browri Posted August 26, 2020 Share Posted August 26, 2020 1 hour ago, crazyguy82 said: This is my new diagnosis. I don’t really understand it all can anyone help explain it? • He provided again clinical evidence consistent for him suffering, at axis-I, recurrent depressive disorder (i.e. F-33 as per the ICD-10 diagnostic criteria) rather a bipolar affective disorder or cyclothymia, along with mixed anxiety and depressive disorder (F-41.2, as per the ICD-10 diagnostic criteria) as a differential diagnosis and having, in background or at axis-II, traits of an anxious (avoidant), as to some extent also of an obsessive, personality with ineffective coping skills in general under any added/acute life stress /pressures. It is worth noting initially that the diagnosis is written using DSM-IV methodology. The DSM acts as a guidebook for mental health clinicians to diagnose various disorders. The DSM-IV used a multi-axial system to describe various portions of a patient's mental condition. Axis I: mental health and substance use disorders Axis II: personality disorders and mental retardation Axis III: general medical conditions Axis IV: psychosocial and environmental problems (e.g. problems at home or at work) Axis V: Known as the GAF Score/scale, was an assessment of overall functioning Quote He provided again clinical evidence consistent for him suffering, at axis-I, recurrent depressive disorder (i.e. F-33 as per the ICD-10 diagnostic criteria) rather a bipolar affective disorder or cyclothymia... Axis 1 would describe mental health disorders like major depressive disorder, bipolar disorder, schizophrenia, etc. This indicates that you have a recurrent depressive disorder. In ICD-10 coding, this would be F33, but your pdoc seems to imply here that he would rather diagnose you as a bipolar disorder, unspecified (F31.9) or cyclothymia (F34.0). Quote ...along with mixed anxiety and depressive disorder (F-41.2, as per the ICD-10 diagnostic criteria) as a differential diagnosis... F41 is the ICD10 major code for some anxiety disorders including panic disorder, generalized anxiety disorder, etc. It does not include social phobia (otherwise known as social anxiety disorder). F41.2 is a relatively new code to imply a mixed anxiety and depressive disorder as he has described. Many times people feel that their anxiety or their depression is stronger, one leading to the other. This statement by your psychiatrist implies that anxiety is tightly intertwined with depression in a way that cannot be described with other anxiety disorders. This is not unusual for a comorbid anxiety diagnosis with a mood disorder like bipolar disorder or cyclothymia (a possibly less mild form of bipolar disorder). This all could also explain why you didn't respond well to imipramine, which is a fairly strong tricyclic AD. Quote ...and having, in background or at axis-II, traits of an anxious (avoidant), as to some extent also of an obsessive, personality with ineffective coping skills in general under any added/acute life stress /pressures. Axis 2 would imply personality traits independent of any mental disorders. In a nutshell, your pdoc has assessed you as having an avoidant personality with obsessive qualities and that these qualities combined with a lack of coping mechanisms can lead to a problem. Don't take this as an attack on who you are as a person but rather as an assessment of what you're capable of under stress. For example, one of my favorite coping skills for anxiety is 4-7-8 breathing: https://www.healthline.com/health/4-7-8-breathing This is a physical coping mechanism for my anxiety. When I feel anxious or stressed, I'm out of my CBD:THC tincture, and I don't want to take a clonazepam or don't have time for it to kick in (which can take a few hours), 4-7-8 breathing is my godsend. Your doctor is looking to see if you have these kinds of coping mechanisms to handle your day-to-day. In summary: Under the DSM-V, you have been re-diagnosed as having bipolar disorder comorbid with a mixed anxiety/depressive disorder, most likely a secondary diagnosis to the bipolar disorder. A comorbid diagnosis (having 2 or more conditions simultaneously) is a fairly common diagnosis for those with bipolar disorder. However without the actual ICD-10 codes that the pdoc's office is using, it's hard to say for sure what their final diagnosis is, and they usually keep that pretty close to the chest (i.e. you usually can't just call your pdoc and ask them what they're using as their diagnosis for your billing claims). Considering that you're already taking Seroquel and Lamictal for some time now, a re-diagnosis as bipolar isn't that far-fetched at all, as both of those medications are for bipolar disorder (although Seroquel has an indication for treatment-resistant MDD and Lamictal is used off-label for that as well). Link to comment Share on other sites More sharing options...
