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Revisions in Diagnostic Categories. Do People Have Concerns or Input?
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Revisions in Diagnostic Categories. Do People Have Concerns or Input?

As is public knowledge the DSM-4 is being updated (as it has been regularly throughout the history of this psychiatric diagnostic manual) and once the criteria are revised will become the DSM-5. This is a standard article about it:
http://www.nytimes.com/2010/02/10/health/10psych.html?ref=todayspaper
Do people have any positive input or concerns about this and if so what would they be?
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Avatar_m_tn
Well this is a positive idea, I think, where they want to fix it where children are diagnosed so much with things like bipolar disorder.  It is also a good idea to diagnose symptoms instead of disorders like they said with schizophrenia for example might have anxiety and insomnia and while it can be linked back to it, it is not a diagnostic requirement.  Yet another good idea is changing "mental retardation" into "intellectual disability" since "retard" has grown to have negative connotations around it I guess due to how much people use it as an insult.  It's funny how the meaning of a word evolves unintentionally over time.  The risk disorders bit I didn't like the idea of all that much due to the obvious problems it can open the door for.  Pretty much I shared the same positive and negative responses, save one.  I can imagine the other problem is it may screw up the diagnostic criteria for a mainstay of the DSM such as bipolar disorder or autism and inadvertently stress out someone with a diagnosis being changed.  I know one family member got angry when their diagnosis had been changed from bipolar disorder to schizoaffective disorder because of how they'd been told all the years before it being changed that they had bipolar disorder.
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Avatar_m_tn
Oh yeah I'd also like to add to the last part that I know it has changed like this in the past so it's not going to surprise me if it does.  People just don't like change much, I guess.
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585414_tn?1288944902
  Well the word "schizophrenia" to some people has a negative connotation and seems stigmatizing because people assume it means "split personality" whereas it of course means a disintegration in the thought process that now is of course called psychosis. Schizophrenia was first called "dementia praecox" when the specific psychiatric disability was first noted. That means literally "early onset dementia". That term was changed because only rarely is dementia associated with schizophrenia although it can occur. However, before antipsychotics existed, schizophrenia of course would worsen over a life time and dementia and catatonia were not uncommon. Categorizing the subtypes of schizophrenia and revising their names came later. There is one proposed critiera (not named in the article but on the website for the site itself, google "DSM-5") which is schizo-obsessive disorder which I believe is schizophrenia with aspects of obessive compulsive disorder.
   As for behaviors they can sometimes be signs of a psychiatric disability and sometimes signs of poor coping skills where a person may need psychotherapy. It would depend on the extent of them and how they affect a person's life and only a psychiatrist could fully understand that. There is still ongoing research into the differentiation between bipolar with psychotic features, schizoaffective disorder and schizophrenia and according to some researchers they may be all part of the same spectrum but that idea is still under clinical study itself. Clearly there is some link between bipolar and schizophrenia and that is being researched. As regarding Asperger's Syndrome what they now propose instead of it being a specific subtype of autism that autism itself is one general developmental disability that can vary in severity. Criteria and nomenclature are often changed but the specifics of what is occuring mentally or neurologically as well as treatment for it all depends on specific controlled studies which are ongoing as well.
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Avatar_f_tn
I realize that everyone is still learning/refining so I have take it with a grain of salt when things are changed. As a parent of a special needs individual, it became important for the diagnose because I wanted a better of idea what kind of things would help for the best outcome.  Being familiar with a number of individuals on the autism spectrum, I realize there is a big difference between those who are non-verbal and those who are at the "higher" end who are more Aspergers or PDD/NOS who can be very verbal.  My child with help was capable of going to college.  One of my friends with a severely autistic son, now 19, will not be able to do that.  

Along the way, various diagnoses were thrown at my child like significant developmental delay (mild-moderate retardation),  ADDHD, and one school pyschologist thought she had "childhood schizophrenia". These were all before 6 yrs. of age.  At 6, she was diagnosed with PDD-NOS.  She had most of the criteria for autism but because she had an imaginary friend, MPM, she was not given the autism diagnose.  I was ok with the diagnose at that time.  I had her re-evaluated at 12 & was told once she was diagnosed with PDD-NOS...always will stick with her.  It can be such a maze for anyone, parent or individual.  No one likes the idea of being a guinea pig with medications and I had my share of horror stories in that area, so if they can diagnose correctly and not resort only to meds, meds, meds....I am more optimistic.

I am at odds with how Aspergers is diagnosed with the language before 3.  I believe my daughter is more like Aspergers but because she didn't have language before 3, she didn't fit the criteria.........so ??????

At least we are not in the dark ages with witch hunting and calling epilepsy...possession.

