Tips for the Diagnostic Interview of Mental Disorders | Hacker News Reader

Tips for the Diagnostic Interview of Mental Disorders

pro.psychcentral.com

39 pointsdangerman20 comments

The truth is that most of the diagnosis have no accepted cure. Trauma->EMDR or exposure therapy. BPD->Dialectical Behavior Therapy. Everything else-> Social Skills Training (SST) and Interpersonal Therapy (IPT). There are other approaches (IFS was good for me) but they are not AFAICT clinically accepted treatments by the DSM. There's a reason they talk a lot about "coping strategies" - they don't have cures.

BTW if I sound cynical it's because I am both a victim of "treatment" and a success story. The later was a side effect...

FYI, the DSM does not specify any treatments for any disorder. Its only use in treatment is as a (rather crude) assessment tool for judging the effectiveness of treatment. See https://www.psychiatry.org/psychiatrists/practice/dsm/feedba...

The DSM is essentially the big book of what insurance will pay for, nothing more or less.

Many critics agree that the DSM-V has become unduly influenced by industry (pharmaceutical, insurance, but mainly pharmaceutical). However, keep in mind that the idea was that insurance base their payments off of the DSM, not the other way around.

Luckily, there are previous editions of the DSM that are far less influenced. Note that I'm not a mental health professional by any means, but even after the DSM-V was published they taught us medical students with DSM-IV-TR.

I can see how it was taken that way, but I wasn’t trying to say that the DSM is bought and paid for. Rather, I was just describing its modern function, without implying anything about influence one way or another. Mostly, the DSM should not be taken for a comprehensive resource for anything other tham insurance codes for accepted disorders. The ICD-10 exists, and there is an accepted, ongoing body of ongoing research.

This is absolutely true...

EMDR... has there been some new study demonstrating efficacy? Last I’d checked it was absolute crap.

Studies have shown it's effective. I have seen it's effects on someone close to me. Rather spectacular, and yet not a full "cure". I was inspired enough to try it and had limited success. It doesn't work for everyone or everything. PTSD it's definitely worth giving a shot.

From what I can find you’re right, sort of. The “sort of” is summarized here:

https://www.scientificamerican.com/article/emdr-taking-a-clo...

So, now to the bottom line: EMDR ameliorates symptoms of traumatic anxiety better than doing nothing and probably better than talking to a supportive listener. Yet not a shred of good evidence exists that EMDR is superior to exposure-based treatments that behavior and cognitive-behavior therapists have been administering routinely for decades. Paraphrasing British writer and critic Samuel Johnson, Harvard University psychologist Richard McNally nicely summed up the case for EMDR: “What is effective in EMDR is not new, and what is new is not effective.”

Studies have shown that the studies you reference have a reproduce-result of only 39 %.

https://osf.io/ezcuj/wiki/home/

Please name the concrete study and whether it could be reproduced.

Did a few sessions back in the 90s, utterly useless, IME. Probably depends on entirely on the subject, for some it may be a miracle therapy.

At the very least it's a profitable venture for the therapist, well north of $100 per session, IIRC.

While reading this, I thought of something I read on twitter [0] the other day:

  @AllenFrancesMD Feb 7

  Diagnoses should almost always be written in pencil:
  
  1)Patients are usually seen on their worst 
    day- seem  sicker than they really are
  2)Takes time to know patient/social context
  3)Role of substances/meds?
  4)Course as important as symptoms
  5)Diagnoses=hypotheses, not proven facts

[0] https://twitter.com/AllenFrancesMD/status/961240167628488704

Then I went to see who this PsychCentral.com piece is written by: Allen Frances too.

Psychiatry is so close to a breakthrough. The "medication management" paradigm of that the mental health industry has used for the past 50+ years are the chains that hold them back.

> Psychiatry is so close to a breakthrough. The "medication management" paradigm of that the mental health industry has used for the past 50+ years are the chains that hold them back.

And what is the paradigm to replace it? The old psychoanalytic stuff? CBT?

Most supposed "mental disorders" have metabolic problems as a component. "Stress" (various types) is important too. This aspect of "mental disorders" was starting to be explored 40 years ago, according to one of the books I bought recently, but psychiatrists of that era were more interested in magic bullet prescriptions to take care of their patients' problems.

I'm curious about this topic as it seems more likely to offer effective treatments, what is the name of the book you reference?

I refer you to my comment history: https://news.ycombinator.com/item?id=16023802

Wtf is $10K/month for ? Just for drugs ? Or in-patient somewhere with therapists and stuff ?

Drug rehab - basically inpatient with counselors/etc.

I'm not so sure.

The biology is very complicated and there are all kinds of feedback mechanisms at play, this is true. What is hard to see for me is what is cause and what is effect, and what that means for treatment.

Let's say you have a patient who is moderately depressed, overweight, w/insulin resistance (metabolic syndrome)... I imagine a very common presentation.

All of these things cause each other. The patient might have started overeating because they lost their wife a few years ago, and never really adjusted - but what can you do for them now?

They might have also gotten depressed because of hormonal imbalances that caused them to be less active and gain weight, but now there's a huge pile of problems to untangle, including NEW hormonal imbalances.

It's true that throwing a Prozac and Ambien Rx at them doesn't solve very much. You can't medicate away overeating and bariatric surgery isn't really that much better.

It would also be GREAT if we could get everybody to exercise, since it treats damn near everything including depression and insomnia pretty well. But doctors have been telling their patients to exercise along with the mass media and everybody in the world for a long time, and it just doesn't work. Might as well tell someone who is depressed to cheer up.

It really is a privileged position to be able to take a sabbatical, focus on your health, have a team of doctors and therapists work with you to handle the issues, mental and physical, that have arisen.

It's no wonder there's been a search for a magic bullet prescription; that's the kind of thing there could be broad access to.

> All of these things cause each other.

Not exactly - the "symptoms" you mention feed into a destructive feedback loop, but there are always causes behind the patient's presentation.

The effigy of Ancel Keys should be ritually burned by every graduating class of medical students, so they are reminded of all the harm their predecessors have done through their gullibility.

Reply on news.ycombinator.com