crazyguy82 Posted August 26, 2020 Share Posted August 26, 2020 4 hours ago, browri said: It is worth noting initially that the diagnosis is written using DSM-IV methodology. The DSM acts as a guidebook for mental health clinicians to diagnose various disorders. The DSM-IV used a multi-axial system to describe various portions of a patient's mental condition. Axis I: mental health and substance use disorders Axis II: personality disorders and mental retardation Axis III: general medical conditions Axis IV: psychosocial and environmental problems (e.g. problems at home or at work) Axis V: Known as the GAF Score/scale, was an assessment of overall functioning Axis 1 would describe mental health disorders like major depressive disorder, bipolar disorder, schizophrenia, etc. This indicates that you have a recurrent depressive disorder. In ICD-10 coding, this would be F33, but your pdoc seems to imply here that he would rather diagnose you as a bipolar disorder, unspecified (F31.9) or cyclothymia (F34.0). F41 is the ICD10 major code for some anxiety disorders including panic disorder, generalized anxiety disorder, etc. It does not include social phobia (otherwise known as social anxiety disorder). F41.2 is a relatively new code to imply a mixed anxiety and depressive disorder as he has described. Many times people feel that their anxiety or their depression is stronger, one leading to the other. This statement by your psychiatrist implies that anxiety is tightly intertwined with depression in a way that cannot be described with other anxiety disorders. This is not unusual for a comorbid anxiety diagnosis with a mood disorder like bipolar disorder or cyclothymia (a possibly less mild form of bipolar disorder). This all could also explain why you didn't respond well to imipramine, which is a fairly strong tricyclic AD. Axis 2 would imply personality traits independent of any mental disorders. In a nutshell, your pdoc has assessed you as having an avoidant personality with obsessive qualities and that these qualities combined with a lack of coping mechanisms can lead to a problem. Don't take this as an attack on who you are as a person but rather as an assessment of what you're capable of under stress. For example, one of my favorite coping skills for anxiety is 4-7-8 breathing: https://www.healthline.com/health/4-7-8-breathing This is a physical coping mechanism for my anxiety. When I feel anxious or stressed, I'm out of my CBD:THC tincture, and I don't want to take a clonazepam or don't have time for it to kick in (which can take a few hours), 4-7-8 breathing is my godsend. Your doctor is looking to see if you have these kinds of coping mechanisms to handle your day-to-day. In summary: Under the DSM-V, you have been re-diagnosed as having bipolar disorder comorbid with a mixed anxiety/depressive disorder, most likely a secondary diagnosis to the bipolar disorder. A comorbid diagnosis (having 2 or more conditions simultaneously) is a fairly common diagnosis for those with bipolar disorder. However without the actual ICD-10 codes that the pdoc's office is using, it's hard to say for sure what their final diagnosis is, and they usually keep that pretty close to the chest (i.e. you usually can't just call your pdoc and ask them what they're using as their diagnosis for your billing claims). Considering that you're already taking Seroquel and Lamictal for some time now, a re-diagnosis as bipolar isn't that far-fetched at all, as both of those medications are for bipolar disorder (although Seroquel has an indication for treatment-resistant MDD and Lamictal is used off-label for that as well). Thanks for such a detailed response. It seems I get more complicated by the second. The doctor is quite insistent that I go back to lithium. I’ve flat out said no due so rather horrible side effect issues. He also wants me to consider coming off Seroquel. I’m not sure the reasoning for this. I have to submit the report to my NHS GP and consultant. I really don’t like the diagnosis of bipolar disorder. I have known myself for some time about the bipolar issues but not really had the conversation with NHS doctors. I will send it in. I’m lucky to have a job that provides private health cover. Link to comment Share on other sites More sharing options...
Recommended Posts