
Tips for the Diagnostic Interview of Mental Disorders - dangerman
https://pro.psychcentral.com/14-tips-for-the-diagnostic-interview-of-mental-disorders/
======
phkahler
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...

~~~
pmiller2
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...](https://www.psychiatry.org/psychiatrists/practice/dsm/feedback-
and-questions/frequently-asked-questions)

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

~~~
epmaybe
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.

~~~
IntronExon
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.

------
tcj_phx
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](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.

~~~
JimboOmega
> 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?

~~~
tcj_phx
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.

~~~
JimboOmega
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.

~~~
tcj_phx
> 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.

