Posted by mtdewcmu on May 8, 2011, at 17:54:28
In reply to Re: Case study of endocrine disorder mimicking bipolar, posted by bleauberry on May 8, 2011, at 5:10:57
> In a perfect world it would be nice if doctors would rule out organic diseases or identifiable problems. I never saw them do that with me. Even if they had, the only true way to rule something in or out is to try treating it as if it existed to see what happens. That provides the information and clues to rule something in or out with a strong degree of certainty. Even though I had all the presentations of Lyme, as soon as the test came back negative, guess what, they ruled out Lyme....bad mistake that cost me almost 15 years, psych ward stays, and multiple drug failures. A simple 2 week trial of Doxycylcine would have been a much more accurate diagnostic tool than the test. I mean, come on, I did get bit by a tick, ok? Oh, but that only happens to other people. Yeah right.
A patient who walks in to a psychiatry clinic is a different situation than a hospitalized patient with an unusual presentation and a lot going on medically. You would hope that when the patient simultaneously developed psych symptoms and became unable to walk, that the psychiatrist would consider more possibilities. In this case, a simple blood test definitively ruled in or out the disease.
Some of the stuff you are talking about is outside the mainstream of medicine, like interpreting a thyroid test as abnormal when most endocrinologists would say that it's normal. I'm pretty sure the kind of hypoadrenalism you're talking about is not the kind most experts would say needs to be treated. Lyme disease is not that common, and if you don't have the characteristic rash or any non-psychiatric symptoms, you can forgive the doctor for missing it.
The fact that this article doesn't direct any blame to the psychiatrist for missing the diagnosis shows that the expectations for psychiatry are pretty low. You can't really blame the hematologist for missing the diagnosis, since there was nothing to really learn from looking at the blood. You might expect the neurologist to have done better than to speculate on some viral mechanism and leave it at that, but I don't know as much about neurology as about psychiatry.
Not a doctor. Contact a doctor for medical advice.
20mg citalopram, 40mg d-amphetamine, 15mg mirtazapine, 300mg bupropion
dx: chronic MDD, probable ADHD (inattentive)
poster:mtdewcmu
thread:984807
URL: http://www.dr-bob.org/babble/20110502/msgs/984927.html