Into the Void

PSYweb DSM-IV Diagnoses and Codes.

PSYweb has a list of the DSM-IV Diagnosis Codes. Notice that there are a lot of psychiatric diagnoses caused by psych meds. This makes it totally clear that your meds can make you sicker, a good argument for doing the minimum meds to make you functional vs. medicating yourself into oblivion.

The following are a few examples of iatrogenic (physician-caused) psychiatric disorders:

292.84

Opioid-Induced Mood Disorder
Yes, pain meds can make you look like a bipolar.

333.99

Neuroleptic-Induced Acute Akathisia
He’s agitated, let’s give him more neuroleptic. Neuroleptics are old-fashioned antipsychotics such as Haldol.

292.12

Amphetamine-Induced Psychotic Disorder, With Hallucinations
Some of the ADHD meds they give to kids, including Ritalin and Adderall, are amphetamines. Can you imagine turning your kid into a Speed Freak?

292.89

Sedative-, Hypnotic-, or Anxiolytic-Induced Anxiety Disorder
Anxiety from anti-anxiety pills? Some of the benzodiazepines can even induce hypomania, however there doesn’t seem to be a diagnosis code for it. Maybe in the DSM-V. Or maybe not. I hear it’s being written by Big Pharma.

Another cool thing on psyweb is a Mood Disorder Flow Chart that is able to distinguish bipolar disorder from the other mood disorders. A real kick in the head is the question “Symptoms Psychotic in nature, occur at times other then during Manic or Mixed Episodes?”

This seems to imply that bipolars don’t have psychotic depressions, but other mood disorders do. Note that the only the 296 numbers are mood disorders, and only a few of those are called bipolar disorder. Been there, done that, bought the t-shirt.

A couple of years ago I did a decision tree for the bipolar disorders based on the DSM-III. It’s a little different from the DSM-IV-based version.

Psyweb also has a decision tree for differential diagnosis, and that’s a better choice than the mood disorders tree, even for diagnosed bipolars. This tree helps you figure out whether you have another psych diagnosis masquerading as bipolar, something that a 15-minute psych eval will definately miss. That would be truly disastrous, being treated for life for bipolar instead of dealing with something less severe. Have fun!

I think I’m going to invent Seroquel jimmies for ice cream.

Pretty much any psych med by itself will affect sex drive. I see folks taking a half a dozen of them, and then another med or two to counteract the side effects. The pdocs tell us that they DON’T because they don’t want us to quit taking them.

Perhaps we should refer to our meds as a “pharmaceutical chastity belt.”

Anything that tweaks your dopamine down is going to get rid of the emotional spark required to have something resembling a sex life. And anything that tweaks UP serotonin receptors does so at the expense of dopamine receptors. See this article, Notes on Anhedonia and SAD.

For men, there’s also the problem of peripheral blood flow – a strictly mechanical problem. Can’t get the old hydraulics to run, eh? Viagra and Cialis work by improving blood flow. Heck, coffee dilates the blood vessels too, and if you brew it at home it’s way cheaper than an ED pill. Diabetes is common cause of ED, so antipsychotics that affect blood sugar (most of the atypicals) might contribute to it.

Maybe the whole idea is to give us drugs that prevent us from breeding lots of little bipolars.

people who experience
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I don’t know where to start to talk about Sylvia Caras. Award-winning mental health consumer advocate, speaker and author, founder of the Madness group and of People Who, Grandma, and a really together lady. I really look up to her – and if you know me, I don’t look up to anyone!

Sylvia recently accepted two of my blog articles for inclusion on the People Who site. Do stop over and look at what she is doing for us.

Sylvia Caras People Who mood swings

Anosognosia (impaired awareness of illness): A major problem for individuals with schizophrenia and bipolar disorder.

As the years go by, I am less and less impressed with NAMI. I think their agenda is to improve the family’s comfort at the expense of the patient’s autonomy. They teach the rather disturbing idea that a large percentage of mentally ill people have no self-awareness, no insight into ourselves. Like the lower animals. Anosognosia, they call it.

The article I’ve linked to above has some glaring logical errors and has terrible ramifications for the mentally ill. I’ll list some of them.

1. The article lumps bipolars together with schizophrenics as if we are all one big, happy family. We aren’t. Bipolar disorder is cyclic, often with long periods of remission in between episodes. This is not the case with schizophrenia. Schizophrenia is associated with unremitting cognitive deficits.
2. In either case, there is no “awareness of illness” modifier to the DSM-IV codes. Frankly, it is my opinion that the majority of so-called “normal” folks are wandering around with the same lack of self-consciousness. Why are we pathologizing it?
3. The article doesn’t examine in detail the cognitive effects of certain medications. Most notably, the antipsychotics have been shown to reduce the IQ by an average of about 10 points. In basing the sweeping generalization that we aren’t self-aware upon those individuals whose short-term memory is ravaged by their medications, the article makes a case for putting more individuals on the same meds. This will skew future research in this direction as more and more psychiatric patients are required to take meds that may cause anosognosia.
4. There is considerable evidence that medications may not be necessary during remission in bipolar disorder type II – see Dr. Fieve’s recent book, “Bipolar II: Enhance Your Highs, Boost Your Creativity, and Escape the Cycles of Recurrent Depression.” If I state that I don’t need meds when I’m in remission, that is a treatment decision, not the symptom of a cognitive deficit.
5. The milder forms of bipolar disorder occur far more that the severe forms. That is, most bipolars never experience psychosis. I suspect that there is a missing qualifier throughout the article – a description of what population exactly they mean. That is, do the authors include the milder forms of bipolar in their 40% statistic, or is the article strictly based on their experience with the sickest of the sick, the ones who wound up in-patient? If this is so, then the authors are stigmatizing most of the bipolar population based on a very biased sample. I suspect that the sample of bipolars in the article are folks who have never been educated as to the symptoms of their illness. Education alone makes a big difference in our ability to manage the illness.
6. The horrible possibility that we aren’t aware of our symptoms is devastating to the self-esteem of even the most intelligent and self-aware mentally ill person. Am I acting out? Should I speak up or will my words betray my condition? I feel good today – maybe that’s just a mania talking? I disagree what what X is saying – am I delusional?
7. This article opens the mentally ill to victimization by society and especially by the medical profession. The word “Anosognosia” gives society the pretense of a valid reason to marginalize the mentally ill, to victimize, to force-medicate, to control us. It enables our families, friends and employers to shrug off our ideas and opinions for no other reason than that we have been diagnosed and they haven’t.
8. Why exactly is it that a heart patient is allowed to request that further treatment be withheld, yet a mentally ill person can be hospitalized against his will? Are we monsters?

For all its talk about stigma busters, NAMI has shown with this single document exactly what they are all about. I am not an animal. Mental illness is not a crime. And NAMI is not advocating for us.

UPDATE 4/15/2007:
Sylvia Caras of People Who accepted this post for inclusion on her own site. Stop over to People Who and check out the tremendous amount of excellent mental health advocacy information she offers.

From an article on PubMed:
“Patients on treatment with antipsychotic drugs had a lower current full scale IQ, lower general memory scores, and lower working memory scores.”

I submit that psych meds actually make you less capable of effectively participating in your treatment, or even in life.
Why are they doing this to us?