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BD spectrum debate


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Glen:

Thanks for the links! Printing out now, will read later. Just wanted to let you know how much I appreciate your many posts and links re: the science.

revlow

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Thanks revlow. As an aside the "Canadian Psychiatric Journal" is a good resource since it is fully available to the public on-line. THey have had many great contributions by notables like Angst and Bennazi. One of the best is McIntyre's (devilla will like this one) seminal paper "Lithium Revisited". A must read for anyone on lithium, it only needs to be updated on the Gelenberg data (See: http://www.ufrgs.br/psiq/textoscelg02.htm).

http://www.cpa-apc.org/Publications/Archiv...May/Lithium.asp

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huh?

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Dr. McIntyre's paper states the following....

Plasma Levels

The maintenance level of approximately 0.8 mEq/L may be the optimal balance between prophylactic efficacy and tolerability (34). Gelenberg studied 94 patients with BD in a randomized double-blind prospective trial of 2 different doses of lithium for maintenance therapy: the

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Ok...spectrum or no spectrum. Is either stance going to improve the quality of treatment? (Since it has sucked overall for so many years...even though it has gotten better recently.)

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You cannot treat what you do not recognize [/Dr. Phil]  ;)

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Considering that the suicide rates for people with BP are higher than those with MDD and that the suicide rates are the same for BP1 and BP2, I think that the Spectrum theory should be taken seriously. There is such a threat that people will harm themselves. I think it is because in hypomania, people feel so great, and then it sets them up for the fall and worse depression, not to mention mixed states which aren't common, or as common, or possible in MDD (I'm not familiar wih MDD so I'm not sure if they have mixed states or not).

Even if there are some people floating around who are notBP who are treated as if they are, the mood stabilizers usually make the ADs more potent, so the MDD people being misdiagnosed are perhaps receiving better treatment. Who knows? I'd rather over treat than let someone suffer under treated. And it is also about how we view ourselves. Some may say that their upswings are a part of who they are, and some may insist it interferes with their lives. Treat what the patient is willing to be treated for.

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Heya,

Currently, from my reading.

The main problem identified with the "spectrum" issue is not so much the mis-dxing of atypical MDD.

It's the overlap with Axis II.

Specifically, with "borderline" (I really really dislike that term BTW).

It's the danger that someone will be tx'd with meds and dismissed, and *not* tx'd with 2 years of intensive therapy to help the personality (Axis II).

It's the danger of tearing down someone's personality (Axis II) when they could be tx'd successfully with meds.

OTOH.

Mis-dx of BP has screwed up how many? of our lives, mine included.

Or, me thinking I was weird, when I'm weird and also crazy.

Who knows WTF BP really encompasses.  A lot of the dx is based, really, on our response to treatment (good or bad or neutral).

At any rate.

I *like* McIntyre.  He's the family-practice-friendly demigod-of-mood-disorders.

Funny though.

No, actually *funny.*

When I saw my psych (Dr. K., the treating one) for the first time, he asked how my doctor came up with Lamictal.

I said, well, I suggested it.  But then, I've had a lot of teaching with McIntyre.

Me and Dr. K. shared a knowing grin on that one.

;)

But yah.

Spectrum is a very, very busy debate right now.

--ncc--

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Ok...spectrum or no spectrum. Is either stance going to improve the quality of treatment? (Since it has sucked overall for so many years...even though it has gotten better recently.)

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ok.  fine for them to help better understand how to diagnose people in the future, but what good does this do to people like me in the NOW?

just asking

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