Friday, January 2, 2009

Managing Symptoms Vs Treating Illness

Ever hear doctors claim labels for severe mental illnesses--like schizophrenia, bipolar disorder, etc.-- are "wastebasket diagnoses"? Have you ever stopped to think why some say this and what that means about our treatment of patients with these diagnoses?

Listening to some Continuing Medical Education (CME) about mental illness can be quite thought-provoking… revealing the huge gap between research and practice, and between medical and “mental.”

In this psychiatric medical discussion about schizoaffective versus schizophrenia[1] they boldly used the term "wastebasket diagnosis" for the DSM diagnosis of schizoaffective when talking about its diagnosis and treatment. But let's take this conclusion about this one diagnosis (and treatment) a step further.

The stated fact that "there is no FDA-approved treatment for schizoaffective" explains why someone I know with an HMO had such a hard time getting medication approved. The insurance company said, "no medication is on the list of approved medications."  The doctor had to write to the insurance company, appealing their decision. It seemed ridiculous.

However back to the “wastebasket diagnosis.” Back when my little girl was still just a little girl, she recognized that these diagnoses were of the “wastebasket” variety for a different reason. They were not labeling illness. They were labeling her symptoms. Apparently even a child could see what we adults were blind to. (See book.)

Also mentioned was having an accurate diagnosis that should be re-evaluated as more information about the patient becomes available. How often is that done in reality? And how is more information supposed to “become available” without comprehensive integrated testing and treatment? (Here are some tips.)

From my experience, the psychiatric care is quite disconnected from the medical care. There is no team approach. There is no collaboration between a group of medical professionals caring for a single patient.

This lack of a collaborative comprehensive approach is, of course, not limited to the mental health field, and is not due to prohibitive costs. Indeed, if better care were given up-front, the United States alone could conceivably save $750 billion a year [2]. Yes. By giving BETTER care—as good as one would get from Mayo clinic.

Another point I found interesting was stating so bluntly that the medications given are NOT to treat the illness. Psychotropic medications are only to manage symptoms. Hmmm... That is thought-provoking. We think of the antipsychotics as treating the "neurochemical imbalance" but what they are saying is they just “manage symptoms” and that's why they usually have to add on other meds.

That certainly can explain the half-life my daughter felt she was stuck in for so long. And the prn meds (emergency medication add-ons) were like chemical straight-jackets. They were better than nothing… when nothing else was available. We were grateful for them. We treated the only way we knew.

But we were ignorant that sometimes research and choices already exist that can help in a deeper and more appropriate way. Even if the only answer we had was partial treatment of actual medical problems and the rest of it was treatment with the psychotropics, that would have been fine.

Treating underlying biological (non-mental) issues eliminated my daughter's schizoaffective symptoms—I guess that is what a "biomedical treatment approach" (also biological, functional, etc.) attempts to do—treat actual illness as opposed to just managing symptoms. And as I said, even if treating the underlying biological isses had only partially helped, we would have been happy. After all, the goal is to treat what we can and alleviate pain and suffering.

But to know what the underlying problems are, and "to treat what we can," we need doctors willing to run tests, and integrate current research into an individualized treatment approach.

Psychiatric researchers often mention "individualizing treatment," but it seems that all that translates into is continuing the trial-and-error method of administering pharmaceutical psychotropic medications to treat symptoms, rather than the biomedical approach of trying to find and treat what truly ails the person. Admittedly, we may not be able to find and treat everything that truly ails the person. But we can do a much better job than is being done now. My daughter, and countless others (look at all the children with autism helped by integrating biomedical testing and treatment approaches) are living proof of that.

[1] "Schizophrenia Versus Schizoaffective Disorder: Clinical Implications for Therapeutic Decisions" by Gustavo Alva, MD; David C. Henderson, MD Medscape 24 Dec. 2008
[2] " Improved efficiency and universal coverage" St. Louis Post-Dispatch 30 Dec. 2008

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