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Avatar_m_tn
Well I had some point I thought of that was also positive about this, but the thought left my head before I could write it down.  Maybe it would just be better if they did away with the term schizophrenia and named it something else?  Kind of like how they want to change "mental retardation" into "intellectual disability" since "schizophrenic" has negative connotations attached to it for some people just like "mentally retarded" does.  Is there anyway to order a copy of the DSM?  I would love to have it on hand just to read through it since that stuff interests me.  I agree with the spectrum idea for bipolar disorder/schizoaffective disorder/schizophrenia in doing my only personal study on it through Medhelp in my time of trying to help people out on here.  I published my findings in general on a journal entry but I didn't know how to organize it all in writing so I just wrote in general that I found the spectrum idea would work.  Perhaps make it just one disorder and make it where it is
                                    V
EMOTIONS ------------------------------- THINKING or something along those lines, as an example, provided they are actually clinically linked enough to be able to make a spectrum like that.

As for the diagnosis part, I thought it was good they wanted to start diagnosing symptoms instead because it's generally a better idea to treat symptoms instead of a diagnosis.  The only importance I see in a diagnosis is that it gives a doctor a general idea of what treatment modality to abide by and also a name so people such as doctors have a general of what's wrong instead of you having to spend like five days explaining it all over and over again when you can just throw out a name and then they will have a good idea.
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Avatar_f_tn
Good view point :-)

I remember being told that some people (parents included) go diagnose hopping.  If they don't like the findings, they find another specialist, psychiatrist, doctor, etc. and go through the process hoping for something different.  On the other hand, getting confirmation isn't such a bad idea as there is more sureness in 2 finding the same diagnose.  

I think I went that route early on when I was advised to wait till MJI was 18 mos., then 2 yrs. with the language delay.  Finally at 2, the doctor gave me the name of who he thought would be good to start with.  The 2nd place enhanced the 1st findings by adding that there was fluid in the ears & advising "tubes" to be put in the ears, but specified that the delays she was experiencing were "across the board" which a mere hearing loss would not account for, therefore...the significant developmental delay stood.  Off record, I was informed that no one wanted to etch in stone for someone that young, but "off record" we were looking at a mild/moderate retardation.  I remember feeling "faint" and holding on to the wall.........

I was told then that parents either go to the extreme of doing everything they can to make it right or the other extreme in ignoring things and doing little if anything to make it better.  I tried to remember that over the years and not be over-bearing.  I think I realized quickly that different people tuned into different things therefore different diagnoses.  Some took time to get more involved with "symptoms"...behaviors, etc.

The scare with childhood schizophrenia was especially hard because of my mother.  I couldn't handle the thought that I would have lost my mother due to it and then have a child with it....didn't seem fair.  So.....this experience hits home the necessity of correct diagnoses (not "hasty" ones by stressed professionals) and treatment.  Being quick to stamp labels for every behavior that is disagreeable doesn't seem smart either.

I think as more people become aware of each disability/challenge, it becomes less frightening.  The unknown is scary to many of us.  Time constraints make it hard for all of us to become familiar with all that is out there, so it will remain a challenge, but one worth facing and dealing with compassionately, etc.
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Avatar_m_tn
I am an example of one of the people they missed as I had schizophrenia since childhood but no one caught on even though I was hallucinating acting funny and looked like I was in another world and so on but of course they should be careful like that anyway.  Seems like they over diagnose people who don't have the specific mental illness they are diagnosing and under diagnose people with mental illness.  It's good to hear you're trying to keep a level head in such a tough situation, it can be devastating to have something serious happen to one's own child.  I would not know from personal experience but I have seen how parents handle it when something extremely negative happens for the parent in relation to their child, such as them dying.  I think this is why parents go "diagnosis hopping" or try to just ignore the problem away.  Who is to say a behavior is right or wrong anyway?  Just because it is not accepted as a part of the society a person lives in, does not mean it is wrong.  Labeling behaviors solely can be extremely troubling.  
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1255530_tn?1269871219
after carefully searching for answers in a obsessive way on my condition on schizoaffective disorder I have to agree that I have symptoms of both schizophrenia and bipolar. Weather Id like to admit it or not. maybe not as bad as some(schizophrenia) but after doing research on schizophrenia and my bipolar I feel confident in the diagnosis. I agree that the name of schizophrenia should be changed and that my disorder should stay in the manual as I have to agree that its right. But I myself would not discuss the term schizophrenia with no one I know evan my husband due to the negative effects the word brings about in myself much less the feelings of what others may think. its bad anof the stigma surrounding bipolar. Just me though. I have anof paranoia on how people look at me.
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