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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by grapebubblegum on June 28, 2001, at 8:48:03
And I say that in a lighthearted tone, trying to have a sense of humor.
I was in a public health clinic the other day briefly and while sitting in the plastic-chairs-bolted-to-the-floor waiting room watching a Disney movie put on to pacify all the young'uns (and that it did!) chanced to see a poster educating the public about epilepsy. Now, I'm 35 and I remember from early childhood seeing these posters and asking my mother, "Why would people discriminate against people with epilepsy anyway?" Her answer was that the traditional (read: unenlightened and uneducated) incorrect view was that epilepsy indicated comorbid psychiatric illness. Well, she didn't put it in exactly those terms, but you get the idea.
Back to the present: the poster listed "What epilepsy is NOT," with the valiant intent of attempting to persuade the casual reader to adopt a non-discriminatory stance toward epileptics as far as employment opportunities go, I suppose. Included on the list was:
"Epilepsy is NOT a mental disease."
Of course I bristled a bit at that. But I can't blame the neurology camp for trying to distance themselves from "our" camp. As fraught with stigma as the psychiatric camp has been and always will be to one extent of another, I definitely could not blame them.
But the irony is: with scientific breakthoughs cropping up so fast we can hardly keep up with them, are we not discovering that neurology and psychiatry and their respective "diseases" are far closer in etiology than we recently believed, after we stopped believing that they were co-morbid, through the use of public education campaigns like the posters which I have viewed my entire life? Again, I'm just a lil' ole layperson so pardon my massive ignorance. But I am getting the impression that neurology and psychiatry are kissing cousins.
I spoke briefly with a psychiatric nurse, as a friend, not as a professional consultation or anything, and I listed for her the meds my recently deceased father was on, at the end of his life, to the best of my knowledge. Tegretol, klonopin, to name a few.. and she said, "What's up with all the neuroleptics for a psychiatric disorder?"
Indeed, what is up with that? Anyone care to comment on the similiarity or polarity of disorders such as the bipolar disorder with which he suffered his entire adult life and the neurological conditions treated with the same meds?
As a side note, I also take klonopin and my five year old son takes topiramate and geodon. Lots of neuroleptics in the family with not a lick of epilepsy ever seen in the bloodline. Just opening up the stigma and the neurology-psychiatry subjects up for a double-whammy of a discussion starter.
Posted by Lorraine on June 28, 2001, at 10:45:23
In reply to Stigma: it will just never go away, will it?, posted by grapebubblegum on June 28, 2001, at 8:48:03
> Back to the present: the poster listed "What epilepsy is NOT,"
>
> "Epilepsy is NOT a mental disease."
>
> Of course I bristled a bit at that.Me too. I was talking with a woman with FMS and giving her some research that I had done on FMS (which I do not have) and I said something about the conditions being similar and how FMS is usually diagnosed depression first. She bristled a bit and said FMS is an immune disease. Well, la tee dah! An immune disease. In some camps there is a growing suspicion that depression is an immune disease. At least we know it affects the immune system--more heart attacks etc. Not to mention the retrovirus theories floating around. Or that FMS is really a neurological disease that affects the immune system. Really, what on earth are people arguing about with this stuff. We have a compromised immune system and brain in both instances. I have a friend who has MS and I am constantly comparing the two conditions. (Here, I know, there are BIG differences, but still a surprising amount of similarities.)
> But the irony is: with scientific breakthoughs cropping up so fast we can hardly keep up with them, are we not discovering that neurology and psychiatry and their respective "diseases" are far closer in etiology than we recently believed, after we stopped believing that they were co-morbid, through the use of public education campaigns like the posters which I have viewed my entire life? Again, I'm just a lil' ole layperson so pardon my massive ignorance. But I am getting the impression that neurology and psychiatry are kissing cousins.I happen to agree and think the medical profession is remarkably ignorant about all of this.
>
> I spoke briefly with a psychiatric nurse"What's up with all the neuroleptics for a psychiatric disorder?"Well, in my case, my QEEG showed subthreshold seizure activity--which is why an anti-convulsant was added to my regiem. I wonder if that is the case with others that take anti-convulsants. My QEEG also suggested that I had brain lesions, causing my neurofeedback clinic to question me extensively about the possibility of brain trauma--from car accidents etc. It's all a muddle at this point in medical history, but I believe that when the dust settles, we will KNOW what the brain/body deficiencies are and treat those instead of arguing over labels.
