Self Diag-nonsense

We’re all guilty of this. With the internet, it’s even easier to diagnose yourself. Everybody has taken the personality disorders test, probably multiple times. (How many times have you scored the exact same? I don’t keep track, so I don’t know)

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Wake up call. Those aren’t diagnostic tests. The same way as an online IQ test can’t tell you you have an IQ of 180: only a few people in the world ever have scored that high in real life, they don’t come around often, based on the Stanford-Binet test. A psychological test has to be carried out by a psychologist or psychiatrist in person (with the new teleconferencing stuff, maybe, I’m not sure) and can take a few weeks or months. I was assessed over 6 months after multiple hospitalizations and treatments. An IQ test is similar, it cannot be biased, and the person has to be assessed by the tester for their reatctions. A lot comes into play.

Basically, an online IQ test is just a test with different scoring. Instead of 0-100% it assigns a number. An online psychological test is the same thing, but they have disclaimers: not a diagnostic tool. (Don’t ever pay for either one!)

I can say I hit a lot of DSM criteria, but it’s easy to say that about myself. Other people can say I hit different criteria. To get 3 psychologists and 5 psychiatrists to agree on my diagnoses was kind of amusing, but they did agree. (For the record, I was diagnosed with bipolar disorder type 1, rapid cycling with psychosis, schizotypal personality disorder, later on ADHD inattentive type and at that time, EDNOS, which is currently in remission). I did have to do that damn 500 question test. Apparently I exaggerated (that was what everyone who took the test got accused of: they exaggerated!) so the results weren’t clear. The psychologist had to use her head instead of the computer. Poor thing. Okay, enough about me.

Insight is good. Being a know-it-all and changing your treatment plan, double doctoring, doctor shopping and more are not good. In socialized health countries (pretty much everywhere but the US) most of that is harder to do. I work with my psychiatrist with medications, that is, if I really hate his medication decision, I’ll let him know, he’ll reconsider. When I was discharged from inpatient care, it was a mutual decision. If I’ve heard of a new medication, I’ll ask about it, and he’ll fill me in, about how he thinks it would work me me, and then it usually ends in, “and your insurance doesn’t cover it yet”. (It generally takes a year from the med coming out for my insurance to cover it!)

I have never told a doctor, “I think I have..”, partly because I think it’s rude and I’m shy, and partly because I’m not a doctor. Well, except for when I broke my jaw and ribs. “I think I have a broken jaw” fit. If you recognize symptoms earlier because you have heard of them and are able to seek help earlier, that’s even better.

Doctors are often guilty of self diagnosis, especially during medical school. They think they have every disease in the book. Medical studentitis is the name it’s given, as a joke.

“When you self-diagnose, you are essentially assuming that you know the subtleties that diagnosis constitutes.”

Not all mood swings mean bipolar disorder(1) for example. Self diagnosis can get in the way of proper diagnosis. Everybody has mood swings, but certain criteria has to be met. Bipolar disorder is actually not that common, despite hearing about it all the time. A GP should be seen before a psychiatrist so physical illness can be ruled out first. Sometimes physical illness feins psychiatric illness.

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Even if you do not want conventional treatment for depression, you may want conventional treatment for a brain tumor.
Self diagnosis is underminig the doctor, too, not good for the relationship, and the doctor could just end it. The diagnosis isn’t what is being treated. That is used for insurance information, symptoms are being treated.

Here are a few problems with self diagnosis:

  • – You can be missing something you can’t see, for example, focusing too much on one thing and forgetting the rest.
  • – Thinking too much is wrong, or thinking not enough is wrong.
  • – It can interfere with the doctor/patient relationship and agitate the doctor (they do get agitated)
  • – It can get in the way of proper treatment
  • – It can be hard to accept a correct diagnosis, and you could be disappointed that you’re wrong if the doctor disagrees.

Let your doctor do the work, that’s his or her job.

Even a doctor cannot diagnose or treat him or herself. For a lack of a better phrase, it’s a conflict of interest!

