treating the other, the goal of attaining a healthy behavioral and attentional state is not realized. They are not one disorder. They are two.
I do not believe that schizophrenia, bipolar affective disorder, and schizoaffective disorder are located along a spectral line of one disorder. More like three.
> There is just too much overlap. Too many gray areas. It's seldom black and white. In his book "Dysthymia, the Spectrum of Chronic Depression" the world renowned psychiatrist Hagop Akiskal pretty much says the same thing.
I didn't read his book, but does Akiskal state that schizophrenia, bipolar disorder, and major depression are simply multiple presentations along a single biological thread? In what ways? Akiskal is a smart guy. I would be surprised if this were so. A single thread containing dysthymia and depression makes sense to me, but not schizophrenia and depression.
I think it is a mistake to think of two disorders related simply because they have some clinical symptomology in common. Manic psychosis and schizophrenic psychosis look very much alike to some people. They are not at all similar in biological presentation or prognosis. The brains of uncomplicated bipolar individuals do not have the enlarged ventricle seen with schizophrenia. Schizophrenic psychosis does not respond to lithium. Then, there is psychotic depression and schizoaffective disorder. All four of these disorders present with psychosis in which thoughts are distorted and disorganized, and effective reality-checking is all but non-existent. That bipolar disorder and schizophrenia have features in common does not imply that they represent a continuum of the same disorder. I believe they are unrelated.
- Scott
------------------------------------------------------
* Robert M. Post is pretty smart too. *
22: Schizophr Res 1999 Sep 29;39(2):153-8; discussion 163Comparative pharmacology of bipolar disorder and schizophrenia.
Post RM
Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892-1272, USA. robert.post@nih.gov
The treatment of acute mania and schizophrenia overlap considerably in terms of the typical and atypical neuroleptics, but begin to diverge with the recognized mood stabilizers for bipolar affective illness--lithium, carbamazepine, and valproate--which are substantially less effective in schizophrenia than in affective illness. Moreover, the L-type calcium channel blocker verapamil is reported to be effective in mania, but it may exacerbate schizophrenia. A series of new putative mood stabilizing anticonvulsants (such as lamotrigine, gabapentin, and topiramate) and possible second-messenger targeted treatments (tamoxifen and omega-3 fatty acids) deserve further study in both affective and schizophrenic syndromes. Repeated transcranial magnetic stimulation (rTMS) of the brain offers considerable promise in the treatment of a variety of neuropsychiatric syndromes, especially with preliminary evidence of frequency-dependent effects on regional cerebral blood flow. New insights about the potential neurotrophic effects of lithium and the gene transcriptional effects of other psychotropics offer exciting new targets for therapeutics and strategies for future clinical trials and therapeutic applications in both syndromes.
Publication Types: Review Review literature
PMID: 10507527, UI: 99435361
poster:SLS
thread:49706
URL: http://www.dr-bob.org/babble/20001130/msgs/49800.html