Posted by grapebubblegum on June 28, 2001, at 13:24:42
In reply to Re: Stigma: it will just never go away, will it? » grapebubblegum, posted by Lorraine on June 28, 2001, at 10:45:23
I'm not sure what FMS is.
Anyway, I forgot to add the most important point, the punch line: at the bottom of the poster in smaller print was "Presented by the makers of Topamax."
Which I found ironic because they are presumably putting in a plug for their product while proclaiming how different epilepsy (the condition presumably treated with their product) is from "mental diseases," yet my son takes the very same medication, Topamax, for a "mental disease." My mother, being an educator in the field of early childhood education a few credits short of a Ph.D., and obviously a grandmother as well, has had some trouble with a diagnosis of a "mental disease" in her grandchild. But she is starting to come around and see that we are all looking out for his quality of life, and labels should not be so scary or upsetting, but regarded merely as tools that may possibly help.
Posted by susan C on June 28, 2001, at 13:50:40
In reply to And here's the punch line I forgot, posted by grapebubblegum on June 28, 2001, at 13:24:42
> Ok, good discussion. It includes the heart of what I am searching for and my pdoc is investigating: genetic basis and autoimmunine disorder as underlying cause of BP type symptoms. They are very hard to pin down. The list I have is Fibromyalgia syndrom (FMS) Lupus, MS, Hypercoaguable state, seizures of all kinds. A good friend, dx Bipolar, psychotic, dilusions, voices, mania, severe depression, whose mother led me to this pdoc, was referred to a rhumetologist who was able to confirm, through blood tests, that he has a very rare type of genetic blood disorder: Neuropsyciatric systemic lupus erythematosus. His treatment? baby asprin (to keep him from having little strokes due to his thick blood-the strokes were causing the mood swings) and a anti malarial drug. He is doing well. So far, blood tests for me have been borderline. and we still investigate. I am taking depakote and it seems to be helping with the swings. Good comments. I think it is always difficult for professionals to be open minded. I know some seem to stop learning when they finish school and maybe some docs do get their degrees out of crackerjack boxes. Thanks Grape. (I love grape juice and soda and as a kid my favorite bubble gum was grape.)
Posted by grapebubblegum on June 28, 2001, at 17:50:38
In reply to Re: And here's the punch line I forgot, posted by susan C on June 28, 2001, at 13:50:40
My dad died a year ago and during his last few years he was hospitalized several times for near-fatal blood clots. He was on blood thinners self-administered daily. No one knew why he suddenly came up with blood clotting problems. I researched and found that Tegretol could contribute to clotting, possibly. He raised the concern with his doctors who said only, "No."
It has always bothered me that they never knew the cause of the sudden onset of blood clots but immediately dismissed the involvement of Tegretol as a possible contributing factor.
To muddy the waters, (or maybe to clear them) he also suffered from chronic lymphocytic leukemia, an infection from which finally did him in. Hmmm... That name sounds like an immune disorder?
Just throwing out some factoids for those who might be able use them in piecing together whatever puzzle you might be working on.
Posted by Elizabeth on June 29, 2001, at 19:35:41
In reply to Stigma: it will just never go away, will it?, posted by grapebubblegum on June 28, 2001, at 8:48:03
> Of course I bristled a bit at that. But I can't blame the neurology camp for trying to distance themselves from "our" camp.
Yup. The "psychiatric illness" camp tries to distance itself from the "addiction" and "personality disorder" camps. Lots of people are afraid to admit to themselves or others that they have an anxiety or mood disorder: they get test after test trying to prove, for example, temporal lobe epilepsy, which is the problem in a small number of cases but really isn't all *that* common an explanation for panic disorder or depression.
In politics it's the same. The medical marijuana proponents try to distance themselves from recreational drug users and advocates of general drug legalisation. These days, in the USA, it's considered bad to be a liberal, even though our country was founded on the classic liberal values of freedom and equality. Democrats want to be thought of as "moderates" or "centrists" instead, anything but the dreaded "L-word." The women's rights movement had a split like this too, a long time ago when they were still fighting for suffrage but other women (like Margaret Sanger, the founder of Planned Parenthood) knew that was only the beginning. The list goes on.
When will people learn that we need to work together to get things done? (Helen Keller had a great quote to this effect. I wish I could recall it!)
> I spoke briefly with a psychiatric nurse, as a friend, not as a professional consultation or anything, and I listed for her the meds my recently deceased father was on, at the end of his life, to the best of my knowledge. Tegretol, klonopin, to name a few.. and she said, "What's up with all the neuroleptics for a psychiatric disorder?"