“Be honest and upfront with your doctor and make sure to let him know all of your symptoms, even if you do not feel that they are important. Also disclose any and all medications you are currently taking as well as supplements to make sure that your doctor has all the information necessary to treat your illness.”(2)

  1.  The Dangers of Self Diagnosis
  2. The Internet and Self Diagnosis

Psychosurgery Part 4: Vagus Nerve Stimulation

For Treatment Resistant Depression

In 1997, the FDA approved vagus nerve stimulation for epilepsy, and in 2005, it was approved for treatment resistant depression. Vagus nerve stimulation is a procedure that stimulates the vagus nerve1 with electrical impulses. (noticing a trend in electrical impulses and psychosurgery?) It is being worked on to treat Alzheimers, MS and migraines. There is one vagus nerve on each side of the body, running from your brainstem to your chest and abdomen2.

With vagus nerve stimulation, a device is surgically placed under the skin of your chest (similar to deep brain stimulation) and a wire connects to the left vagus nerve. After it’s activated, signals are sent to the vagus nerve and in turn, sent to various areas of the brain. Vagus nerve stimulation is used when epilepsy medications no longer work, or if depression is treatment resistant and everything else has been tried. (There is a link between epilepsy and mood disorders, I’ll get into that at a later date)

Since vagus nerve stimulation (VNS) has been FDA approved and is out of the clinical trial stage, the FDA has set rules for who may undergo the procedure. Here are the following criteria:

  • Age 12 and older (epilepsy)
  • Have partial epilepsy
  • Seizures that aren’t controlled by medications
  • Have treatment resistant (hard to control) depression
  • Haven’t improved after trying 4+ medications / ECT.
  • Continue standard depression treatments after the VNS procedure.3

This is a relatively safe procedure, but all procedures have risks. Some include: pain from the incision, infection, scarring, difficulty swallowing, vocal cord paralysis (sometimes permanent).

After the surgery, when the VNS is turned on and working, other side effects include: voice changes, hoarseness, throat pain, cough, headache, chest pain, breathing problems (especially while exercising), difficulty swallowing, abdominal pain or nausea, tingling or prickling of the skin, and I’ve heard rumours that it can cause spontaneous orgasms! (I can’t cite the source at the moment, or I would)

If the side effects don’t go away, the device can be turned off. You can change the amount of stimulation to help control side effects.

This actually isn’t brain surgery. One incision is made in the chest, for the pacemaker like tool, and another incision is done in the neck. This mayor may not be done under general anesthesia, it depends on the doctor and your own preferences. It takes one to two hours to perform the operation and it is done on an outpatient basis.

You are given a hand held magnetic device to turn the device on and off, and adjust the amount of stimulation running through the vagus nerve. You can turn it on and off at will, if you feel you need it. MRI’s are now out of the picture, except for the head in carefully monitored conditions.

This isn’t a cure, but there can be improvement of 30-50% in seizures and depression. Some treatments and medications may have to be used after the procedure.

We evaluated the efficacy and safety of vagus nerve stimulation therapyinthe treatment of 11 patients with chronic treatment-resistant depression. Mood was evaluated at frequent intervals over the year following implantation. All measures of depression, including the Hamilton Rating Scale for Depression reduced significantly. The response and remission rates were 55% and 27% respectively at 1 year. Side-effects were common, and some were severe

This study suggests that vagus nerve stimulation may be an effective treatment for some individuals suffering from chronic treatment-resistant depression. The response rates for the acute phase of the study were disappointing, in that only one patient responded after 3 months. By 1 year, 55% of the sample had responded to treatment, suggesting that long-term follow-up is required to realise the therapeutic potential of vagus nerve stimulation treatment. The placebo response in these patients was typically poor and so probably does not account for the response rate 4.”

Compared to the other psychosurgeries, this one seems to have quite a few serious side effects, but they should go away. It is reversible, which is a bonus, because once you’ve burned away cells in the brain, they don’t come back. If I really needed it, I would have his procedure done. It seems much safer, as they aren’t actually doing brain surgery. The time spent in the operating room and hospital is less and it is FDA approved for epilepsy and depression, where some other psychosurgeries are still going through clinical trials with no long term reports.

 

  1. The vagus nerve is responsible for speech, swallowing, breathing, monitoring the digestive process, acting as an anti-inflammatory, mood and some parts of body weight.
    http://www.naturalnews.com/038473_Vagus_nerve_weight_loss_moods.html
  2. http://www.mayoclinic.com/health/vagus-nerve-stimulation/MY00183
  3. http://www.mayoclinic.com/health/vagus-nerve-stimulation/MY00183/DSECTION=why-its-done
  4. http://bjp.rcpsych.org/content/189/3/282.full

     

 

Psychosurgery Part 3: Deep Brain Stimulation

Highly Experimental Surgery for Chronic Depression

Deep brain stimulation is a highly experimental neurosurgical treatment for chronic depression is stimulated with electrical impulses.

Although it’s been approved for several other conditions, deep brain stimulation hasn’t been approved by the Food and Drug Administration (FDA) for depression treatment and is in the early stages of research.

Requiring brain surgery, deep brain stimulation is the most invasive form of brain stimulation treatment for depression. Deep brain stimulation works much like a pacemaker for your brain.1

Deep brain stimulation is some serious shit we’re talking about. It is also used for Parkinson’s disease and has many side effects, some of them potentially fatal or life altering. We’ll start with the surgical aspect of it. It is similar to a pacemaker, but for your brain, which has a lot of risks on its own. To top it all off, the long term effects aren’t even known yet, it’s still in the experimental phases2.

So, how does it work? There are electrodes placed deep in various areas of the brain that create pulses to override pre-existing ones causing disorders like depression, OCD and bipolar disorder. It is also said that the probes can effect certain cells and chemicals in the brain2. The amount of stimulation to the brain is controlled by a pacemaker like device implanted in the chest, with a wire (under the skin) connecting it to your brain. That sounds a little too much like Frankenstein to me!

Most people undergoing deep brain stimulation are in clinical trials. It has found to be generally safe, with normal surgery risks, but does have some permanent side effects that are irreversible. Generally, it is used in people who have tried everything. Currently it is used for Parkinson’s and other movement disorders, such as Tourette’s, but it is being tested in epilepsy, depression and more.

The surgery involves drilling small holes into the skull to implant the electrodes and surgery on the chest to install the pacemaker. There are complications to these surgeries such as: bleeding in the brain, stroke, infection, breathing problems, nausea, heart problems and scarring. It’s not a one time thing, either, those batteries aren’t changing themselves. There can also be malfunctions in the system, but the positive is that it would generally be where the pacemaker is, or where the wires run, so you don’t have to go through more brain surgery2.

Side effects after the surgery include: seizure, infection, headache, insomnia, memory problems and temporary swelling. The device is turned on after a couple of weeks which has a bundle of side effects, itself. These include: Numbness/tingling sensations, muscle tightness in the face or arm, speech problems, balance problems, lightheadedness and unwanted mood changes.

I thought it was supposed to help your mood?!

And the entire procedure is done while you’re awake, with a local anesthetic.

From the famous Mayo Clinic in the USA:

“Deep brain stimulation won’t cure your disease, but it may help lessen your symptoms. If deep brain stimulation works, your symptoms will improve significantly, but they usually don’t go away completely. In some cases, medications may still be needed for certain conditions. Deep brain stimulation isn’t successful for everyone. ”

To me, this surgery sounds scary and I don’t think it will be used frequently in mental illness due to the “unwanted mood changes” side effect. It’s serious surgery and needs constant upkeep (the battery in the pacemaker) plus you might still have to take daily meds. It would be a worst-case last-resort scenario, but you could be permanently brain damaged (well, any surgery can permanently damage you) and the success rate isn’t guaranteed.

  1. http://www.winmentalhealth.com/psychosurgery_lobotomy_cingulotomy.php

  2. http://www.mayoclinic.com/health/deep-brain-stimulation/MY00184