"Neuroleptics?" Well, what can you expect? ("Neuroleptic" is an old word for the antipsychotic drugs!) Although they are often wonderful clinicians with their own unique place in the medical hierarchy, nurses aren't trained in pharmacology, and they really don't know much about drugs in general, especially off-label uses. (Klonopin is labelled for panic disorder now, though. Tegretol was never approved for bipolar disorder, despite overwhelming evidence that it works very well, often for people who don't respond to lithium.)
The use of the same drugs doesn't mean they're the same conditions. Lots of people have tried to connect panic disorder, depression, bipolar disorder, borderline personality, etc., to epilepsy. Although in the rare case, there turns out to be a seizure disorder with psychiatric symptoms (e.g., panic-like seizures or interictal dysphoria), more often it's just that the drugs have broad effects (for example, the antikindling effect of Tegretol also prevents kindling in bipolar disorder, particularly with mixed states or rapid-cycling; and the "antipsychotic" drugs often help with mania and certain types of obsessive states.)
-elizabeth
Posted by Elizabeth on June 29, 2001, at 19:39:11
In reply to Re: Stigma: it will just never go away, will it? » grapebubblegum, posted by Lorraine on June 28, 2001, at 10:45:23
> I was talking with a woman with FMS and giving her some research that I had done on FMS (which I do not have) and I said something about the conditions being similar and how FMS is usually diagnosed depression first. She bristled a bit and said FMS is an immune disease.
Like that's a proven fact. FMS is a syndrome of unknown etiology, and it's controversial as to whether it even constitutes a distinct condition rather than a manifestation of one or more other conditions. That's just like when people with depression say, as though it were an established fact (or even as though it means anything in particular at all) that depression is "a chemical imbalance." Nobody knows what causes depression -- or FMS, epilepsy, and many other conditions.
> Well, in my case, my QEEG showed subthreshold seizure activity--which is why an anti-convulsant was added to my regiem. I wonder if that is the case with others that take anti-convulsants.No, not usually.
> My QEEG also suggested that I had brain lesions, causing my neurofeedback clinic to question me extensively about the possibility of brain trauma--from car accidents etc.
That's something that would show up on a structural image (like an MRI).
-elizabeth
Posted by Chris A. on June 30, 2001, at 0:00:15
In reply to Re: Stigma: it will just never go away, will it? » grapebubblegum, posted by Elizabeth on June 29, 2001, at 19:35:41
>nurses aren't trained in pharmacology, and they really don't know much about drugs in general, especially off-label uses.
Careful about generalizations. Pharmacology is a required course for RNs, at least in the US. Don't insult the profession.
Chris A.
Posted by Lorraine on June 30, 2001, at 12:47:17
In reply to Re: Stigma: it will just never go away, will it? » Lorraine, posted by Elizabeth on June 29, 2001, at 19:39:11
> > She bristled a bit and said FMS is an immune disease.
>
> Like that's a proven fact. FMS is a syndrome of unknown etiologyPrecisely! And that is what I think depression is also.
> > Well, in my case, my QEEG showed subthreshold seizure activity--which is why an anti-convulsant was added to my regiem. I wonder if that is the case with others that take anti-convulsants.
>
> No, not usually.Elizabeth--how would they know? Most people don't get a QEEG done. Also, I had a temporal lobe only EEG print out from the Neurofeedback people and showed it to my pdoc; it still showed these sharp spikes or subthreshold seizure activity. I said, it looks like the anti-convulsant (Neurontin) isn't doing anything to these spikes; he said "You're right!"; pondered it a bit and then said "you know, maybe you need to think about Xanax or Ativan". What do Xanax or Ativan have to do with subthreshold seizure activity?
>
> > My QEEG also suggested that I had brain lesions, causing my neurofeedback clinic to question me extensively about the possibility of brain trauma--from car accidents etc.
>
> That's something that would show up on a structural image (like an MRI).You're right. I should think about having one done, although I'm not sure it would make a difference in the treatment course.
Posted by judy1 on June 30, 2001, at 14:58:09
In reply to Stigma: it will just never go away, will it?, posted by grapebubblegum on June 28, 2001, at 8:48:03
Hi,
Of course I agree with your stigma observations, but wanted to mention that my shink (who like all shrinks is certified by the American Board of Psychiatry and Neurology) actually practices both specialties. He has seen considerable overlap with panic, bipolar and epilepsy. While he has me go to another neurologist who has the fancy equipment (and is getting a SPECT machine) he basically takes care of my neurological problems (results of head traumas) that intertwine so closely with my psychiatric conditions. I really think this is the future of psychiatry or neuropsychiatry- judy
Posted by Elizabeth on June 30, 2001, at 18:08:51
In reply to Re: Stigma: it will just never go away, will it? » Elizabeth, posted by Chris A. on June 30, 2001, at 0:00:15
> >nurses aren't trained in pharmacology, and they really don't know much about drugs in general, especially off-label uses.
>
> Careful about generalizations. Pharmacology is a required course for RNs, at least in the US. Don't insult the profession.Fair enough. That's just been my experience with nurses (including psych nurses). My apologies; you're right, I shouldn't have generalised.
So, nurses take pharmacology? What can you tell me about the content of the course? What are the prerequisites? etc.
-curious elizabeth
Posted by Elizabeth on June 30, 2001, at 18:13:41
In reply to Re: Stigma: it will just never go away, will it? » grapebubblegum, posted by judy1 on June 30, 2001, at 14:58:09
> Of course I agree with your stigma observations, but wanted to mention that my shink (who like all shrinks is certified by the American Board of Psychiatry and Neurology) actually practices both specialties.
That's not usually the case, actually. Most psychiatrists are just psychiatrists and treat the conditions that have come to be considered "psychiatric disorders," and most neurologists are just neurologists who treat conditions that have come to be known as "neurological disorders." (That doesn't mean there's any particular definition that distinguishes "psychiatric" and "neurological" disorders. Although there's a tendency for the physiology of "neurological" disorders to be at least a little better understood, this isn't true of every "neurological" disorder by any means.)
> He has seen considerable overlap with panic, bipolar and epilepsy. While he has me go to another neurologist who has the fancy equipment (and is getting a SPECT machine)
I think those things have a big place in the future of psychiatry, myself.
> he basically takes care of my neurological problems (results of head traumas) that intertwine so closely with my psychiatric conditions. I really think this is the future of psychiatry or neuropsychiatry- judy
To a certain extent, I do too. But most psychiatric patients don't have a history of head trauma and don't show lesions on structural brain scans (e.g., standard MRI -- more common than SPECT, PET, fMRI).
-elizabeth
Posted by Elizabeth on June 30, 2001, at 18:25:22
In reply to Re: Stigma: it will just never go away, will it? » Elizabeth, posted by Lorraine on June 30, 2001, at 12:47:17
> > Like that's a proven fact. FMS is a syndrome of unknown etiology
>
> Precisely! And that is what I think depression is also.No "I thinks" about it -- it's what depression is. (And the etiology is almost certainly not the same in all cases of depression, as the syndrome is defined in a very general, broad way.)
> > > Well, in my case, my QEEG showed subthreshold seizure activity--which is why an anti-convulsant was added to my regiem. I wonder if that is the case with others that take anti-convulsants.
> >
> > No, not usually.
>
> Elizabeth--how would they know? Most people don't get a QEEG done.OK, that's true; even in cases when epilepsy is suspected, qEEGs are not the usual first approach, and are often not employed when the EEG turns out to be normal. But the evidence for any consistent type of abnormal brain wave activity in bipolar disorder is rather sparse (except for the well-known changes in depression that are largely limited to sleep). The use of qEEG may prove differently, but I'm not terribly optimistic about being able to get consistent results unless we try to refine our definitions (of mania and depression, that is).
> What do Xanax or Ativan have to do with subthreshold seizure activity?
All benzodiazepines are anticonvulsants. I don't know the specifics of why they occurred to your pdoc (or why he thought of Ativan and Xanax in particular) -- probably just his clinical experience.
> > That's something that would show up on a structural image (like an MRI).
>
> You're right. I should think about having one done, although I'm not sure it would make a difference in the treatment course.Me neither. But who knows?
-elizabeth
Posted by Lorraine on June 30, 2001, at 20:41:43
In reply to qEEG and stuff » Lorraine, posted by Elizabeth on June 30, 2001, at 18:25:22
> > What do Xanax or Ativan have to do with subthreshold seizure activity?
>
> All benzodiazepines are anticonvulsants. I don't know the specifics of why they occurred to your pdoc (or why he thought of Ativan and Xanax in particular) -- probably just his clinical experience.Saaay! Now I get it. Thanx.
This is the end of the thread.
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